5. Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance.
6. Having admitted or been found to have committed any insurance unfair trade practice or fraud.
7. Using fraudulent, coercive, or dishonest practices in the conduct of business in this state or elsewhere.
8. Demonstrating incompetence, untrustworthiness or financial irresponsibility in the conduct of personal financial transactions or professional business in this state or elsewhere.
9. Having an insurance producer license, or its equivalent, denied, suspended or revoked in any other state, province, district or territory.
10. Forging another's name to an application for insurance or to any document related to an insurance transaction.
11. Improperly using notes or any other reference material to complete an examination for an insurance or navigator license.
12. Failing to comply with an administrative or court order imposing a child support obligation.
13. Failing to pay state income tax or comply with any administrative or court order directing payment of state income tax.
(e) Minimum Age and Residency. An applicant for navigator licensure shall have attained at least eighteen (18) years of age and shall be a resident of this state or maintain his or her principal place of business in this state.
(f)
Proof of Financial Responsibility. An applicant who is not affiliated with a navigator entity shall comply with the requirements of s.
628.92 (5) (b), Stats., or provide evidence of an equivalent coverage alternative subject to the commissioner's prior approval.
(4) Change of name or address. (a) Each navigator shall, within 30 days, notify the commissioner in writing of any change in the navigator's name, residence address, principal place of business, and mailing address.
(b) A navigator who is not employed or supervised by or affiliated with a navigator entity and changes residency to a location outside of this state or changes his or her principal place of business to an address outside this state and is not a resident of this state shall have his or her navigator license terminated effective 60 days after the change of address.
(c) Criteria used by the insurance commissioner to establish state residency shall include, but not be limited to:
1. Jurisdiction for payment of state taxes.
2. Jurisdiction for automobile driver's license and motor vehicle registration.
3. Location of voter registration.
4. Location of principal residence, such as owned or rented dwelling, condominium or apartment.
5. Location of principal place of business.
(5) Applicability of Other Laws. Licensed navigators are subject to the requirements contained at ss.
628.095,
628.097 and
628.10, Stats., as applicable to individual navigators.
(6) License Renewals. (a) The nonrefundable renewal fee of $35.00 is due before September 1 of each year. The commissioner shall send notice of the renewal fee by 1st-class mail at least 60 days prior to the fee due date to each navigator at the mailing address on file. Applications for navigator license renewal shall be submitted before the September 1 renewal deadline. The navigator shall provide proof of a bond in compliance with s.
628.92 (5) (b), or evidence of an equivalent coverage alternative subject to the commissioner's prior approval.
(b) An individual navigator is required to complete at least 8 hours of navigator continuing education training before September 1 of each year. Training must be completed prior seeking annual renewal of a navigator license. Recurring training shall be completed and reported at a rate of not less than 8 hours each 12 months of each compliance period. Training required under this subsection must be approved by the commissioner and provided by an education provider that is approved by the commissioner.
(c) Any navigator whose license is revoked for failing to pay renewal fees, failing to complete required annual navigator continuing education, or failing to pay delinquent taxes may, within 12 months from the revocation date, apply to reinstate for the same navigator license without completing prelicensing navigator training or passing a written examination. The navigator must satisfy the requirement of s.
628.10 (a), (am) or (cm), Stats., satisfactorily complete a reinstatement application and pay twice the amount of the license renewal fee under par. (a). If a navigator license has been revoked for more than 12 months, the navigator shall, in order to be relicensed, satisfy the examination and other licensing requirements established by subs. (2) to (6).
Note: A copy of a sample navigator and navigator entity bond form OCI 11-093, required in sub. (7), may be obtained at no cost from the Office of the Commissioner of Insurance at 125 S. Webster Street, Madison WI 53703, or at the Office's web address: oci.wi.gov.
Ins 6.93 Registration of navigator entities. (1) (a)
Registration application for navigator entity. An entity registering as a navigator entity shall submit an application to the commissioner in the form prescribed by the commissioner. A completed application consists of the navigator entity's name, the names of the entity's officers, the current mailing address, the name of at least one licensed designated responsible navigator, names and addresses for the navigators it employs, supervises or is affiliated with, and any documentation required to questions on the application. The navigator entity shall be designated by the exchange as a navigator entity, receive funding through a federal grant, and be in compliance s.
628.92 (2), Stats., and with applicable federal requirements including
45 CFR § 155.215 (a) (1), as amended.
Note: A copy of the navigator entity registration application form OCI 11-091, required in par. (a), may be obtained at no cost from the Office of the Commissioner of Insurance at 125 S. Webster Street, Madison WI 53703, or at the Office's web address: oci.wi.gov.
(b) Payment of fees. An applicant for an original registration shall pay an initial, non-refundable, registration fee of $100.00 is due with submission of the application.
(c) Acknowledgement of registration. An applicant for an original registration who satisfies the requirements in pars. (a) and (b) shall be registered as a navigator entity. Determination of the acceptance or rejection of a completed application shall be made within 90 days of receipt by the commissioner of the completed application including any required or requested documentation.
(2) Registration Renewals. The renewal fee of $100.00 is due before September 1 of each year. The commissioner will send notice of the registration renewal fee by 1
st-class mail at least 60 days prior to the fee due date to each navigator entity at the mailing address on file. The navigator entity shall provide proof of a current bond in compliance with s.
628.92 (5) (a), or evidence of an equivalent coverage alternative subject to the commissioner's prior approval.
(3) Entity Reporting. A navigator entity shall comply with s.
628.92 (4), Stats., by filing with the commissioner the list of individual licensed navigators it employs, supervises or is affiliated with in a manner prescribed by the commissioner. After providing the commissioner with an initial notification of navigators in the application form, the navigator entity shall report any updates to the list of navigators, including additions, deletions or modifications, within 30 days of the addition, deletion or modification to the list of navigators.
(4) Entity Liability. (a) A navigator entity assumes full legal responsibility for the acts of the navigators whom the entity employs, supervises or is formally affiliated with for acts that are performed in this state and that are within the scope of the apparent authority to act as a navigator on behalf of the entity.
(b) The entity shall provide evidence of financial responsibility consistent with s.
628.92 (5) (a), Stats., by submitting the original bond and form to the office in the form prescribed by the commissioner. Alternatively the navigator entity, subject to the commissioner's prior approval, may provide evidence of an equivalent coverage alternative.
Note: A copy of a sample navigator and navigator entity bond form OCI 11-093, required in sub. (5), may be obtained at no cost from the Office of the Commissioner of Insurance at 125 S. Webster Street, Madison WI 53703, or at the Office's web address: oci.wi.gov.
Ins 6.94 Registration of certified application counselors and other nonnavigator assisters. Certified application counselors and other nonnavigator assisters shall be employed or supervised by a registered nonnavigator assister entity, or be affiliated with a registered nonnavigator assister entity. To be registered with a nonnavigator assister entity as a certified application counselor or other nonnavigator assister, the individual is required to comply with all of the following:
(1) Procedure. (a) Certified application counselors and other nonnavigator assisters must be authorized by the exchange to provide consumer assistance and compliant with federal requirements set forth in
45 CFR § 155.225, as amended.
(b) Certified application counselors shall complete 16 hours of prelicensing navigator training, successfully pass a written examination, and annually thereafter complete 8 hours of navigator continuing education training that is approved by the commissioner, in addition to any federal training or other federal requirements. The state training required under this subsection must be approved by the commissioner and provided by an education provider that is approved by the commissioner.
(2) Exception. (a) An agent who holds an active resident license with the accident and health line of authority and is in compliance with continuing education requirements, may apply to be registered as a nonnavigator assister by a nonnavigator assister entity if the currently licensed agent can meet all of the following:
1. Demonstrate compliance as set forth in s.
628.96, Stats., including competence and trustworthiness.
2. Demonstrate satisfactory completion of 4 hours of navigator training specific to public assistance programs, including Medicaid, in addition to the completion of any federally required nonnavigator assister training and compliance with federal restrictions and requirements including those set forth in
45 CFR § 155.225, as amended. The state training required under this subsection must be approved by the commissioner and provided by an education provider that is approved by the commissioner.
(b) A currently licensed agent that is in compliance with par. (a) is exempt from taking prelicensing training and passing the written navigator examination.
(3) Refusal to register nonnavigator assisters. The commissioner may refuse to register a nonnavigator assister for any of the following reasons:
(a) Failing to possess requisite character, integrity, competency and trustworthiness. In addition to the requirements set forth in s.
628.04, Stats., the commissioner may consider the criteria established in s.
Ins 6.92 (3), in assessing trustworthiness and competence.
(b) Commission of any act that would warrant the denial, suspension, or revocation of an insurance license or registration including any of the acts delineated in s.
Ins 6.92 (3).
Ins 6.95 Registration of nonnavigator assister entities. (1) Electronic registration for a nonnavigator assister entity. An entity registering as a nonnavigator assister entity shall provide all of the following information to the commissioner in the form prescribed by the commissioner:
(a) The nonnavigator assister entity's name and current mailing address.
(b) The name and contact information for the nonnavigator assister entity.
(c) The name, business address and type of nonnavigator assister for each nonnavigator assister it employs, supervises or is affiliated with.
(d) An attestation that each nonnavigator assister is in compliance with applicable state law including any nonnavigator assister who is a certified application counselor and who has complied with s.
628.96 (2), Stats.
(e) The nonnavigator assister entity's agreement to provide to the commissioner all supporting documents as requested by the commissioner.
(2) Entity Reporting of Updates. A nonnavigator assister entity shall comply with s.
628.96 (1), Stats., reporting in an electronic format as prescribed by the commissioner, any updates to the list of nonnavigator assisters that the nonnavigator assister entity provided when it first registered with the commissioner, including additions, deletions or modifications. The information shall be provided within 30 days of the addition, deletion or modification to the list of nonnavigator assisters.
(3) Entity Liability. A nonnavigator assister entity assumes legal responsibility, in accordance with s.
628.95 (3), Stat., for the acts of the nonnavigator assisters, on behalf of the entity, that the entity employs, supervises or is formally affiliated with, that are performed in this state and that are within the scope of the apparent authority to act as a nonnavigator assister.
(4) Revocation of Entity Registration. The commissioner may revoke a nonnavigator assister entity registration if the nonnavigator assisters it employs, supervises or is affiliated with, fail to comply with s.
Ins 6.95 (3), or the nonnavigator assister entity fails to comply with any provision contained in this section or by failing to comply with requests of the commissioner.
Ins 6.96 Prohibited business practices. In addition to the prohibited acts contained in s.
628.95 (2), Stats., navigators and nonnavigator assisters are prohibited from all of the following:
(1) Receiving compensation from an insurer, stop-loss insurance or a third-party administrator.
(2) Receiving compensation that is dependent upon, in whole or in part, on whether an individual enrolls in or renews coverage in a health benefit plan.
(3) Providing any information related to enrollment or other insurance products not offered in the federal exchange.
(4) Making or causing to be made false or misleading statements.
(5) Providing advice comparing health benefit plans that may be better or worse for the consumer or employer.
(6) Recommending a particular health benefit plan or insurer or advising consumers or employers regarding a particular insurer or health benefit plan selection.
(7) Engaging in any fraudulent, deceptive or dishonest acts or unfair methods of competition.
(8) Receiving consideration directly or indirectly from any health insurance issuer in connection with the enrollment of individual or employees into a qualified health plan as defined
45 CFR § 155.20, as amended.
6.97 Navigator, nonnavigator assister, navigator entity, and nonnavigator assister entity records. (1) Purpose. This section protects consumers by prescribing minimum standards and techniques of accounting and data handling of navigators, nonnavigator assisters, navigator entities and nonnavigator assister entities to ensure that timely and reliable information will exist, if applicable, and be available to the commissioner. This section implements and interprets ss.
601.42, and
628.34, Stats., by establishing the minimum records that are to be maintained.
(2) Cash disbursed record. The cash disbursed record shall show the name of the party to whom the payment was made, date of payment, and reason for payment.
(3) Cash receipts record. The cash receipts record shall show the name of the party who remitted the money, date of receipt, and reason for payment.
(4) Personnel records. Personnel records shall include dates of employment, supervision or affiliation; position held; description of principal duties; name and last known address and telephone number of employee, supervisee or affiliated person.
(5) Recordkeeping requirements. Beginning October 1, 2013, each navigator, nonnavigator assister, navigator entity or nonnavigator assister entity shall maintain, for at least a 3-year period, unless a specific period is provided elsewhere, all of the following financial, consumer and employee records, as applicable:
(a) Business checking account.
(b) Cash disbursed records.
(c) Cash receipts records.
(d) Personnel records.
(e) Consumer or policyholder records.
(6) Place of maintaining records. (a) The navigator shall maintain records required by subs. (2) to (5), at the business address of the navigator or the navigator entity, or at another location only if the navigator provides written notice of the other location to the commissioner of insurance.
(b) The nonnavigator assister shall maintain records required by subs. (2) to (5), at the business address of the nonnavigator assister entity or at another location only if the nonnavigator assister entity provides written notice of the other location to the commissioner of insurance.
(7) Updating records. The navigator entities and nonnavigator assister entities shall maintain all financial records, records of compliance with prelicensing training completion, successful passage of the examination and continuing education completion, compliance with federal training and other federal requirements for the navigators and nonnavigator assisters it employs, supervises, or is affiliated with, as applicable for at least 3 years from the transaction of an insurance business.
Ins 6.98 Prohibition of uses of designations. (1) Prohibited uses of designations. It is an unfair and deceptive trade practice under s.
628.34 (12), Stats., for an agent to use terms including “navigator," “navigator entity," “nonnavigator assister," “certified application counselor," and “nonnavigator assister entity," in such a way as to mislead a purchaser or prospective purchaser that the agent has special certification or training in advising or providing services to consumers in connection with the advertising, solicitation, sale, or purchase of a health insurance policy or in the provision of advice as to the advisability of purchasing a health insurance policy, either directly or indirectly, offered in the state either within or outside the exchange. The terms may not be used by an agent who is not licensed as a navigator or registered as a nonnavigator assister. The terms may not be used alone or be combined with one or more such terms as “certified," “licensed," “registered," or like words, in the name of the certification or professional designation that appears as a certification or professional designation.
Ins 6.99 Exemption. Governmental entities or any persons acting on behalf of a governmental entity are exempt from subch. II.
SECTION 3.
These changes first apply to navigators, navigator entities, nonnavigator assisters and nonnavigator assister entities on the effective date of the emergency rule.
SECTION 5.
These emergency rule changes will take effect on day of publication as provided in s.
227.24(1)(c), Stats.
Office of the Commissioner of Insurance Private Sector Fiscal Analysis
Section
Ins 6.91 relating to navigators and nonnavigator assisters and affecting small business.
The proposed rule will not have a significant effect on the private sector. With an exemption for governmental entities, there will be no effect on county, city, village, town, school district, technical college district and sewerage districts. Additionally the office will be able to manage any cost associated with maintaining the licensure and registration process without additional state funds being provided to the office during this current biennium.
STATE OF WISCONSIN
DEPARTMENT OF ADMINISTRATION
DOA-2049 (C04/2011)
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Division of Executive Budget and Finance
101 East Wilson Street, 10th Floor
P.O. Box 7864
Madison, WI 53707-7864
FAX: (608) 267-0372
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ADMINISTRATIVE RULES – FISCAL ESTIMATE
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1. Fiscal Estimate Version
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X Original ⍽ Updated ⍽ Corrected
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2. Administrative Rule Chapter Title and Number
INS 691
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3. Subject
navigators and nonnavigator assisters and affecting small business
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4. State Fiscal Effect:
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X No Fiscal Effect
⍽ Indeterminate
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⍽ Increase Existing Revenues
⍽ Decrease Existing Revenues
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⍽ Increase Costs
⍽ Yes X No May be possible to absorb
within agency's budget.
⍽ Decrease Costs
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5. Fund Sources Affected:
⍽ GPR ⍽ FED ⍽ PRO ⍽ PRS ⍽ SEG
⍽ SEG-S
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6. Affected Ch. 20, Stats. Appropriations:
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7. Local Government Fiscal Effect:
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X No Fiscal Effect
⍽ Indeterminate
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⍽ Increase Revenues
⍽ Decrease Revenues
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⍽ Increase Costs
⍽ Decrease Costs
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8. Local Government Units Affected:
⍽ Towns ⍽ Villages
⍽ Cities ⍽ Counties ⍽ School Districts ⍽ WTCS Districts ⍽ Others: None
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9. Private Sector Fiscal Effect (small businesses only):
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X No Fiscal Effect
⍽ Indeterminate
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⍽ Increase Revenues
⍽ Decrease Revenues
⍽ Yes X No May have significant
economic impact on a
substantial number of
small businesses
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⍽ Increase Costs
⍽ Yes X No May have significant
economic impact on a
substantial number of
small businesses
⍽ Decrease Costs
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10. Types of Small Businesses Affected:
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Individual licensed agents working as a navigator or nonnavigator assister, small organizations that work with consumers, and some surety bond issuers that may be considered a small business.
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11. Fiscal Analysis Summary
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The proposed rule may affect small businesses, however, the Office has taken steps to minimize the impact of the rule by limiting the effect of the regulation to those navigators or nonnavigator assisters who are working on behalf of the federal government. For perspective, the federal government only awarded six navigator grants for the entire state of Wisconsin. There are no restrictions or regulations for governmental entities or persons who work with such entities. These governmental entities currently assist consumers with health insurance and public assistance concerns and will not be impacted by this regulation. By keeping the scope of the proposed rule very narrow, the impact on small businesses is lessened. Further, the proposed rule limited the amount of fees navigator and navigator entities are required to pay annually and did not impose fees on nonnavigator assisters or nonnavigator assister entities other than the cost of prelicensing training and examination costs. The office minimized the impact by establishing less stringent requirements than those imposed on licensed insurance agents and agencies. Further, the office provided, and continues to provide, some free prelicensing training to interested parties and in locations throughout the state in advance of the first open enrollment period. Additionally, the office approved licensed vendors to provide prelicensing training both in-person and on-line to reduce imposition on organizations. Finally the office imposed slightly lower fees than is required for licensed agents.
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12. Long-Range Fiscal Implications
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None.
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13. Name — Prepared by
Julie E. Walsh
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Telephone Number
(608) 264-8101
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Date
Aug. 26, 2013
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14. Name – Analyst Reviewer
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Telephone Number
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Date
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Signature—Secretary or Designee
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Telephone Number
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Date
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Notice of Hearing
Natural Resources
Fish, Game, etc., Chs.
NR 1—
(DNR # WM-05-13)
