Ins 6.95(1r)(e)(e) The nonnavigator assister entity’s agreement to provide to the commissioner all supporting documents as requested by the commissioner.
Ins 6.95(2)(2)Certified application counselors and other nonnavigator assisters.
Ins 6.95(2)(a)(a) Certified application counselors under 45 C.F.R. 155.225, and other nonnavigator assisters, are eligible to be registered by a nonnavigator assister entity if either of the following apply:
Ins 6.95(2)(a)1.1. The application counselor or other nonnavigator assister is designated by the federal government to provide consumer assistance; that designation is not withdrawn; and the person has completed the training and examination requirement under ss. 628.92 (7) and 628.96 (2), Stats.
Ins 6.95(2)(a)2.2. The application counselor or other nonnavigator assister is an insurance agent who hold an active resident license with the accident and health line of authority and is in compliance with continuing education requirements; complies with s. 628.96 (3), Stats., including competence and trustworthiness, and satisfactorily completes 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. An insurance agent who meets the requirements of this subdivision is not required to complete prelicensing training or the navigator licensing examination under ss. 628.92 (7) and 628.96 (2), Stats.
Ins 6.95(2)(b)(b) The nonnavigator assister entity shall maintain records that each certified application counselor and other nonnavigator assister registered under par. (a) has completed the annual continuing education training. The nonnavigator assister entity shall provide an attestation of compliance with such requirement to the commissioner in a form prescribed by the commissioner by October 1 of each year. The commissioner will provide guidance on the topics for the continuing education training required under this subsection.
Ins 6.95(2)(c)(c) The commissioner may deny registration for a certified application counselor and other nonnavigator assisters, for any of the following:
Ins 6.95(2)(c)1.1. Failure to possess requisite character, integrity, competency and trustworthiness. In addition to the requirements set forth in s. 628.04, Stats., and s. Ins 6.92 (3)
Ins 6.95(2)(c)2.2. 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(2)(c)3.3. Failure to fully provide required or requested information, to complete requisite training including continuing education, to maintain certification from the federal government as a certified application counselor or nonnavigator assister entity.
Ins 6.95(3)(3)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.
Ins 6.95(4)(4)Entity liability. A nonnavigator assister entity assumes legal responsibility, in accordance with s. 628.96 (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.
Ins 6.95(5)(5)Revocation of entity registration. The commissioner may deny, suspend or revoke a nonnavigator assister entity registration if the nonnavigator assisters it employs, supervises or is affiliated with, fail to comply with s. Ins 6.92 (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 6.95(6)(6)Investigation and review.
Ins 6.95(6)(a)(a) The commissioner, or designated examiner, may investigate and review all nonnavigator entities under ss. 601.43 and 601.44, Stats. The method and timing of the reviews shall be determined by the commissioner in each case and may consist of any of the following:
Ins 6.95(6)(a)1.1. Consideration of information available from state, federal, or local agencies, private organizations or agencies, or interested persons.
Ins 6.95(6)(a)2.2. Investigation upon receipt of a complaint from any person.
Ins 6.95(6)(a)3.3. Any other information the commissioner deems relevant to the investigation.
Ins 6.95(6)(b)(b) If, after the investigation the commissioner suspends, denies, or revokes the registration, written notification shall be given with reasons for such action. The suspension, denial or revocation constitutes an order pursuant to s. 601.62 (3) (a), Stats., and the nonnavigator entity may request a hearing before the commissioner under that section.
Ins 6.95 HistoryHistory: EmR1314: emerg. cr. eff. 9-10-13; CR 13-113: cr. Register August 2014 No. 704, eff. 9-1-14; (1g) and (1r) renumbered from (intro.) and (1) under s. 13.92 (4) (b) 1., Stats., (1g) (title) added under s. 13.92 (4) (b) 2., Stats., correction in (2) (intro.) made under s. 13.92 (4) (b) 7. Register August 2014 No. 704.
Ins 6.96Ins 6.96Prohibited business practices. In addition to the prohibited acts contained in s. 628.95 (2), Stats., navigators, navigator entities, nonnavigator assisters and nonnavigator assister entities are prohibited from all of the following:
Ins 6.96(1)(1)Providing enrollment or other specific information regarding a health benefit plan that is not offered in the federal exchange.
Ins 6.96(2)(2)Providing a recommendation comparing health benefit plans that may be better or worse for the consumer or employer.
Ins 6.96(3)(3)Making misleading statements to a consumer or employer regarding or otherwise misrepresenting one’s qualifications or services.
Ins 6.96(4)(4)Offering a recommendation directly to a consumer or employer regarding a particular health benefit plan concerning deductible, coinsurance, or any substantive benefits, terms, or conditions of the contract.
Ins 6.96(5)(5)Asking or urging a consumer to apply for a particular health benefit plan from a particular insurance company.
Ins 6.96(6)(6)Distributing cards, documents or advertisements regarding a particular health insurer.
Ins 6.96(7)(7)Recommending a particular health benefit plan or insurer.
Ins 6.96(8)(8)Receiving consideration directly or indirectly from any health insurer in connection with the enrollment of individual or employees into a qualified health plan as defined 45 CFR 155.20, as amended.