Illinois Administrative Code › Title 50 - INSURANCE › Part 4515 - NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR CERTIFICATION › Section 4515.20 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Certification" means the issuance by the Director of a license
				or authorization pursuant to this Part.
"Certified Application Counselor" means any employee or
				volunteer of a Certified Application Counselor Organization that enters into an
				agreement with the Marketplace to have its employees or volunteers provide
				information to individuals and employees about insurance affordability programs
				and qualified health plan coverage options; assist individuals and employees to
				apply for coverage in a qualified health plan through the Marketplace and for
				insurance affordability programs; and help to facilitate enrollment of eligible
				individuals in qualified health plans and insurance affordability
				programs.
"Certified Application Counselor Organization" means any
				organization designated by the Marketplace to certify its staff members or
				volunteers to act as certified application counselors and includes those
				organizations described in
				45 CFR
				155.225.
"Code" means the Illinois Insurance Code [ 215 ILCS 5 ].
"Course" means any course of study certified to the Director
				that meets the requirements of this Part, including but not limited to seminar,
				classroom, and self-study formats.
"Department" means the Illinois Department of Insurance.
"Director" means the Director of the Illinois Department of
				Insurance or anyone to whom the Director's responsibilities and authority are
				lawfully delegated.
"In-Person Counselor" means any individual or entity who
				receives grant funds from the State of Illinois to perform the activities and
				duties identified in
				45 CFR
				155.205 or is described or designated by a
				Marketplace, the State, or the United States Department of Health and Human
				Services, or could reasonably be described or designated as "non-Navigator
				assistance personnel" as described in
				45
				CFR 155.215. An In-Person Counselor would
				engage in the activities and meet the standards described in
				45
				CFR 155.215, including, but not limited
				to:
conduct public education activities to raise awareness of the
				availability of qualified health plans;
distribute fair and impartial information concerning enrollment
				in qualified health plans, and the availability of premium tax credits under
				26 USC
				36B and cost-sharing reductions under
				42
				USC 18071;
facilitate enrollment in qualified health plans;
provide referrals to any applicable office of health insurance
				consumer assistance or health insurance ombudsman established under section
				2793 of the Public Health Services Act (
				42 USC
				300gg-93 ), or any other appropriate State
				agency or agencies, for any enrollee with a grievance, complaint, or question
				regarding his or her health plan, coverage, or a determination under a plan or
				coverage; and
provide information in a manner that is culturally and
				linguistically appropriate to the needs of the population being served by the
				Marketplace.
"Marketplace" means any health benefit exchange authorized
				under the federal Patient Protection and Affordable Care Act and established or
				operating in this State, including any exchange established or operated by the
				United States Department of Health and Human Services.
"Navigator" means any individual or entity who is certified as
				a "Navigator" under the federal Patient Protection and Affordable Care Act, and
				means any individual or entity, other than an insurance producer licensed by
				the Department, who receives grant funds from the United States Department of
				Health and Human Services to perform any of the activities and duties
				identified in
				42 USC
				18031(i)(3) or is described
				or designated by a Marketplace, the State, or the United States Department of
				Health and Human Services, or could reasonably be described or designated, as
				Navigators, as described in
				45 CFR
				155.210. A Navigator would engage in the
				activities and meet the standards described in
				45 CFR
				155.210 and 45 CFR 155.215, including, but
				not limited to:
conduct public education activities to raise awareness of the
				availability of qualified health plans;
distribute fair and impartial information concerning enrollment
				in qualified health plans, and the availability of premium tax credits under
				26 USC
				36B and cost-sharing reductions under
				42
				USC 18071;
facilitate enrollment in qualified health plans;
provide referrals to any applicable office of health insurance
				consumer assistance or health insurance ombudsman established under section
				2793 of the Public Health Services Act (
				42 USC
				300gg-93 ), or any other appropriate State
				agency or agencies, for any enrollee with a grievance, complaint, or question
				regarding his or her health plan, coverage, or a determination under a plan or
				coverage; and
provide information in a manner that is culturally and
				linguistically appropriate to the needs of the population being served by the
				Marketplace.
"Qualified health plan" has the meaning given that term in
				42 USC
				18021(a).