Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-5 - Agents, Licensing, Continuing Education › Section 3901-5-13 - Insurance navigator certification and agent exchange requirements

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to set forth procedures and
				requirements for the certification of insurance navigators as recognized by the
				department as both an individual and business entity, and the requirements for
				agents who sell health coverage on the exchange.
(B) Authority
This rule is promulgated pursuant to the authority vested in
				the superintendent under sections
				3901.041,
				3905.12,
				3905.47 to
				3905.473 of the Revised
				Code.
(C) Insurance
			 navigator certification
(1) An individual
			 applying for certification as an insurance navigator must comply with the
			 requirements contained in section
			 3905.471 of the Revised
			 Code.
(2) An individual applying
			 for certification shall do all of the following:
(a)
										
										Complete at least
			 twenty-four hours of precertification education requirements including all of
			 the following, but not limited to;
(i)
			 Compliance with the Health Insurance Portability and Accountability Act of
			 1996, Pub. L. No.
			 104-191, 110 Stat. 1955,
			 42 U.S.C.A.
			 300gg, as amended, and any regulation adopted
			 thereunder;
(ii) Ethics;
(iii) Provisions of the Patient Protection
			 and Affordable Care Act (ACA), 124 Stat. 119,
			 42 U.S.C.
			 18031 (2011);
(iv) Levels of coverage available under the
			 ACA;
(v) Eligibility requirements
			 to purchase qualified health plans;
(vi) Means of appeal and dispute
			 resolution;
(vii) Conflict of
			 interest and impartiality;
(viii)
			 Exchange privacy policies and requirements;
(ix) Individual eligibility requirements for
			 medicaid;
(x) Advanced premium tax
			 credits and cost sharing reductions;
(xi) Publicly funded health care (children's
			 health insurance program, medicaid); and
(xii) Eligibility requirements for employers
			 to make insurance available to their employees through the "Small Business
			 Health Options Program" (SHOP) created by division (b)(1)(B) of section 1311 of
			 the ACA.
(b)
										
										Successfully complete a criminal background check
			 pursuant to section 3905.051 of the Revised Code
			 
										with satisfactory results
			 upon review by the
										
			 superintendent. Any applicant with a conviction notes in the background check
			 may submit information to the superintendent on why the conviction does not
			 impact their fitness to perform as a navigator.
(c)
										
										Successfully complete
			 a comprehensive exam including pertinent information that is included within
			 the required education credits. This requirement will be met by the successful
			 completion of an examination administered under the regulations implemented by
			 the secretary of health and human services.
(d)
										
										Submit an application and
			 disclosure form by which the insurance navigator shall disclose any potential
			 conflicts of interest based upon the regulations implemented by the secretary
			 of health and human services to avoid conflicts of interest.
(3) If the applicant has met the
			 required education standards set forth by the exchange as defined in division
			 
									(X) of
			 section 3905.01 of the Revised Code, the
			 applicant shall have subsequently met all education requirements listed in this
			 rule.
(4) A certified insurance
			 navigator must notify the department of a criminal conviction within thirty
			 days of a court ruled conviction.