HOUSE BILL 564
51st legislature - STATE OF NEW MEXICO - first session, 2013
Thomas C. Taylor
RELATING TO INSURANCE; ENACTING THE INSURANCE NAVIGATOR LICENSING ACT; REQUIRING LICENSING FOR INSURANCE NAVIGATORS; REQUIRING CONTINUING EDUCATION; PROHIBITING CERTAIN CONDUCT; REQUIRING REPORTS TO THE SUPERINTENDENT OF INSURANCE; PROVIDING FOR RULEMAKING; PROVIDING FOR SEVERABILITY.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. A new section of the New Mexico Insurance Code is enacted to read:
"[NEW MATERIAL] SHORT TITLE.--This act may be cited as the "Insurance Navigator Licensing Act"."
SECTION 2. A new section of the New Mexico Insurance Code is enacted to read:
"[NEW MATERIAL] DEFINITIONS.--As used in the Insurance Navigator Licensing Act:
A. "exchange" means a health benefit exchange established or operating in this state, including an exchange established or operated by the United States department of health and human services; and
B. "navigator" means a person, other than an insurance producer, who:
(1) receives funding, directly or indirectly, from an exchange, the state or the federal government to perform any of the activities and duties identified for a navigator in the federal Patient Protection and Affordable Care Act of 2010;
(2) facilitates enrollment of individuals or employers in health plans or public insurance programs offered through an exchange;
(3) conducts public education or consumer assistance activities for or on behalf of an exchange; or
(4) is described or designated by an exchange, the state or the United States department of health and human services, or could reasonably be described or designated as, a navigator, an in-person assister, enrollment assister, application assister or application counselor."
SECTION 3. A new section of the New Mexico Insurance Code is enacted to read:
"[NEW MATERIAL] LICENSE REQUIRED.--A person shall not act as, offer to act as or advertise a service as a navigator unless licensed as a navigator pursuant to the Insurance Navigator Licensing Act. A licensed navigator is subject to regulation by the superintendent."
SECTION 4. A new section of the New Mexico Insurance Code is enacted to read:
"[NEW MATERIAL] APPLICATION FOR LICENSE.--
A. A person applying for a navigator license shall make application to the superintendent on a form developed by the superintendent and declare under penalty of refusal, suspension or revocation of the license that the statements made in the application are true, correct and complete to the best of the person's knowledge and belief. Before approving the application, the superintendent shall find that the person:
(1) is at least eighteen years of age;
(2) resides in this state or maintains the person's principal place of business in the state;
(3) is not disqualified for having committed an act that would be grounds for denial, suspension or revocation of a license pursuant to the Insurance Code;
(4) has not had a license issued pursuant to the Insurance Code or an equivalent license or certification from another jurisdiction denied, suspended or revoked;
(5) has completed the pre-licensing training and course of study prescribed by the superintendent;
(6) has successfully passed the written examination prescribed by the superintendent;
(7) has submitted a full set of fingerprints to the superintendent and successfully completed a criminal history and regulatory record check in a manner prescribed by the superintendent;
(8) when applicable, has the written consent of the superintendent pursuant to a federal law regulating crimes by or affecting persons engaged in the business of insurance whose activities affect interstate commerce;
(9) possesses the requisite character and integrity;
(10) has identified the entity with which it is affiliated and supervised; and
(11) has paid the fees prescribed by the superintendent.
B. A person other than an individual that acts as a navigator, supervises or is responsible for the activities of individual navigators or receives funding to perform those activities shall obtain a navigator license as an entity. An entity applying for a navigator license shall:
(1) make application on a form and containing the information prescribed by the superintendent; and
(2) designate an individual licensed as a navigator to be responsible for the entity's compliance with the Insurance Code.
C. The superintendent may require any documents deemed necessary to verify the information contained in an application submitted in accordance with Subsections A and B of this section.
D. An entity licensed as a navigator shall, in a manner prescribed by the superintendent, periodically provide the superintendent with a list of all individual navigators that it employs, supervises or with whom it is affiliated.
E. The superintendent shall require that each navigator obtain a surety bond in an amount acceptable to the superintendent or otherwise demonstrate a level of financial responsibility capable of protecting all persons against the wrongful acts, misrepresentations, errors, omissions or negligence of the navigator. The superintendent may ask for a copy of the bond or other evidence of financial responsibility at any time.
F. Prior to an exchange becoming operational, the superintendent shall prescribe initial training, continuing education and written examination standards and requirements for navigators."
SECTION 5. A new section of the New Mexico Insurance Code is enacted to read:
"[NEW MATERIAL] LICENSE TERM--RENEWAL--CONTINUING EDUCATION.--
A. A navigator license shall be valid for two years.
B. A navigator may file an application for renewal of a license in a method prescribed by the superintendent and pay the renewal fee prescribed by the superintendent. Any navigator who fails to timely file for license renewal shall be charged a late fee in an amount prescribed by the superintendent.
C. Prior to the filing date for application for renewal of a license, an individual licensee shall comply with ongoing training and continuing education requirements established by the superintendent. The navigator shall file with the superintendent, by a method prescribed by the superintendent, satisfactory certification of completion of the continuing education requirements. A failure to fulfill the ongoing training and continuing education requirements shall result in the expiration of the license."
SECTION 6. A new section of the New Mexico Insurance Code is enacted to read:
"[NEW MATERIAL] NAVIGATOR CONDUCT--INSURANCE PRODUCER FUNCTIONS.--
A. A navigator shall not:
(1) engage in any activities that would require an insurance producer license;
(2) provide advice concerning the benefits, terms and features of a particular health plan or offer advice about which health plan is better or worse or suitable for a particular individual or employer;
(3) recommend or endorse a particular health plan or advise consumers about which health plan to choose; or
(4) provide information or services related to health benefit plans or other products not offered in the exchange.
B. Only a person licensed as an insurance producer in this state may:
(1) sell, solicit or negotiate health insurance;
(2) provide advice concerning the benefits, terms and features of a particular health plan or offer advice about which health plan is better or worse for a particular individual or employer; or
(3) recommend a particular health plan or advise consumers about which health plan to choose.
C. On contact with a person who acknowledges having existing health insurance coverage obtained through an insurance producer, a navigator shall refer the person back to that insurance producer for information, assistance and other services."
SECTION 7. A new section of the New Mexico Insurance Code is enacted to read:
"[NEW MATERIAL] GROUNDS FOR PLACING ON PROBATION, REFUSAL TO ISSUE OR RENEW, REVOCATION OR SUSPENSION OF LICENSE.--
A. The superintendent may place on probation, suspend, revoke or refuse to issue, renew or reinstate a navigator license, or may levy a fine not to exceed five thousand dollars ($5,000), for each violation of the Insurance Code or for other good cause.
B. In addition to imposing the penalties authorized by Subsection A of this section, the superintendent may require that restitution be made to any person who has suffered financial injury because of a violation of the Insurance Navigator Licensing Act.
C. The superintendent may examine and investigate the business affairs and records of a navigator to determine whether the individual or entity has engaged or is engaging in a violation of the Insurance Code.
D. The navigator license held by an entity may be suspended or revoked, or renewal or reinstatement of the license may be refused or a fine may be levied, with or without a suspension, revocation or refusal to renew a license, if the superintendent finds that an individual licensee's violation was known or should have been known by the employing or supervising entity and the violation was not reported to the superintendent on a timely basis."
SECTION 8. A new section of the New Mexico Insurance Code is enacted to read:
"[NEW MATERIAL] REPORTING TO THE SUPERINTENDENT.--
A. A licensed navigator shall report to the superintendent an administrative action taken by a governmental agency against the navigator in this state or in another jurisdiction within thirty calendar days of the final disposition of the matter. This report shall include a copy of the order, consent to order or other relevant legal documents.
B. Within thirty days of the initial pretrial hearing date, a navigator shall report to the superintendent a criminal prosecution of the navigator taken in another jurisdiction. The report shall include a copy of the initial complaint filed, the order resulting from the hearing and any other relevant legal documents.
C. An entity that acts as a navigator that terminates the employment, engagement, affiliation or other relationship with an individual navigator shall notify the superintendent within thirty days following the effective date of the termination, using a format prescribed by the superintendent, if the reason for termination is one of the reasons set forth in the Insurance Navigator Licensing Act or the entity has knowledge that the navigator was found by a court or government body to have engaged in any of the activities prohibited by the Insurance Code. Upon the written request of the superintendent, the entity shall provide additional information, documents, records or other data pertaining to the termination or activity of the individual."
SECTION 9. A new section of the New Mexico Insurance Code is enacted to read:
"[NEW MATERIAL] OTHER LAWS--RULEMAKING AUTHORITY.--
A. The requirements of the Insurance Code and the Unfair Practices Act and rules promulgated pursuant to those acts shall apply to navigators. The activities and duties of a navigator shall be deemed to constitute transacting the business of insurance.
B. The requirements of the Insurance Navigator Licensing Act shall not apply to a person licensed as an insurance producer in this state.
C. The superintendent may promulgate rules that are necessary or appropriate for the administration and enforcement of the Insurance Navigator Licensing Act."
SECTION 10. SEVERABILITY.--If any part or application of the Insurance Navigator Licensing Act is held invalid, the remainder or its application to other situations or persons shall not be affected.
SECTION 11. EFFECTIVE DATE.--The effective date of the provisions of this act is July 1, 2013.
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