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Texas Insurance Commission Proposes Rules to Regulate “Navigators” who help Apply for Health Care Programs

Attorney & Counselor at LawTexas Insurance Commission Proposes Rules to Regulate “Navigators” who help Apply for Health Care Programs

On December 7, the Texas Insurance Commissioner published proposed rules to regulate “navigators” who will help Texas residents to apply for health care affordability including Medicaid and the Children’s Health Insurance Program (CHIP). The proposed regulations set out a number of specific requirements to become licensed. Navigator services include (a) assisting consumers in completing health care affordability applications through a health benefit exchange; (b) explaining how health affordability programs work and interact, including Medicaid, CHIP, or advance premium tax credits and cost-sharing assistance; (c) explaining health insurance concepts related to qualified health plans, including premiums, cost-sharing networks or essential health benefits; (d) providing culturally and linguistically appropriate information; (e) avoiding conflicts of interest; or (f) establishing standards and processes relating to privacy and data security.  Except for life, accident and health insurance agents, counselors or insurance companies, the law is to become effective March 1, 2014. Navigators would be prohibited from: (a) charging for providing information to consumers; (b) selling, soliciting or negotiating health insurance coverage; (c) recommending a specific health benefit plan; or (d) providing advice regarding substantive or comparative benefits of different health benefit plans. They are also prohibited from engaging in electioneering activities for the support of the candidacy of an individual for government positions.

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