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‘Navigator’ Rules Proposed for Affordable Care Act

WASHINGTON (CN) - The Department of Health and Human Services proposed new rules on the "navigator" program, which aims to help eligible individuals buy health insurance under the Affordable Care Act.

Under the Affordable Care Act, health insurance marketplaces must create a "navigator" program to help eligible individuals find and enroll in health care plans.

Navigators will receive grants for their services, and the government has published a proposed rule for the navigator program that explains standards for eligibility, conflicts of interest, and training, among other issues.

The proposed rule clarifies that a navigator cannot be an insurer or be employed by one, and cannot issue stop-loss insurance for self-funded plans. Navigators could, however, sell certain forms of insurance like life or disability plans.

Under the proposed rule, navigators cannot be health insurance issuers, lobbyists, or receive commissions for past sales. The same rules would apply to individuals and entities who receive grant money.

Navigators would also be required to make conflict of interest disclosures to insurance exchanges and consumers, explaining any employment with health insurers in the past five years, among other things.

To meet eligibility requirements, a navigator does not have to be a licensed broker or agent. Navigators must, however, meet any certification standards ordered by state health insurance exchanges, as long as those standards comply with the Affordable Care Act.

Previously, the Department of Health and Human Services had proposed that navigators be trained in qualified health plan options, eligibility, and other rules related to insurance exchanges.

The proposed rule clarifies that navigators must receive up to 30 hours of training, obtain certification and pass an exam before registering with the department.

The department is seeking comments on the proposed rule, to be submitted by May 6. The health insurance marketplace under the Affordable Care Act is set to open at the beginning of October.

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