HHS proposes rule clarifying navigator role for federal exchanges

Health and Human Services (HHS) released a proposed rule defining the eligibility, standards and training of “navigators,” who are responsible for providing guidance to people enrolling in federal health exchanges under the Affordable Care Act (ACA).

Under the ACA, each exchange must have two certified navigators. The proposal states that navigators are expected to provide “fair, impartial and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions among [qualified health plans] and helping qualified individuals make informed decisions during the health plan selection process.” They will also provide additional assistance to consumers who are disabled, do not speak English or who are unfamiliar with health insurance.

The proposal specifies that while navigators do not have to be insurance agents or brokers, they:

  • Cannot be employed by an insurer;
  • Cannot receive compensation or rewards from insurers;
  • Cannot select a plan for their clients;
  • Must disclose what other lines of insurance they intended to sell;
  • Must disclose any employment with health insurers in the previous five years;
  • Must certify that they will abide by conflict-of-interest and impartiality standards developed by HHS; and
  • Are not tasked with determining whether a client is eligible for a subsidy through the ACA.

Navigators in state-run exchanges do not have to abide by the same conflict-of-interest standards as those in federal and partnership exchanges. However, HHS suggested that state exchanges use the proposed rule as a model for developing their own guidelines.

2013-04-09T00:00:00+00:00 April 9th, 2013|Advocacy|