Effective: July 30, 2013
Latest Legislation: House Bill 3 - 130th General Assembly
(A) No individual or entity shall act as or hold itself out to be an insurance navigator unless that individual or entity is certified as an insurance navigator under this section and is receiving funding under division (i) of section 1311 of the Affordable Care Act.
(B) An insurance navigator who complies with the requirements of this section may do any of the following:
(1) Conduct public education activities to raise awareness of the availability of qualified health plans;
(2) Distribute fair and impartial general information concerning enrollment in all qualified health plans offered within the exchange and the availability of the premium tax credits under section 36B of the Internal Revenue Code of 1986, 26 U.S.C. 36B, and cost-sharing reductions under section 1402 of the Affordable Care Act;
(3) Facilitate enrollment in qualified health plans, without suggesting that an individual select a particular plan;
(4) Provide referrals to appropriate state agencies for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan coverage;
(5) Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the exchange.
(C) An insurance navigator shall not do any of the following:
(1) Sell, solicit, or negotiate health insurance;
(2) Provide advice concerning the substantive benefits, terms, and conditions of a particular health benefit plan or offer advice about which health benefit plan is better or worse or suitable for a particular individual or entity;
(3) Recommend a particular health plan or advise consumers about which health benefit plan to choose;
(4) Provide any information or services related to health benefit plans or other products not offered in the exchange. Division (C)(4) of this section shall not be interpreted as prohibiting an insurance navigator from providing information on eligibility for medicaid;
(5) Engage in any unfair method of competition or any fraudulent, deceptive, or dishonest act or practice.
(D) An individual shall not act in the capacity of an insurance navigator, or perform insurance navigator duties on behalf of an organization serving as an insurance navigator, unless the individual has applied for certification and the superintendent finds that the applicant meets all of the following requirements:
(1) Is at least eighteen years of age;
(2) Has completed and submitted the application and disclosure form required under division (F)(2) of this section and has declared, under penalty of refusal, suspension, or revocation of the insurance navigator's certification, that the statements made in the form are true, correct, and complete to the best of the applicant's knowledge and belief;
(3) Has successfully completed a criminal records check under section 3905.051 of the Revised Code, as required by the superintendent;
(4) Has successfully completed the certification and training requirements adopted by the superintendent in accordance with division (F) of this section;
(5) Has paid all fees required by the superintendent.
(E)(1) A business entity that acts as an insurance navigator, supervises the activities of individual insurance navigators, or receives funding to provide insurance navigator services shall obtain an insurance navigator business entity certification.
(2) Any entity applying for a business entity certification shall apply in a form specified, and provide any information required by, the superintendent.
(3) A business entity certified as an insurance navigator shall, in a manner prescribed by the superintendent, make available a list of all individual insurance navigators that the business entity employs, supervises, or with which the business entity is affiliated.
(F) The superintendent of insurance shall, prior to any exchange becoming operational in this state, do all of the following:
(1)(a) Adopt rules to establish a certification and training program for a prospective insurance navigator and the insurance navigator's employees that includes screening via a criminal records check performed in accordance with section 3905.051 of the Revised Code, initial and continuing education requirements, and an examination;
(b) The certification and training program shall include training on compliance with the "Health Insurance Portability and Accountability Act of 1996," 110 Stat. 1955, 42 U.S.C. 1320d, et seq., as amended, training on ethics, and training on provisions of the Affordable Care Act relating to insurance navigators and exchanges.
(2) Develop an application and disclosure form by which an insurance navigator may disclose any potential conflicts of interest, as well as any other information the superintendent considers pertinent.
(G)(1) The superintendent may suspend, revoke, or refuse to issue or renew the insurance navigator certification of any person, or levy a civil penalty against any person, that violates the requirements of this section or commits any act that would be a ground for denial, suspension, or revocation of an insurance agent license, as prescribed in section 3905.14 of the Revised Code.
(2) The superintendent shall have the power to examine and investigate the business affairs and records of any insurance navigator.
(3)(a) The superintendent shall not certify as an insurance navigator, and shall revoke any existing insurance navigator certification of, any individual, organization, or business entity that is receiving financial compensation, including monetary and in-kind compensation, gifts, or grants, on or after October 1, 2013, from an insurer offering a qualified health benefit plan through an exchange operating in this state.
(b) Notwithstanding division (G)(3)(a) of this section, the superintendent may certify as a navigator a qualified health center and a federally qualified health center look-alike, as defined in section 3701.047 of the Revised Code.
(4)(a) If the superintendent finds that a violation of this section made by an individual insurance navigator was made with the knowledge of the employing or supervising entity, or that the employing or supervising entity should reasonably have been aware of the individual insurance navigator's violation, and the violation was not reported to the superintendent and no corrective action was undertaken on a timely basis, then the superintendent may suspend, revoke, or refuse to renew the insurance navigator certification of the supervising or employing entity.
(b) In addition to, or in lieu of, any disciplinary action taken under division (G)(4)(a) of this section, the superintendent may levy a civil penalty against such an entity.
(H) A business entity that terminates the employment, engagement, affiliation, or other relationship with an individual insurance 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 section 3905.14 of the Revised Code, or the entity has knowledge that the insurance navigator was found by a court or government body to have engaged in any of the activities in section 3905.14 of the Revised Code.
(I) Insurance navigators are subject to the laws of this chapter, and any rules adopted pursuant to the chapter, in so far as such laws are applicable.
(J) The superintendent may deny, suspend, approve, renew, or revoke the certification of an insurance navigator if the superintendent determines that doing so would be in the interest of Ohio insureds or the general public. Such an action is not subject to Chapter 119. of the Revised Code.
(K) The superintendent may adopt rules in accordance with Chapter 119. of the Revised Code to implement sections 3905.47 to 3905.473 of the Revised Code.
(L) The superintendent may, by rule, apply the requirements of this chapter to any entity or person designated by an exchange, the state, or the federal government to assist consumers or participate in exchange activities.
(M) Any fees collected under this section shall be paid into the state treasury to the credit of the department of insurance operating fund created under section 3901.021 of the Revised Code.
Structure Ohio Revised Code
Chapter 3905 | Insurance Producers Licensing Act
Section 3905.01 | Insurance Producers Licensing Act Definitions.
Section 3905.02 | License Required.
Section 3905.03 | Exceptions to Licensing Requirement.
Section 3905.04 | Written Examination of Applicant for Agent License.
Section 3905.041 | Exceptions to Program of Insurance Education or Examination Requirement.
Section 3905.05 | Application for Resident Insurance Agent License.
Section 3905.051 | Criminal Records Check; Fingerprinting; Confidentiality.
Section 3905.06 | Issuance and Contents of License - Lines of Authority.
Section 3905.061 | Agent to File of Change of Address.
Section 3905.062 | Portable Electronics Insurance.
Section 3905.063 | Self-Service Storage Insurance; License Required.
Section 3905.064 | Travel Insurance Definitions.
Section 3905.065 | Travel Insurance Agent License; Travel Protection Plans; Policy Requirements.
Section 3905.066 | Travel Retailers.
Section 3905.067 | Unfair and Deceptive Acts or Practices.
Section 3905.068 | Tax on Travel Insurance Premiums.
Section 3905.069 | Travel Administrators.
Section 3905.0610 | Classification of Travel Insurance; Eligibility and Underwriting Standards.
Section 3905.07 | Nonresident Insurance Agent or Surplus Lines Broker License; Renewal.
Section 3905.071 | Nonresident to File Change of Address.
Section 3905.072 | Nonresident Limited Lines Insurance Agent License.
Section 3905.08 | Reciprocity.
Section 3905.09 | Temporary Insurance Agent License.
Section 3905.11 | Agent's Use of Assumed Name.
Section 3905.14 | Disciplinary Actions.
Section 3905.15 | Hearing to Determine Administrative Action Modification.
Section 3905.16 | Surrender of License.
Section 3905.18 | Paying Unlawful Consideration.
Section 3905.181 | Accepting Consideration Without License.
Section 3905.182 | Sale of Shares of Capital Stock of Life Insurance Company or Agency.
Section 3905.20 | Appointment of Insurance Agent to Act as Agent of Insurer.
Section 3905.201 | Limited Line Credit Insurance Program of Instruction.
Section 3905.21 | Notice of Terminating Relationship With Insurance Agent.
Section 3905.24 | Confidentiality of Records and Information - Exceptions.
Section 3905.26 | Centralized Agent License Registry.
Section 3905.29 | Mutual Protective Associations Exempted.
Section 3905.30 | Resident and Nonresident Surplus Lines Broker's License.
Section 3905.31 | Prohibitions.
Section 3905.32 | License Fees.
Section 3905.331 | Exempt Commercial Purchasers; Qualifications; Qualified Risk Managers.
Section 3905.332 | Designation as Domestic Surplus Lines Insurer.
Section 3905.34 | Separate Accounts.
Section 3905.37 | Prohibited Acts.
Section 3905.39 | Continuation of Certificates and Licenses.
Section 3905.40 | Fees Paid to Superintendent of Insurance.
Section 3905.401 | Valuation Fee Not Applicable to Reinsurance Ceded to Affiliated Companies.
Section 3905.41 | Accounts for Fees.
Section 3905.42 | Insurance Business Must Be Authorized.
Section 3905.421 | Vehicle Protection Product Warranty.
Section 3905.422 | Homes Service Contract Are Consumer Transactions.
Section 3905.423 | Consumer Goods Contracts to Be Covered by Reimbursement Insurance.
Section 3905.424 | Waiver of Customer Obligation Not Insurance Matter.
Section 3905.426 | Requirements for Ancillary Product Protection Contracts.
Section 3905.43 | Advertising Limitations.
Section 3905.44 | Limitation Upon Domestic Companies.
Section 3905.45 | Payment of Funeral or Burial Expenses Policy.
Section 3905.451 | Funeral or Burial Goods or Services Coverage Not Subject to Preneed Provisions.
Section 3905.46 | Application of Law.
Section 3905.47 | Agent Training Programs.
Section 3905.471 | Insurance Navigator Certification.
Section 3905.472 | Qualified Health Benefit Plans.
Section 3905.473 | Exchange Listings.
Section 3905.474 | Qualifications for In-Person Assisters.
Section 3905.481 | Continuing Education Requirements.
Section 3905.484 | Establishing Criteria for Course or Program of Study for License Examination.
Section 3905.486 | Adoption of Rules.
Section 3905.49 | Prohibiting False Representation as Independent Agent.
Section 3905.50 | Terminating Independent Insurance Agent Contract.
Section 3905.53 | Effect of Child Support Default on License.
Section 3905.56 | Compensation by Public Entity for Placement of Insurance.
Section 3905.61 | Controlled Insurers Definitions.
Section 3905.62 | Application of Sections.
Section 3905.63 | Limits on Business Placed With Controlled Insurer by Controlling Producer.
Section 3905.64 | Notice to Prospective Insured by Controlling Producer.
Section 3905.65 | Remedies for Noncompliance.
Section 3905.71 | Managing General Agent Definitions.
Section 3905.72 | Managing General Agent License Requirement.
Section 3905.73 | Responsibilities of Managing General Agent.
Section 3905.74 | Independent Financial Examination of Each Managing General Agent.
Section 3905.75 | Acts of Agent Deemed Acts of Insurer - Examinations.
Section 3905.76 | Prohibition.
Section 3905.77 | Penalties for Violations.
Section 3905.78 | Rights Not Limited or Restricted.
Section 3905.81 | Reinsurance Intermediary-Broker or Intermediary-Manager License Required - Rules.
Section 3905.83 | Surety Bail Bond Agent Definitions.
Section 3905.84 | Surety Bail Bond Agent to Be Qualified, Licensed, and Appointed.
Section 3905.841 | Persons or Classes of Persons Not to Act as Agents.
Section 3905.85 | Surety Bail Bond Agent License.
Section 3905.851 | No Imposition of Local Licensing Fees.
Section 3905.86 | Appointment of Agent by Insurer.
Section 3905.861 | Extending Appointments to Affiliated Agents.
Section 3905.862 | Expiration or Cancellation of Appointment; Fee.
Section 3905.88 | Continuing Education.
Section 3905.89 | Notice of Change of Principal Business Address or Telephone Number.
Section 3905.90 | Records of Surety Bonds to Be Maintained - Furnishing of Information.
Section 3905.901 | Determination of Direct Written Premiums for Bail Bonds.
Section 3905.91 | Build-Up Funds.
Section 3905.92 | Requirements for Acceptance of Collateral Security or Other Indemnity.
Section 3905.921 | Discharge of Bond Where Collateral Security or Other Indemnity Accepted.
Section 3905.93 | Bail Bond - Charges and Fees.
Section 3905.931 | Furnishing of Forms and Other Supplies.
Section 3905.932 | Prohibited Acts.
Section 3905.933 | Signing or Countersigning Agent's Name to a Bond.
Section 3905.934 | Advertising Requirements.
Section 3905.94 | License Suspension or Revocation.