Industry Update: IDOI Hearing for Indiana Navigator and Application Organization Proposed Rules

On April 12th, the Indiana Department of Insurance (IDOI) will hold a public hearing on a proposed rule relating to individuals acting as a navigator and entities acting as an application organization in Indiana.

Some items to be discussed are:

  • Certification and Registration Requirements
  • Precertification Education and Examinations
  • Continuing Education
  • Duties
  • Conflicts of Interest
  • Privacy and Security of Information
  • Reporting Requirements
  • Enforcement

What you need to know: New regulations will require an evaluation of current policies and procedures to ensure they are in compliance with any changes.  At ClaimAid, we’re on top of the rules and regulations being proposed and what action will need to take place to ensure staff and facilities remain compliant.

A few excerpts from the proposed rule are:

  • 760 IAC 4-3-1 Certification and registration requirement

Sec. 1. (a) A person shall not assist individuals with application for and enrollment in a QHP through a health benefit exchange or in a public health insurance program or otherwise function as a navigator or application organization unless the individual is certified as a navigator or the entity is registered as an application organization under this rule.

 

  • 760 IAC (c) Navigators and application organizations shall do the following:

(1) Provide fair, accurate, and impartial information and assistance when assisting individuals with application for and enrollment in a QHP through a health benefit exchange or in a public health insurance program.

(2) Act in the best interests of the individuals whom they are assisting.

(3) Not allow any actual or potential conflict of interest to affect the assistance they provide to individuals.

(4) Agree to follow the department’s conflict of interest policy.

(5) Disclose in writing all actual or potential conflicts of interest to the department on a form provided by the department.

(6) Disclose in writing all actual or potential conflicts of interest to individuals prior to assisting individuals with application for and enrollment in a QHP through a health benefit exchange or in a public health insurance program.

  • 760 IAC 4-7-1 Enforcement

(d) A civil penalty imposed against a navigator or application organization under subsection(c) shall be not less than fifty dollars ($50) and not more than ten thousand dollars ($10,000) per violation. A civil penalty imposed may be enforced in the same manner as a civil judgment.

(e) A navigator or application organization may appeal an action listed under subsection (c) pursuant to section 2 of this rule. (Department of Insurance; 760 IAC 4-7-1)

 

More information about the proposed rule is available here: http://www.in.gov/legislative/iac/irtoc.htm?lsayear=15&lsadoc=33&view=list&ldn=Y

 

ClaimAid is the leading resource for Indiana Navigator certification and Application Organization compliance.  For more information about these services, please visit: https://www.indiananavigators.org or contact the ClaimAid Corporate Office at 800.842.4052.