Missouri § 376.2002 - Navigators, license required — permitted acts — prohibited acts — exemptions.

§ 376.2002. Navigators, license required — permitted acts — prohibited acts — exemptions.

1.  No individual or entity shall perform, offer to perform, or advertise any service as a navigator in this state, or receive navigator funding from the state or an exchange unless licensed as a navigator by the department under sections 376.2000 to 376.2014.

2.  A navigator may:

(1)  Provide fair and impartial information and services in connection with eligibility, enrollment, and program specifications of any health benefit exchange operating in this state, including information about the costs of coverage, advance payments of premium tax credits, and cost-sharing reductions;

(2)  Facilitate the selection of a qualified health plan;

(3)  Initiate the enrollment process;

(4)  Provide referrals to any applicable office of health insurance consumer assistance, ombudsman, or other agency for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or determination under the plan; and

(5)  Use culturally and linguistically appropriate language to communicate the information authorized in this subsection.

3.  Unless also properly licensed as an insurance producer in this state with authority for health under section 375.014, a navigator shall not:

(1)  Sell, solicit, or negotiate health insurance;

(2)  Engage in any activity that would require an insurance producer license;

(3)  Provide advice concerning the benefits, terms, and features of a particular health plan or offer advice about which exchange health plan is better or worse for a particular individual or employer;

(4)  Recommend or endorse a particular health plan or advise consumers about which health plan to choose; or

(5)  Provide any information or services related to health benefit plans or other products not offered in the exchange.

4.  The following entities or persons are exempt from the requirement to be licensed as a navigator:

(1)  An entity or person licensed as an insurance producer in this state with authority for health under section 375.014;

(2)  A law firm or licensed attorney in this state; and

(3)  A "health care provider" as defined in section 376.1350 provided that:

(a)  The health care provider does not receive any funds from the United States Department of Health and Human Services or a health exchange operating in this state to act as a navigator; and

(b)  The activities or functions performed are related to advising, assisting, or counseling patients regarding private or public coverage or financial matters related to medical treatments or government assistance programs.  

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(L. 2013 S.B. 262)

Effective 7-12-13

(2016) Provisions prohibiting state navigators from providing certain information to consumers about health benefit plans are preempted by the federal Patient Protection and Affordable Care Act.  St. Louis Effort for AIDS v. Huff, 170 F.Supp.3d 1219 (W.D.Mo.).

---- end of effective  12 Jul 2013 ----

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