Zane Benefits Publishes New Information on Health Exchange Navigators

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Navigators and Insurance Agents to Have Separate Roles in the New Health Insurance Exchanges

Today, Zane Benefits, Inc. published new information on health exchange navigators. Zane Benefits, which provides comprehensive and flexible alternatives to traditional employer sponsored health benefits, is the leader in defined contribution and health reimbursement arrangements.

According to Zane Benefits’ website, on Wednesday, April 3, 2013 the U.S. Department of Health and Human Services (HHS) released proposed rules on Navigators in the state health insurance exchanges. The much-anticipated release clarifies standards for Navigator eligibility, conflict of interest, training, and service delivery.

Key highlights from the proposed rules include:

According to Zane Benefits’ website, Navigators cannot be employed by health insurers, and cannot be issuers of stop-loss insurance for self-funded plans (or their subsidiaries), although Navigators would be permitted to sell other forms of insurance, such as life and disability plans.

Navigators, as individuals or organizations, would be required to make several conflict of interest disclosures to the exchanges and consumers, listing any lines of non-health or stop-loss insurance business and any employment with health or stop-loss insurers during the last five years.

Insurance agents and brokers would be able to serve as Navigators, absent of financial ties to health insurers. However, states could not require Navigators to be licensed brokers or to carry professional liability insurance. In other words, any individual or entity could be a Navigator if they meet the exchange's requirements and standards.

Agents and brokers will have a choice to operate either as a traditional producer (selling individual and small group health insurance policies on and off the exchange), or change their business model and serve as a Navigator. Further rules will be released on producers registering and selling with the exchanges, and may vary by state.

Here is a look at the HHS proposed rules on Navigators in more depth.

1. Proposed Rules for Navigators - Eligibility

According to Zane Benefits’ website, these eligibility standards would apply to Navigators in all state health insurance exchanges, including Federal Exchanges, Partnership Exchanges and State-based Exchanges.

The proposed rule clarifies Navigators (entity or individual) must meet any licensing, certification or other standard prescribed by the state or Exchange (if applicable), as long as such standards do not prevent the application of the provisions of title I of the Affordable Care Act. In other words, a Navigator does not need to be licensed as a broker or agent.

2. Proposed Rules for Navigators - Conflict of Interest

According to Zane Benefits’ website, the following proposed rules would be applicable to Navigators, and and non-Navigator assisters ("in-person assisters") in the Federal Exchange, Partnership Exchanges, and State-based Exchanges federally funded through 1311(a) Exchange Establishments grants.

Conflict of Interest: The proposed rules provide further details on conflict of interest standards.The conflict of interest prohibition found in the original rule is expanded. Under existing rules Navigators may not be health insurance issuers, subsidiaries of issuers, associations of insurers or insurer lobbyists, or receive direct or indirect consideration for insurers, including trailer commissions for past sales. The proposed rule expands prohibited relationships to include relationships with stop loss issuers or subsidiaries of stop loss issuers, or consideration from stop loss issuers.

Individual vs. Entity Navigator: The same conflict of interest rules would apply to individuals as to entities awarded a Navigator grant. If an entity or organization is awarded a Navigator grant, the entity as a whole is considered to be a Navigator. While a Navigator could retain staff members who serve as agents and brokers, those staff members—and the organization itself—could not receive compensation from health insurance or stop loss insurance issuers for enrolling individuals or employees in QHPs or health insurance plans outside of the exchange. Such staff members, however, could continue to be compensated for selling other insurance products (for example, auto, life, and homeowners' policies).

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About Zane Benefits
Zane Benefits was founded in 2006 to provide a revolutionized SaaS (Software-as-a-Service) administration platform ("ZaneHRA") for Health Reimbursement Arrangements (HRAs) and defined contribution health care. The flagship software provides a 100% paperless administration experience to employers and insurance professionals that want to offer better health benefits without a traditional group health insurance plan at lower costs. For more information about ZaneHRA, visit http://www.zanebenefits.com.

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Christina Merhar
Zane Benefits
800-391-9209 6725
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