Bill Text: MI HB4614 | 2013-2014 | 97th Legislature | Introduced

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Bill Title: Occupations; insurance; licensing and regulation for navigators; provide for. Amends secs. 102, 1201, 1238 & 1242 of 1956 PA 218 (MCL 500.102 et seq.) & adds secs. 1229, 1230, 1231, 1231a & 1231b.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2013-04-25 - Printed Bill Filed 04/25/2013 [HB4614 Detail]

Download: Michigan-2013-HB4614-Introduced.html

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HOUSE BILL No. 4614

 

April 24, 2013, Introduced by Rep. Shirkey and referred to the Committee on Health Policy.

 

     A bill to amend 1956 PA 218, entitled

 

"The insurance code of 1956,"

 

by amending sections 102, 1201, 1238, and 1242 (MCL 500.102,

 

500.1201, 500.1238, and 500.1242), section 102 as amended by 2000

 

PA 252, section 1201 as amended by 2012 PA 462, section 1238 as

 

amended by 2012 PA 453, and section 1242 as amended by 2002 PA 32,

 

and by adding sections 1229, 1230, 1231, 1231a, and 1231b.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 102. (1) "Commissioner" as used in this act means the

 

commissioner of the office of financial and insurance

 

services.director.

 

     (2) "Department" as used in this act means the office of

 

financial and insurance services.department of insurance and

 

financial services.

 

     (3) "Director" as used in this act, unless the context clearly

 

implies a different meaning, means the director of the department

 

of insurance and financial services.

 

     Sec. 1201. As used in this chapter:

 

     (a) "Affordable care act" means the patient protection and

 

affordable care act, Public Law 111-148, as amended by the health

 

care and education reconciliation act of 2010, Public Law 111-152.

 

     (b) (a) "Agent" except as provided in section 1243 means an

 

insurance producer.

 

     (c) (b) "Business entity" means a corporation, association,

 

partnership, limited liability company, limited liability

 

partnership, or other legal entity.

 

     (d) "Exchange" means an American health benefits exchange

 

established or operating in this state pursuant to the affordable

 

care act.

 

     (e) (c) "Home state", except as provided in section 1224,

 

means the District of Columbia or any state or territory of the

 

United States in which an insurance producer maintains his or her

 

principal place of residence or principal place of business and is

 

licensed to act as an insurance producer.

 

     (f) (d) "Insurance" means any of the lines of authority in

 

chapter 6.

 

     (g) (e) "Insurance producer" means a person required to be

 

licensed under the laws of this state to sell, solicit, or

 

negotiate insurance.

 

     (h) (f) "License" means a document issued by this state's

 

commissioner the director authorizing a person to act as an

 

insurance producer or navigator for the qualifications specified in

 

the document. The license itself does not create any actual,

 

apparent, or inherent authority in the holder to represent or

 

commit an insurer.

 

     (i) (g) "Limited line credit insurance" includes credit life,

 

credit disability, credit property, credit unemployment,

 

involuntary unemployment, mortgage life, mortgage guaranty,

 

mortgage disability, guaranteed automobile protection insurance,

 

and any other form of insurance offered in connection with an

 

extension of credit that is limited to partially or wholly

 

extinguishing that credit obligation that the commissioner director

 

determines should be designated a form of limited line credit

 

insurance.

 

     (j) (h) "Limited line credit insurance producer" means a

 

person who sells, solicits, or negotiates 1 or more forms of

 

limited line credit insurance coverage to individuals through a

 

master, corporate, group, or individual policy.

 

     (k) (i) "Limited lines insurance" means any of the following:

 

     (i) Marine insurance as defined in section 614.

 

     (ii) Credit insurance as described in section 624(1)(e).

 

     (iii) Surety and fidelity insurance as defined in section 628.

 

     (iv) Legal expense insurance as defined in section 618.

 

     (v) Livestock insurance as described in section 624(1)(g).

 

     (vi) Malpractice insurance as described in section 624(1)(h).

 

     (vii) Plate glass insurance as described in section 624(1)(c).

 

     (viii) Any other miscellaneous insurance described in section

 

624(1)(i).

 

     (ix) Any other line of insurance that the commissioner director

 

considers necessary to recognize to comply with section 1206a(5).

 

     (l) (j) "Limited lines producer" means a person authorized by

 

the commissioner director to sell, solicit, or negotiate limited

 

lines insurance.

 

     (m) "Navigator" means a person required to be licensed under

 

the laws of this state to perform any of the activities described

 

in 42 USC 18031(i).

 

     (n) (k) "Negotiate" means the act of conferring directly with

 

or offering advice directly to a purchaser or prospective purchaser

 

of a particular contract of insurance concerning any of the

 

substantive benefits, terms, or conditions of the contract,

 

provided that the person engaged in that act either sells insurance

 

or obtains insurance from insurers for purchasers.

 

     (o) (l) "Sell" means to exchange a contract of insurance by any

 

means, for money or its equivalent, on behalf of an insurance

 

company.

 

     (p) (m) "Solicit" means attempting to sell insurance or asking

 

or urging a person to apply for a particular kind of insurance from

 

a particular company.

 

     (q) (n) "Terminate" means the cancellation of the relationship

 

between an insurance producer and the insurer or the termination of

 

a producer's authority to transact insurance.

 

     Sec. 1229. (1) An individual shall not act as a navigator or

 

hold himself or herself out to the public as a navigator unless he

 

or she is licensed as a navigator.

 

     (2) Unless licensed as a navigator, an individual shall not

 

receive funding from an exchange.

 

     (3) A navigator may do all of the following:

 

     (a) Conduct public education activities to raise awareness of

 

the availability of qualified health plans.

 

     (b) 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 USC 36B, and

 

cost-sharing reduction under section 1402 of the affordable care

 

act.

 

     (c) Facilitate enrollment in qualified health plans, without

 

suggesting that an individual select a particular plan.

 

     (d) Provide referrals to appropriate state agencies for an

 

enrollee with a grievance, complaint, or question regarding the

 

enrollee's health plan, coverage, or a determination under such

 

plan coverage.

 

     (e) Provide information in a manner that is culturally and

 

linguistically appropriate to the needs of the population served by

 

the exchange.

 

     (4) A navigator shall not do any of the following:

 

     (a) Sell, solicit, or negotiate health insurance.

 

     (b) Provide advice concerning the benefits, terms, and

 

features of a particular health plan or offer advice about which

 

health plan is better or worse for a particular individual or

 

entity.

 

     (c) Recommend a particular health plan or advise consumers

 

about which health plan to choose.

 

     (d) Provide any information or services related to health

 

benefit plans or other products not offered in the exchange.

 

     (5) If an exchange is established or operating in this state,

 

the director shall do all of the following:

 

     (a) Establish a licensing and training program for a

 

prospective navigator. The licensing and training program shall

 

include, but is not limited to, training on compliance with the

 

health insurance portability and accountability act of 1996, Public

 

Law 104-191, or regulations promulgated under that act, training on

 

ethics, and training on provisions of the affordable care act

 

relating to navigators.

 

     (b) Develop an application and disclosure form by which a

 

navigator may disclose any potential conflicts of interest, as well

 

as any other information required by the director.

 

     Sec. 1230. (1) An individual applying for a navigator license

 

shall file with the director the uniform application required by

 

the director and shall declare under penalty of refusal,

 

suspension, or revocation of the license that the statements made

 

in the application are true, correct, and complete to the best of

 

the individual's knowledge and belief. An application for a

 

navigator's license shall not be approved unless the director finds

 

that the individual meets all of the following:

 

     (a) Is at least 18 years of age.

 

     (b) Has not committed any act listed that would be a ground

 

for denial, suspension, or revocation of an insurance producer's

 

license in section 1239(1).

 

     (c) As required under section 1229, has completed a

 

prelicensing course of study for the qualifications for which the

 

person has applied.

 

     (d) Has paid the fees required by the director.

 

     (e) Has successfully passed the examination required for each

 

qualification for which the person has applied.

 

     (2) A business entity acting as a navigator shall obtain a

 

navigator license. A business entity applying for a navigator

 

license shall file with the director the uniform business entity

 

application required by the director. An application for a

 

navigator license under this subsection shall not be approved

 

unless the director finds all of the following:

 

     (a) The business entity has paid the fees required by the

 

director.

 

     (b) The business entity has designated an individual licensed

 

navigator responsible for the business entity's compliance with

 

this state's insurance laws, rules, and regulations.

 

     (c) The business entity has not committed any act listed in

 

section 1239(1).

 

     (3) The director may require the production of any documents

 

reasonably necessary to verify the information contained in an

 

application.

 

     Sec. 1231. (1) In addition to any other powers under this act,

 

the director may place on probation, suspend, or revoke a

 

navigator's license or may levy a civil fine under section 1244 or

 

any combination of actions, and the director shall refuse to issue

 

a navigator license under section 1230, for any 1 or more causes

 

that would be a ground for refusal, suspension, or revocation of an

 

insurance producer's license under section 1239. Beginning October

 

1, 2013, the director shall revoke a navigator license of any

 

person or refuse to issue a navigator license for a person that

 

receives financial compensation, including monetary and in-kind

 

compensation, gifts, or grants from an insurer offering qualified

 

health benefits through an exchange operating in this state. The

 

director may deny, suspend, approve, renew, or revoke the license

 

of a navigator if the director considers it necessary to protect

 

insureds and the public.

 

     (2) Before the director denies an application for a navigator

 

license under section 1230, the director shall notify in writing

 

the applicant or licensee of the denial and of the reason for the

 

denial. Not later than 30 days after this written denial, the

 

applicant or licensee may make written demand upon the director for

 

a hearing before the director to determine the reasonableness of

 

the director's action. A hearing under this subsection shall be

 

held pursuant to the administrative procedures act of 1969, 1969 PA

 

306, MCL 24.201 to 24.328.

 

     (3) The navigator license of a business entity may be

 

suspended, revoked, or refused if the director finds, after

 

hearing, that an individual navigator's violation was known or

 

should have been known by 1 or more of the partners, officers, or

 

managers acting on behalf of the business entity and the violation

 

was neither reported to the director nor corrective action taken.

 

     (4) The director may examine the books and records of a

 

navigator to determine whether the navigator is conducting its

 

business in accordance with this chapter. For the purpose of

 

facilitating the examination, the navigator shall allow the

 

director free access, at reasonable times, to all of the

 

navigator's books and records relating to transactions to which

 

this chapter applies.

 

     Sec. 1231a. A business entity licensed as a navigator shall,

 

in a manner prescribed by the director, make available a list of

 

all individual navigators that the business entity employs or

 

supervises or with which the business entity is otherwise

 

affiliated.

 

     Sec. 1231b. A business entity that terminates the employment,

 

engagement, affiliation, or other relationship with an individual

 

navigator shall notify the director using a format prescribed by

 

the director of the termination within 30 days following the

 

effective date of the termination if the reason for termination is

 

1 of the reasons listed in section 1239 or the business entity has

 

knowledge the individual navigator was found by a court or

 

government body to have engaged in any of the activities listed in

 

section 1239.

 

     Sec. 1238. (1) When applying for a license to act as an agent,

 

solicitor, counselor, or adjuster, or navigator, the applicant

 

shall report his or her mailing and electronic mail address to the

 

commissioner. director. An agent, solicitor, counselor, or

 

adjuster, or navigator shall notify the commissioner director of

 

any change in his or her mailing or electronic mail address within

 

30 days after the change. The commissioner director shall maintain

 

the mailing and electronic mail address of each agent, solicitor,

 

counselor, or adjuster, or navigator on file.

 

     (2) A notice of hearing or service of process may be served

 

upon an agent, solicitor, counselor, or adjuster, or navigator in

 

any action or proceeding for a violation of this act by mailing the

 

notice or process by first class mail to the agent's, solicitor's,

 

counselor's, or adjuster's, or navigator's mailing address reported

 

to the commissioner director under subsection (1).

 

     Sec. 1242. (1) The commissioner director shall refuse to grant

 

a license to act as a solicitor, an insurance counselor, or an

 

adjuster, or a navigator to an applicant who fails to meet the

 

requirements of this chapter. Notice of the refusal shall be in

 

writing and shall set forth the basis for the refusal. If the

 

applicant submits a written request within 30 days after mailing of

 

the notice of refusal, the commissioner director shall promptly

 

conduct a hearing in which the applicant shall be given an

 

opportunity to show compliance with the requirements of this

 

chapter.

 

     (2) The commissioner, director, after notice and opportunity

 

for a hearing, may suspend or revoke the license of a solicitor,

 

insurance counselor, or adjuster, or navigator who fails to

 

maintain the standards required for initial licensing or who

 

violates any provision of this act.

 

     (3) After notice and opportunity for a hearing, the

 

commissioner director may refuse to grant or renew a license to act

 

as a solicitor, adjuster, or insurance counselor if he or she

 

determines by a preponderance of the evidence, that it is probable

 

that the business or primary occupation of the applicant will give

 

rise to coercion, indirect rebating of commissions, or other

 

practices in the sale of insurance that are prohibited by law.

 

     (4) Without prior hearing, the commissioner director may order

 

summary suspension of a license if he or she finds that protection

 

of the public requires emergency action and incorporates this

 

finding in his or her order. The suspension shall be effective on

 

the date specified in the order or upon service of a certified copy

 

of the order on the licensee, whichever is later. If requested, the

 

commissioner director shall conduct a hearing on the suspension

 

within a reasonable time but not later than 20 days after the

 

effective date of the summary suspension unless the person whose

 

license is suspended requests a later date. At the hearing, the

 

commissioner director shall determine if the suspension should be

 

continued or if the suspension should be withdrawn, and, if proper

 

notice is given, may determine if the license should be revoked.

 

The commissioner director shall announce his or her decision within

 

30 days after conclusion of the hearing. The suspension shall

 

continue until the decision is announced.

 

     (5) The commissioner, director, or his or her designated

 

deputy, may issue subpoenas to require the attendance and testimony

 

of witnesses and the production of documents necessary to the

 

conduct of the hearing and may designate an office of financial and

 

insurance services a department employee to make service. The

 

subpoenas issued by the commissioner, director, or his or her

 

designated deputy, may be enforced upon petition to the circuit

 

court of Ingham county to show cause why a contempt order should

 

not be issued, as provided by law.

 

     Enacting section 1. (1) This amendatory act does not do any of

 

the following:

 

     (a) Authorize or be construed to authorize the establishment

 

or operation of an American health benefit exchange in this state

 

pursuant to the patient protection and affordable care act, Public

 

Law 111-148, as amended by the health care and education

 

reconciliation act of 2010, Public Law 111-152.

 

     (b) Authorize this state or an agency of this state to conduct

 

or oversee state-level governmental consumer assistance functions

 

for an American health benefit exchange established or operating in

 

this state pursuant to the patient protection and affordable care

 

act, Public Law 111-148, as amended by the health care and

 

education reconciliation act of 2010, Public Law 111-152.

 

     (c) Convey any administrative, statutory, rule-making, or

 

other power to this state or an agency of this state to authorize,

 

establish, or operate an American health benefit exchange in this

 

state that did not exist before the effective date of this

 

amendatory act.

 

     (2) It is the intent of this legislature that any consumer

 

assistance functions by or overseen by this state or an agency of

 

this state with regard to an American health benefit exchange shall

 

be conducted in a manner that utilizes and highlights Michigan-

 

based resources, including insurance producers, in order to best

 

serve the residents of this state and to ensure appropriate health

 

care decisions.

 

     Enacting section 2. This amendatory act applies to policies,

 

certificates, or contracts delivered, issued for delivery, or

 

renewed in this state on and after the effective date of this

 

amendatory act.