Bill Text: OH HB613 | 2011-2012 | 129th General Assembly | Engrossed

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Bill Title: To specify licensing and continuing education requirements for insurance agents involved in selling, soliciting, or negotiating sickness and accident insurance through a health benefit exchange.

Spectrum: Partisan Bill (Republican 13-0)

Status: (Engrossed - Dead) 2012-12-06 - To Insurance, Commerce, & Labor [HB613 Detail]

Download: Ohio-2011-HB613-Engrossed.html

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As Passed by the House

129th General Assembly Regular Session 2011-2012

Sub. H. B. No. 613

Representative Sears 

Cosponsors: Representatives Hackett, Blessing, Bubp, Buchy, Combs, Henne, Hill, Huffman, Maag, Terhar, Wachtmann Speaker Batchelder 

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A BILL

To amend section 3905.01 and to enact sections

1

3905.47, 3905.471, 3905.472, and 3905.473 of the

2

Revised Code to specify licensing and continuing

3

education requirements for insurance agents

4

involved in selling, soliciting, or negotiating

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sickness and accident insurance through a health

6

benefit exchange.

7

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1.  That section 3905.01 be amended and sections	8
3905.47, 3905.471, 3905.472, and 3905.473 of the Revised Code be	9
enacted to read as follows:	10

Sec. 3905.01.  As used in this chapter:

11

(A) "Affordable Care Act" means the "Patient Protection and	12
Affordable Care Act," 124 Stat. 119, 42 U.S.C. 18031 (2011).	13

(B) "Business entity" means a corporation, association,	14
partnership, limited liability company, limited liability	15
partnership, or other legal entity.	16

(B)(C) "Home state" means the state or territory of the	17
United States, including the District of Columbia, in which an	18
insurance agent maintains the insurance agent's principal place of	19
residence or principal place of business and is licensed to act as	20
an insurance agent.	21

(C)(D) "Insurance" means any of the lines of authority set	22
forth in Chapter 1739., 1751., or 1761. or Title XXXIX of the	23
Revised Code, or as additionally determined by the superintendent	24
of insurance.	25

(D)(E) "Insurance agent" or "agent" means any person that, in	26
order to sell, solicit, or negotiate insurance, is required to be	27
licensed under the laws of this state, including limited lines	28
insurance agents and surplus line brokers.	29

(E)(F) "Insurer" has the same meaning as in section 3901.32	30
of the Revised Code.	31

(F)(G) "License" means the authority issued by the	32
superintendent to a person to act as an insurance agent for the	33
lines of authority specified, but that does not create any actual,	34
apparent, or inherent authority in the person to represent or	35
commit an insurer.	36

(G)(H) "Limited line credit insurance" means credit life,	37
credit disability, credit property, credit unemployment,	38
involuntary unemployment, mortgage life, mortgage guaranty,	39
mortgage disability, guaranteed automobile protection insurance,	40
or any other form of insurance offered in connection with an	41
extension of credit that is limited to partially or wholly	42
extinguishing that credit obligation and that is designated by the	43
superintendent as limited line credit insurance.	44

(H)(I) "Limited line credit insurance agent" means a person	45
that sells, solicits, or negotiates one or more forms of limited	46
line credit insurance to individuals through a master, corporate,	47
group, or individual policy.	48

(I)(J) "Limited lines insurance" means those lines of	49
authority set forth in divisions (B)(7) to (11) of section 3905.06	50
of the Revised Code or in rules adopted by the superintendent, or	51
any lines of authority the superintendent considers necessary to	52
recognize for purposes of complying with section 3905.072 of the	53
Revised Code.	54

(J)(K) "Limited lines insurance agent" means a person	55
authorized by the superintendent to sell, solicit, or negotiate	56
limited lines insurance.	57

(K)(L) "NAIC" means the national association of insurance	58
commissioners.	59

(L)(M) "Navigator" means a person selected to perform the	60
activities and duties identified in division (i) of section 1311	61
of the Affordable Care Act that is certified by the superintendent	62
of insurance under section 3905.471 of the Revised Code.	63

(N) "Negotiate" means to confer directly with, or offer	64
advice directly to, a purchaser or prospective purchaser of a	65
particular contract of insurance with respect to the substantive	66
benefits, terms, or conditions of the contract, provided the	67
person that is conferring or offering advice either sells	68
insurance or obtains insurance from insurers for purchasers.	69

(M)(O) "Person" means an individual or a business entity.

70

(N)(P) "Sell" means to exchange a contract of insurance by	71
any means, for money or its equivalent, on behalf of an insurer.	72

(O)(Q) "Solicit" means to attempt to sell insurance, or to	73
ask or urge a person to apply for a particular kind of insurance	74
from a particular insurer.	75

(P)(R) "Superintendent" or "superintendent of insurance"	76
means the superintendent of insurance of this state.	77

(Q)(S) "Terminate" means to cancel the relationship between	78
an insurance agent and the insurer or to terminate an insurance	79
agent's authority to transact insurance.	80

(R)(T) "Uniform application" means the NAIC uniform	81
application for resident and nonresident agent licensing, as	82
amended by the NAIC from time to time.	83

(S)(U) "Uniform business entity application" means the NAIC	84
uniform business entity application for resident and nonresident	85
business entities, as amended by the NAIC from time to time.	86

(V) "Exchange" means a health benefit exchange established by	87
the state government of Ohio or an exchange established by the	88
United States department of health and human services in	89
accordance with the "Patient Protection and Affordable Care Act,"	90
124 Stat. 119, 42 U.S.C. 18031 (2011).	91

Sec. 3905.47. (A)(1) No agent shall sell, solicit, or	92
negotiate insurance through an exchange on or after January 1,	93
2014, without first completing training approved by the	94
superintendent of insurance in accordance with division (B) of	95
this section.	96

(2) Any agent that sells, solicits, or negotiates insurance	97
through an exchange shall complete continuing education, as	98
required by the superintendent in accordance with division (B) of	99
this section, as applicable.	100

(B) The superintendent shall approve courses to be used for	101
compliance with division (A) of this section. Division (B) of this	102
section may be satisfied by those continuing education courses	103
approved by the superintendent under sections 3905.481 to 3905.486	104
of the Revised Code. Any course the superintendent approves shall	105
consist of topics related to insurance offered within an exchange,	106
including all of the following:	107

(1) The levels of coverage provided in an exchange;

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(2) The eligibility requirements for individuals to purchase	109
insurance through an exchange;	110

(3) The eligibility requirements for employers to make	111
insurance available to their employees through a small business	112
health options program;	113

(4) Individual eligibility requirements for medicaid;

114

(5) The use of enrollment forms used in an exchange;

115

(6) Any other topics as required by the superintendent.

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(C) The superintendent shall certify an agent who	117
successfully completes the courses approved by the superintendent.	118

(D) An individual who receives a resident insurance agent	119
license under section 3905.06 of the Revised Code and that is	120
certified under this section shall submit to the exchange the	121
individual's name, business address, telephone number, electronic	122
mail address, and any other information required by the exchange.	123

Sec. 3905.471. (A) A navigator may do any of the following:

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(1) Conduct public education activities to raise awareness of	125
the availability of qualified health plans;	126

(2) Distribute fair and impartial general information	127
concerning enrollment in all qualified health plans offered within	128
the exchange and the availability of the premium tax credits under	129
section 36B of the Internal Revenue Code of 1986, 26 U.S.C. 36B,	130
and cost-sharing reductions under section 1402 of the Affordable	131
Care Act;	132

(3) Facilitate enrollment in qualified health plans, without	133
suggesting that an individual select a particular plan.	134

(B) A navigator shall not do any of the following, unless	135
that navigator is otherwise licensed to do so under this chapter:	136

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

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(2) Enroll an individual or employee in a qualified health	138
plan offered through an exchange;	139

(3) Assist or provide information to an individual or entity	140
seeking to purchase health insurance through the small business	141
health options program portion of an exchange.	142

(C) An individual, or an individual performing navigator	143
duties on behalf of an organization serving as a navigator, shall	144
not act in the capacity of a navigator unless the individual has	145
met all of the following requirements, as applicable:	146

(1) Is at least eighteen years of age;

147

(2) Has completed and submitted the disclosure form required	148
under division (D)(2) of this section and has declared, under	149
penalty of refusal, suspension, or revocation of the navigator's	150
certification, that the statements made in the form are true,	151
correct, and complete to the best of the applicant's knowledge and	152
belief;	153

(3) Has completed a criminal records check under section	154
3905.051 of the Revised Code, as required by the superintendent;	155

(4) Has successfully completed the certification and training	156
requirements adopted by the superintendent in accordance with	157
division (D) of this section;	158

(5) Has paid all fees required by the superintendent.

159

(D) The superintendent of insurance shall, prior to any	160
exchange becoming operational in this state, do all of the	161
following:	162

(1)(a) Adopt rules to establish a certification and training	163
program for a prospective navigator and the navigator's employees	164
that includes screening via a criminal records check performed in	165
accordance with section 3905.051 of the Revised Code, initial and	166
continuing education requirements, and an examination;	167

(b) The certification and training program shall include	168
training on compliance with the "Health Insurance Portability and	169
Accountability Act of 1996," 110 Stat. 1955, 42 U.S.C. 1320d, et	170
seq., as amended, training on ethics, and training on provisions	171
of the Affordable Care Act relating to navigators and exchanges.	172

(2) Develop a disclosure form by which a navigator may	173
disclose any potential conflicts of interest, as well as any other	174
information the superintendent considers pertinent.	175

(E)(1) The superintendent may suspend, revoke, or refuse to	176
issue or renew the navigator certification of any person that has	177
committed any act that would be a ground for denial, suspension,	178
or revocation of an insurance agent license, as prescribed in	179
section 3905.14 of the Revised Code.	180

(2) The superintendent shall not certify as a navigator, and	181
shall revoke any existing navigator certification of, any	182
individual, organization, or business entity that is receiving	183
financial compensation, including monetary and in-kind	184
compensation, gifts, or grants, on or after October 1, 2013, from	185
an insurer offering a qualified health benefit plan through an	186
exchange operating in this state.	187

(F) Navigators are subject to the laws of this chapter, and	188
any rules adopted pursuant to the chapter, in so far as such laws	189
are applicable.	190

(G) The superintendent may deny, suspend, approve, renew, or	191
revoke the certification of a navigator if the superintendent	192
determines that doing so would be in the interest of Ohio insureds	193
or the general public. Such an action is not subject to Chapter	194
119. of the Revised Code.	195

(H) The superintendent may adopt rules in accordance with	196
Chapter 119. of the Revised Code to implement sections 3905.47 to	197
3905.473 of the Revised Code.	198

(I) Any fees collected under this section shall be paid into	199
the state treasury to the credit of the department of insurance	200
operating fund created under section 3901.021 of the Revised Code.	201

Sec. 3905.472. An exchange shall permit an insurer to offer	202
any health benefit plan that the insurer seeks to offer through	203
the exchange, so long as the health benefit plan in question is a	204
qualified health plan under the Affordable Care Act, as approved	205
by the superintendent of insurance.	206

Sec. 3905.473. (A) An exchange operating in this state shall	207
maintain a current list of both of the following:	208

(1) Licensed insurance agents that have met all of the	209
requirements necessary to sell insurance through an exchange;	210

(2) Individuals or entities that are not licensed insurance	211
agents that have met all the requirements to be certified by the	212
superintendent as a navigator.	213

(B) An exchange shall make available to an individual upon	214
request a list of insurance agents operating near the individual's	215
residence address that are certified to sell a health benefit plan	216
through an exchange and navigators that are certified under	217
section 3905.471 of the Revised Code. An exchange operating in	218
this state shall maintain a means of communication by which an	219
individual may make such a request.	220

(C) Any web site, software application, or other electronic	221
medium, or an exchange-sanctioned outreach event that enables a	222
consumer to determine eligibility for and to purchase a qualified	223
health plan through an exchange shall include information on how	224
an individual can obtain from an exchange the contact information	225
of insurance agents operating near the individual's residence	226
address that are certified to sell health benefit plans through an	227
exchange and navigators that are certified under section 3905.471	228
of the Revised Code.	229

Section 2.  That existing section 3905.01 of the Revised Code	230
is hereby repealed.	231