MISSISSIPPI LEGISLATURE
2015 Regular Session
To: Insurance
By: Senator(s) Hill
AN ACT TO PROVIDE THAT A PERSON MAY NOT ACT OR CLAIM TO BE A NAVIGATOR OR CERTIFIED APPLICATION COUNSELOR UNDER FEDERAL LAW TO ASSIST INDIVIDUALS IN OBTAINING HEALTH INSURANCE THROUGH A HEALTH BENEFIT EXCHANGE UNLESS THAT PERSON HAS A LICENSE; TO PRESCRIBE DEFINITIONS AND REQUIREMENTS FOR SUCH LICENSURE TO BE ISSUED BY THE MISSISSIPPI DEPARTMENT OF INSURANCE; TO PROVIDE FOR ENFORCEMENT OF VIOLATIONS OF THIS ACT BY THE MISSISSIPPI DEPARTMENT OF INSURANCE AND TO AUTHORIZE RULES AND REGULATIONS FOR THE ENFORCEMENT OF THIS ACT; TO PROVIDE EXEMPTIONS; TO PROVIDE FOR CRIMINAL HISTORY RECORDS CHECKS; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Definitions. In this act, unless the context otherwise requires:
(a) "Certified application counselor" means an individual who is licensed pursuant to this act and who is authorized by the United States Department of Health and Human Services to perform the activities and duties of a certified application counselor as described by 45 Code of Federal Regulations Section 155.225.
(b) "Exchange" means a health benefit exchange that is established or operated by the Secretary of the United States Department of Health and Human Services pursuant to 42 United States Code 3 Section 18031.
(c) "Health Benefit Plan:
(i) Means a hospital and medical service corporation policy or certificate, a health care services organization contract or certificate of coverage, an individual or group or blanket disability policy or certificate of coverage, a certificate of insurance of a group disability policy that is not issued in this state. A multiple employer welfare arrangement or any other arrangement under which health services or health benefits are provided to one or more individuals.
(ii) Does not include:
1. An insurance policy that is designed, advertised and marketed to supplement major medical insurance, which includes accident only, vision only, disability income only, fixed or hospital indemnity, specified disease insurance, credit insurance or Taft-Hartley Trusts.
2. Coverage that is issued as a supplement to liability insurance.
3. Medicare Supplemental Insurance.
4. Workers' Compensation Insurance.
5. Automobile Medical Payment Insurance.
6. Long-Term Care Insurance.
(d) "Issuer" means a disability insurer, group disability insurer, blanket disability insurer, health care services, organization, hospital service corporation, medical service corporation, dental service corporation, prepaid dental plan organization or hospital, medical, dental and optometric service corporation.
(e) "Navigator" means a person who is licensed pursuant to this act and who is certified or compensated by the United States Department of Health and Human Services to perform the activities and duties described by 42 United States Code Section 18031 and 45 Code of Federal Regulations Section 155.215.
(f) "Department" means the Mississippi Department of Insurance.
SECTION 2. Scope and application of article. Beginning October 1, 2015, this act applies to a person who acts or claims to be a navigator or certified application counselor.
SECTION 3. License required. (a) A person may not act as or claim to be a navigator or certified application counselor unless the person is licensed pursuant to this act.
(b) An unlicensed person who knowingly performs any act for which the person is required to be licensed under this act is guilty of a misdemeanor punishable, upon conviction, by a fine of Twenty Thousand Dollars ($20,000.00) and imprisoned for not more than one (1) year.
SECTION 4. Navigators; licensing. (1) A person who applies for a navigator license shall apply to the Department of Insurance on a form prescribed by the department and shall declare under penalty of license denial, suspension or revocation that the statements made in the application are true, correct and complete to the best of the knowledge and belief of the applicant or the applicant's duly authorized representative. The applicant shall provide information concerning the applicant's identity, personal history, business record and experience in insurance and any other pertinent fact the department requires.
(2) Before the department approves an individual's navigator application, the department shall find that the individual:
(a) Is at least eighteen (18) years of age;
(b) Has not committed any act that is a ground for license denial, suspension or revocation and has not been convicted of a misdemeanor involving fraud or dishonesty;
(c) Has provided evidence of navigator certification from the United States Department of Health and Human Services;
(d) Has submitted a full set of fingerprints to the department and successfully completed a criminal history records check in a manner prescribed by the department; and
(e) Has identified the entity with which it is affiliated and supervised.
(3) A business entity that acts as a navigator, supervises the activities of individual navigators or receives funding to perform navigator activities shall obtain a navigator entity license. Before the department approves a business entity's navigator application, the department shall find that the business entity:
(a) Has not committed any act that is a ground for license denial, suspension or revocation and has not been convicted of a misdemeanor involving fraud or dishonesty.
(b) Has designated an individually licensed navigator who is responsible for the business entity's compliance with the insurance laws of this state.
(4) A business entity's navigator application shall also include the names of all members, officers and departments of the business entity. For any individual who is identified pursuant to this subsection, the department may require the applicant to provide the information required for a license as an individual.
(5) The Department of Insurance shall submit the fingerprints received pursuant to subsection (2) of this section to the Department of Public Safety for the purpose of obtaining a state and federal criminal records check pursuant to Public Law 92-544. The Department of Public Safety may exchange the fingerprint data it receives pursuant to this subsection with the Federal Bureau of Investigation.
(6) Unless the person is licensed pursuant to this act, a navigator may not:
(a) Sell, solicit or negotiate insurance in this state for any class or classes of insurance;
(b) Recommend, endorse or offer opinions about the benefits, terms and features of a particular health benefit plan or offer an opinion about which health benefit plan is better or worse for a particular individual or employer;
(c) Provide any information or services related to a health benefit plan or another product not offered in the exchange; or
(d) Engage in any unfair method of competition or any fraudulent, deceptive or dishonest act or practice.
(7) The expiration date for a navigator license issued to a person who also holds a license pursuant to this act is the same as the expiration date for the insurance producer license.
SECTION 5. Certified application counselors; licensing. (1) An individual who applies for a certified application counselor license shall apply to the department on a form prescribed by the department and shall declare under penalty of license denial, suspension or revocation that the statements made in the application are true, correct and complete to the best of the knowledge and belief of the applicant or the applicant's duly authorized representative. The applicant shall provide information concerning the applicant's identity, personal history, business record and experience in insurance and any other pertinent fact the department requires.
(2) Before the department approves an individual's certified application counselor application, the department shall find that the individual:
(a) Is at least eighteen (18) years of age;
(b) Has not committed any act that is a ground for license denial, suspension or revocation and has not been convicted of a misdemeanor involving fraud or dishonesty;
(c) Has met the standards and provided evidence of certification as prescribed by 45 Code of Federal Regulations Section 155.225;
(d) Has submitted a full set of fingerprints to the department and successfully completed a criminal history records check in a manner prescribed by the department; and
(e) Has identified the entity with which the individual is affiliated and supervised.
(3) The Department of Insurance shall submit the fingerprints received pursuant to subsection (2) of this section to the Department of Public Safety for the purpose of obtaining a state and federal criminal records check pursuant to this section and Public Law 92-544. The Department of Public Safety may exchange the fingerprint data it receives pursuant to this subsection with the Federal Bureau of Investigation.
(4) Unless the person is licensed pursuant to this act, a certified application counselor may not:
(a) Sell, solicit or negotiate insurance in this state for any class or classes of insurance;
(b) Recommend, endorse or offer opinions about the benefits, terms and features of a particular health benefit plan or offer an opinion about which health benefit plan is better or worse for a particular individual or employer;
(c) Provide any information or services related to a health benefit plan or another product not offered in the exchange; or
(d) Engage in any unfair method of competition or any fraudulent, deceptive or dishonest act or practice.
(5) The expiration date for a certified application counselor license issued to a person who also holds a license pursuant to this act is the same as the expiration date for the insurance producer license.
SECTION 6. Enforcement; rules. (1) The department may examine and investigate the business affairs and records of any navigator or certified application counselor to determine whether the individual or entity has engaged or is engaging in any violation of this act.
(2) The Commissioner of Insurance, acting through the department, may adopt rules to carry out this act.
SECTION 7. Exemptions. (1) The following persons are exempt from the provisions of this act when engaged in the regular course of their respective businesses:
(a) Attorneys-at-law.
(b) A person regularly employed on a regular wage or salary in the capacity of credit person or a similar capacity, except as an independent contractor.
(c) Banks, including trust departments of a bank, fiduciaries and financing and lending institutions.
(d) Common carriers.
(e) Title insurers, title insurance agents and abstract companies while doing an escrow business.
(f) Licensed real estate brokers.
(g) Substation payment offices employed by or serving as independent contractors for public utilities.
(h) A participant in a finance transaction in which a lender receives the right to collect commercial claims due the borrower by assignment, by purchase or by the taking of a security interest in those commercial claims.
(i) An accounting, bookkeeping or billing service provider that complies with all of the following:
(i) Does not accept accounts that are contractually past due at the time of receipt.
(ii) Does not initiate any contact with individual debtors except for the initial written notice of the amount owing and one (1) written follow-up notice.
(iii) Does not give or send to any debtor a written communication that requests or demands payment.
(iv) Does not receive or have access to monies paid by debtors or their insurers.
(v) All communications with the debtors are done in the name of the creditor.
(j) A person collecting claims owed, due or asserted to be owed or due to a financial institution the deposits of which are insured by an agency of the federal government, or any affiliate of the financial institution, if the person is related by common ownership or affiliated by corporate control with the financial institution and collects the claims only for the financial institution or any affiliate of the financial institution.
(k) A person who is a licensed insurance agent and who is authorized to collect premiums under an insurance policy financed by a premium finance agreement.
(2) For the purposes of subsection (1), subparagraph (h) of this section:
(a) A transaction shall not be deemed a finance transaction if the primary purpose is to facilitate the collection of claims.
(b) Commercial claim does not include an account arising from the purchase of a service or product intended for personal, family or household use.
(3) For the purposes of subsection (1), paragraph (ii), subparagraph (i) of this section, the initial written notice and follow-up notice may contain only the following information:
(a) The name, address and telephone and telefacsimile numbers of the creditor.
(b) The amount due and an itemization of that amount.
(c) The date payment is due.
(d) The address or place where payment is to be made.
(e) If the payment is past due, that payment is past due.
(4) For a person who is exempt under this section, the department shall investigate complaints of residents of this state relating to any violations of this act, may examine the books, accounts, claims and files of a person that relate to the complaint.
SECTION 8. This act shall take effect and be in force from and after July 1, 2015.