Texas Adopts Rules for Health Insurance Exchange Navigators

February 10, 2014

The Texas Department of Insurance (TDI) issued final rules that it says will strengthen protections for consumers who seek assistance from federal health benefit exchange navigators.

The rules do not apply to licensed insurance agents.

Texas Insurance Commissioner, Julia Rathgeber
“These rules will help ensure Texans have confidence that anyone registered as a navigator has passed appropriate background checks and received the training they need to safeguard a consumer’s most sensitive and personal information,” Commissioner of Insurance Julia Rathgeber said in an announcement released by TDI.

For individual navigators who provide enrollment assistance in a health benefit exchange, the rules require background checks, training and proof of identity.

Entities that perform or oversee an individual’s performance of enrollment assistance in a health benefit exchange must provide evidence of financial responsibility.

Entities and individuals providing enrollment assistance are required to register with TDI. There is no fee to register.

Navigators have until March 1to register with TDI and until May 1 to complete the required 20 hours of preregistration education courses on:

  • Texas-specific Medicaid and Children’s Health Insurance Program provisions
  • Applicable privacy requirements
  • Ethics
  • Basic insurance terminology and how insurance works

Two hours of exam preparation are also required and one hour is alloted for the completion of a final examination.

The rules prohibit navigators while providing navigator services from:

  • Charging consumers for providing information about health coverage
  • Selling, soliciting, or negotiating health insurance coverage
  • Recommending a specific health benefit plan, and
  • Engaging in electioneering activities, or otherwise supporting the candidacy of an individual for government positions

The final rules apply to both federal grant recipients and other entities and individuals that may wish to provide federal benefit exchange enrollment assistance.

Texas Insurance Code provisions related to privacy and protection of personal information would also apply to navigators.

The final rules were submitted to the Texas Register for publication on Feb. 7.