Feds release rules for exchange ‘navigators’

(AP photo/Carolyn Kaster) (AP photo/Carolyn Kaster)

The Obama administration on Wednesday released a proposed rule outlining the standards for "navigators” who will help consumers shop for health insurance in new exchanges set up by the Patient Protection and Affordable Care Act.

Navigators are organizations that will provide unbiased information to consumers about health insurance, the new health exchanges, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.

“Navigators will be an important resource for consumers who want to learn about and apply for coverage in the new marketplace,” Centers for Medicare & Medicaid Services Acting Administrator Marilyn Tavenner said in a statement.

For those who are not familiar with health insurance, have limited English literacy, or living with disabilities, the administration says navigators will serve an “important role in ensuring people understand the health coverage options available to them.” Navigators will provide accurate and impartial assistance to consumers shopping for coverage plans in the new marketplace.

In regulations released Wednesday by the Department of Health and Human Services, navigators cannot select a plan for their clients and are not in charge of determining whether customers are eligible for federal subsidies.

They do, however, play an “important role in facilitating a consumer’s enrollment by providing fair, impartial and accurate information that assists consumers with submitting the eligibility application, clarifying the distinctions among qualified health plans, and helping qualified individuals make informed decisions during the health plan selection process.”

In its 63-page rule, HHS says “holding an agent or broker license is neither necessary, nor by itself sufficient, to perform the duties of a navigator, as these licenses generally do not address areas in which navigators need expertise, including the public coverage options that would be available to some consumers.”

Navigators also may not be paid by insurance companies.

In addition to navigators, consumers will have access to assistance through services such as a call center, where customer service representatives can provide referrals to the appropriate state or federal agencies, or other forms of assistance programs including in-person assistance personnel, certified application counselors and agents and brokers.

Open enrollment in exchanges begins Oct. 1, with coverage to begin Jan. 1, 2014.

The administration will take comments from interested parties and the public for 30 days.

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