The guides do not have to be licensed agents or brokers, and they are prohibited from being employees of insurers, including stop-loss insurers, and cannot receive compensation from carriers. In addition, they can only distribute “fair and impartial information” to consumers regarding enrollment. HHS is charged with developing standards on that impartiality, as well as standards to avoid conflicts of interest among navigators, who must certify to exchanges they will abide by those standards.
“The navigator must not have a personal interest in the coverage choices made by individuals or employers who receive the navigator's assistance,” the rule states. “More specifically, with respect to the assistance offered by a navigator to a small employer, a navigator should not have a personal interest in whether a small employer chooses to self-insure its employees, or chooses to enroll in fully-insured coverage inside or outside the exchange.”
Navigators would also have to disclose what other lines of insurance that they intend on selling during their work, as well as any employment over the past five years they have had with a health insurance carrier. Current agents and brokers can also serve as navigators, though they cannot receive financial rewards from insurers for signing up consumers.
While state-run exchanges are not required to abide by the conflict-of-interest standards that apply to federally facilitated and partnership exchanges, HHS suggests the state-run exchanges use the standards as a guide when developing their own.
Navigators and other assistance personnel would have to be trained to inform consumers about cost-sharing reductions and tax credits that will help cover premiums, as well as help them submit information to see if they qualify for subsidies. The navigators also would have to be trained to help consumers with limited English proficiency and disabilities.
