Agents Navigators Assisters in Ohio

Prior to Obamacare, only licensed insurance agents were able to sell or enroll people in health insurance products.

Starting 10/1/13, Navigators and Assisters will also be involved.

Here is a breakdown from the National Association of Health Underwriters that describes what each of these categories can do.

This is specific to Ohio:

Who can sell on the Exchange/Marketplace in Ohio?

  • Only licensed agents and brokers may sell, solicit, or negotiate a contract of health insurance.
  • Only licensed agents and brokers may recommend a particular product, or option, to a consumer.
  • Within the Exchange/Marketplace Agents and Brokers are required to provided unbiased information and comparisons of plans.

What is required to be an Agent in Ohoi?

  • Active State of Ohio Health Insurance License
  • Current appointment with all carriers they are writing
  • Complete Exchange training

What is a Navigator?

Under Ohio Law (H.B.3):

Navigator can: (1) conduct public education activities and raise awareness of  availability of Qualified Health Plans; (2) distribute fair and impartial general
information concerning enrollment in all QHPs and availability of premium tax credits and cost-sharing reductions; (3) Facilitate enrollment in QHPs, without
suggesting that an individual select a particular plan; (4) May provide information related to Medicaid eligibility.

Navigator cannot: (1) Sell, solicit or negotiate health insurance; (2) Provide advise concerning substantive benefits, terms or conditions of a plan or offer
advice about which plan is better or worse or suitable for a particular individual or entity; (3) Recommend a particular plan or advise consumers about which plan to
choose; (4) Provide any information or services related to plans or products not offered in an Exchange; (5) Engage in any unfair method of competition or any
fraudulent, deceptive, or dishonest act or practice.

5 Navigator Grants have been given in Ohio in 2013 totaling over $3 Million.  The grants went to:

  • Ohio Association of Food Banks
  • Children’s Hospital Medical Center (out)
  • Clermont Recovery Center, Inc
  • Helping Hands Community Outreach Center
  • Neighborhood Health Association

More about Navigators:

  •  Navigators do not receive commissions – their funding mechanism is via the Federal grants in 2014
  • Structured as a cooperative agreement – Performance period is up to 12 months from the date of the award and future awards funded by the exchange/marketplace
  • Navigators will be required to annually recertify
  • Navigator includes the organization receiving the grant and certification plus each person designated to perform navigator duties
  • Navigators DO NOT carry errors and omissions coverage

Certified Application Counselors:

  • On July 17, 2013 CMS issued a final rule at 45 CFR 155.225 introducing a separate class of Certified Application Counselors (CACs), such as community health centers, health care providers  and entities, and community-based organizations, to assist consumers with enrolling in coverage through the Marketplace.
  • Certified Application Counselors will be designated by the Marketplace to provide the same application assistance that is available from Navigators, but will not be funded through the Marketplace. However, the conflict of interest provisions that apply to navigators do not apply to CACs.
  • Certified Application Counselors must complete the CMS Exchange Training
    Certified Application Counselors do not receive commissions
  • Certified Application Counselors receive grants from states or other organizations
  • Certified Application Counselors will be required to annually recertify
  • Certified Application Counselors DO NOT carry errors and omissions coverage

Source: National Association of Health Underwriters


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