(a) (1) A person shall not act as a guide in this state through a health insurance marketplace unless licensed under this subchapter as an eligible entity.
(2) A health insurer or an affiliate of a health insurer is not an eligible entity.
(b) A contract awarded to a guide is contingent on a person's:
(1) Being licensed under this subchapter;
(2) Becoming licensed under this subchapter by September 30, 2013, or within ninety (90) days after the receipt of funding; or
(3) Employing a licensee that meets the requirements in subdivision (b)(1) or subdivision (b)(2) of this section.
(c) A guide shall:
(1) Assist consumers in understanding the available qualified health plans offered through a health insurance marketplace, their differences, premium tax credits, cost-sharing provisions, and the public programs and their eligibility;
(2) Provide enrollment information in a culturally and linguistically appropriate manner that meets the needs of the population being served by a health insurance marketplace in this state, including those individuals with limited English proficiency or who are protected under section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794 and Title II of the Americans with Disabilities Act of 1990, 42 U.S.C. §§ 12131-12165, as they existed on January 1, 2013;
(3) Ensure that information is provided in a way that simplifies choices and considers the individual needs of consumers;
(4) Maintain expertise in eligibility, enrollment, and public and private insurance specifications and conduct public education activities to raise awareness about the health insurance marketplace in this state;
(5) Provide information and services in a fair, accurate, and impartial manner that acknowledges other health programs;
(6) Increase awareness of insurance options in a way that does not stigmatize qualified health plans;
(7) Facilitate enrollment in qualified health plans or coverage offered through a health insurance marketplace and with post-enrollment dispute resolution;
(8) Provide referrals to an applicable office of health insurance consumer assistance or health insurance ombudsman established under section 2793 of the Public Health Service Act, 42 U.S.C. § 300gg et seq., as it existed on January 1, 2013, or any other appropriate state agency or agencies, for a consumer participating in enrollment with a grievance, complaint, or question regarding his or her health plan, coverage, or a determination under the plan or coverage;
(9) Not receive any financial consideration directly or indirectly from a health insurer or stop-loss insurance company or qualified health plan;
(10) Demonstrate that no conflict of interest exists in providing in-person assistance and the services as stated in 45 C.F.R. § 155.210; and
(11) Provide resources or avenues for consumers to register complaints and grievances with a service provided through the health insurance marketplace.
Section: Previous 23-64-602 23-64-603 23-64-604 23-64-605 23-64-606 23-64-607 23-64-608 23-64-609 23-64-610 23-64-611 23-64-612 23-64-613 23-64-614 NextLast modified: November 15, 2016