Guide license required

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  1. (a)

    1. (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. (2) A health insurer or an affiliate of a health insurer is not an eligible entity.

  2. (b) A contract awarded to a guide is contingent on a person's:

    1. (1) Being licensed under this subchapter;

    2. (2) Becoming licensed under this subchapter by September 30, 2013, or within ninety (90) days after the receipt of funding; or

    3. (3) Employing a licensee that meets the requirements in subdivision (b)(1) or subdivision (b)(2) of this section.

  3. (c) A guide shall:

    1. (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. (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. (3) Ensure that information is provided in a way that simplifies choices and considers the individual needs of consumers;

    4. (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. (5) Provide information and services in a fair, accurate, and impartial manner that acknowledges other health programs;

    6. (6) Increase awareness of insurance options in a way that does not stigmatize qualified health plans;

    7. (7) Facilitate enrollment in qualified health plans or coverage offered through a health insurance marketplace and with post-enrollment dispute resolution;

    8. (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. (9) Not receive any financial consideration directly or indirectly from a health insurer or stop-loss insurance company or qualified health plan;

    10. (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. (11) Provide resources or avenues for consumers to register complaints and grievances with a service provided through the health insurance marketplace.


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