Section 4515.70 Navigator, In-Person Counselor and Certified Application Counselor Prohibited Conduct

TITLE 50: INSURANCE

CHAPTER I: DEPARTMENT OF INSURANCE

SUBCHAPTER ww: HEALTH CARE SERVICE PLANS

PART 4515 NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR CERTIFICATION

SECTION 4515.70 NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR PROHIBITED CONDUCT

Section 4515.70  Navigator,

In-Person Counselor and Certified Application Counselor Prohibited Conduct

a)         A Navigator, In-Person Counselor, Certified

Application Counselor and Certified Application Counselor Organization may not:

1)         sell, solicit, or negotiate, as these terms

are defined in Section 500-10 of the Illinois Insurance Code, any of the

classes of insurance enumerated in Section 4 of the Illinois Insurance Code;

2)         offer advice about which health plan is

better or worse for a particular individual or employer;

3)         recommend or endorse a particular health

plan or advise consumers about which health plan to choose;

4)         provide any information or services related

to health benefit plans or other insurance products not offered in the

exchange, except for health care providers when furnishing information or

services related to a patient's existing health benefit plan or other existing

health insurance coverage;

5)         accept any compensation or consideration,

directly or indirectly, from any issuer of accident and health insurance or

stop-loss insurance that is dependent, in whole or in part, on whether a person

enrolls in or purchases a particular private health benefit plan; or

6)         engage in any unfair method of competition

or any fraudulent, deceptive or dishonest act or practice with respect to the

Marketplace or with respect to that individual's or entity's absence of a

conflict of interest in connection with the enrollment of any individuals or

employees in a particular private health benefit plan

n or purchases a particular private health benefit plan; or

6)         engage in any unfair method of competition

or any fraudulent, deceptive or dishonest act or practice with respect to the

Marketplace or with respect to that individual's or entity's absence of a

conflict of interest in connection with the enrollment of any individuals or

employees in a particular private health benefit plan.

b)         Subsections (a)(1) through (a)(5) do not

apply to Navigators, In-Person Counselors, Certified Application Counselors or

Certified Application Counselor Organizations when assisting individuals with

the enrollment process in the State Medicaid program or other public programs.

c)         A Navigator or In-Person Counselor may not:

1)         Be a health insurance issuer or issuer of

stop-loss insurance;

2)         Be a subsidiary of a health insurance

issuer or issuer of stop-loss insurance;

3)         Be an association that includes members of,

or lobbies on behalf of, the insurance industry; or

4)         Receive any consideration directly or

indirectly from any health insurance issuer or issuer of stop-loss insurance in

connection with the enrollment of any individuals or employees in a Qualified

Health Plan or Non-Qualified Health Plan.