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Who is Considered to be a Navigator?
"Navigator" means an individual or entity described in 42 U.S.C. § 1311 (i)(2) that is selected to perform the activities and duties identified in 42 U.S.C. § 18031 (i) in the Commonwealth. A "Navigator" does not include an individual or entity licensed as an agent under Chapter 18 (§ 38.2-1800 et seq.) of this title to sell, solicit, or negotiate contracts of insurance or annuity in the Commonwealth.
How do I Register as a Navigator?
Article 7 of Chapter 34 of Title 38.2 requires that no individual or entity shall act as a navigator in the Commonwealth, unless such individual or entity has been certified by the U.S. Department of Health and Human Services (HHS) and registered with the Bureau of Insurance (Bureau).
In accordance with Virginia Code §38.2-3459, a navigator’s registration shall terminate immediately when the navigator becomes decertified by HHS, whether or not the Commission has been notified of such decertification.
Individual applicants residing in Virginia are required to obtain a current CHRR from the Virginia State Police (VSP). If the applicant fails to provide a current CHRR (no more than 90 days old), the Bureau will refuse registration. Visit www.vsp.state.va.us to download the form (SP-167). When completing the form, have the report mailed back to the applicant; not to the Bureau. Attach the completed report to the application for registration.
Individual applicants not residing in Virginia are required to obtain a current CHRR (no more than 90 days old) from their home state of residence. Attach the completed report to the application for registration.
Apply for Navigator Registration
Does Virginia Register Certified Application Counselors (CAC)?
No, however, CAC’s must be registered through the U.S. Department of Health and Human Services (HHS).
Centers for Medicare & Medicaid Services (CMS) regulations require all navigators in the Federally Facilitated Marketplace (FFM) to complete training, on an annual basis, that has been approved by HHS, before being certified/recertified to carry out any required or authorized navigator functions. Furthermore, CMS regulations prohibit individuals from acting as a navigator or performing navigator duties in the FFM unless they are affiliated with a current CMS Navigator grantee and have a current certification that accurately reflects that affiliation, or they are themselves certified as a current CMS Navigator grantee.
Virginia does not have a state-run training program for navigators.
Standards of Conduct
Prohibited Activities (Virginia Code §38.2-3456):
A navigator shall not:
- Engage in any activity that would require an insurance agent license under this title;
- Offer advice about which qualified health plan or dental plan is better or worse for a particular individual or employer;
- Act as an intermediary between an employer and an insurer that offers a qualified health plan or dental plan offered through an exchange; or
- Violate any unfair trade practice and privacy requirements in §§38.2-502, 38.2-503, 38.2-506, 38.2-509, 38.2-512, 38.2-515, 38.2-612.1, 38.2-613, and 38.2-614 to the extent such requirements are applicable to the activities of navigators; or
- Receive compensation for services or duties as a navigator that are prohibited by federal law, including compensation from a health carrier.
An individual or entity shall not claim to be, or otherwise hold themselves out as, a navigator or conduct business as a navigator in the Commonwealth without:
- Being selected as a navigator in accordance with applicable federal law;
- Having evidence of successful completion of all navigator requirements prescribed by the Secretary; and
- Meeting requirements established pursuant to §38.2-3457.
- If an individual or entity has engaged in the Commonwealth in one or more of the prohibited activities identified in this section, a complaint may be filed with the Commission. The Commission, upon investigation and verification of the prohibited activity or activities, may order such individual or entity to cease and desist such prohibited conduct.
Pursuant to Virginia Code §38.2-3459 Bif a navigator is decertified by HHS, it must it be reported to the Bureau of Insurance.
- Pursuant to Virginia Code §38.2-3458 B each registered navigator shall report to the Commission within 30 calendar days the following:
- any action taken by the U.S. Department of Health and Human Services to decertify the navigator;
- upon conviction of a felony, the facts and circumstances surrounding that conviction; and
- the disposition of the matter of any administrative action taken against the navigator in another jurisdiction or by another governmental agency in the Commonwealth.