Section 760IAC4-5-1. Conflict of interest policy

   (a) The commissioner shall, in consultation with the secretary, develop a conflict of interest policy concerning actual or potential conflicts of interest affecting navigators or application organizations.

  (b) A conflict of interest includes a conflict of loyalty or a financial interest, which are defined as follows:

(1) A conflict of loyalty exists when a navigator or application organization has, directly or indirectly, through business or family, an interest or relationship with a third party that prohibits or inhibits, or potentially prohibits or inhibits, the navigator or application organization from exercising independent judgment in the best interests of individuals the person assists or may assist with application for and enrollment in a QHP through a health benefit exchange or in a public health insurance program. A conflict of loyalty does not exist solely because a navigator or application organization is employed by a hospital that owns or is owned, in whole or in part, by an issuer.

(2) A financial interest exists if, as a result of an individual's health plan selection at issue, a navigator or application organization receives or may receive any consideration, compensation, or financial benefit, either directly or indirectly, from a third party as a condition of assisting individuals with application for and enrollment in a particular health plan as follows:

(A) A person that receives consideration, compensation, or financial benefit from a health insurance issuer (as defined in Section 2791 of the federal Public Health Service Act (42 U.S.C. 300gg-91)) in connection with application for and enrollment of an individual in a health plan is prohibited from serving as a navigator or application organization when receipt of such consideration, compensation, or financial benefit requires or otherwise influences the person to direct the individual towards a particular health plan.

(B) A navigator or application organization receiving grant funding through the federal navigator grant program provided under Section 1311(i)(6) of PPACA does not have a prohibited financial interest by reason of that compensation.

  (c) Navigators and application organizations shall do the following:

(1) Provide fair, accurate, and impartial information and assistance when assisting individuals with application for and enrollment in a QHP through a health benefit exchange or in a public health insurance program.

(2) Act in the best interests of the individuals whom they are assisting.

(3) Not allow any actual or potential conflict of interest to affect the assistance they provide to individuals.

(4) Agree to follow the department's conflict of interest policy.

(5) Disclose in writing all actual or potential conflicts of interest to the department on a form provided by the department.

(6) Disclose in writing all actual or potential conflicts of interest to individuals prior to assisting individuals with application for and enrollment in a QHP through a health benefit exchange or in a public health insurance program.

  (d) A navigator or application organization shall inform the department, on a form provided by the department, of a change in conflict of interest status or any new actual or potential conflict of interest no later than thirty (30) days after the change in status or new actual or potential conflict of interest arises.

  (e) If the commissioner determines that an actual or potential conflict of interest will prohibit a navigator or application organization from providing fair, accurate, and impartial information and assistance regarding application for and enrollment in a QHP through a health benefit exchange or in a public health insurance program, or prohibit the navigator or application organization from acting in the best interests of individuals whom they are assisting, the commissioner may:

(1) deny certification or registration;

(2) request that the navigator or application organization mitigate the circumstances creating the actual or potential conflict of interest; or

(3) request that the navigator or application organization cancel their certification or registration in a manner specified by the commissioner if the actual or potential conflict of interest is due to a change in conflict of interest status after certification or registration.

If a navigator or application organization does not comply with the commissioner's request to mitigate an actual or potential conflict of interest or cancel their certification or registration in a manner specified by the commissioner, the commissioner may initiate an enforcement action against the navigator or application organization under 760 IAC 4-7.

  (f) A navigator or application organization may appeal an action listed under subsection (e) pursuant to 760 IAC 4-7. (Department of Insurance; 760 IAC 4-5-1; filed Jun 10, 2016, 1:21 p.m.: 20160706-IR-760150033FRA)