Chapter 13. Application Counselor Training and Certification Standards
Regulation .01 Scope.LinkCopy Citation
This chapter sets forth the qualifications, training, and certification standards for an agent, employee, or volunteer of an application counselor sponsoring entity who applies to receive an application counselor certification and is required under Insurance Article, §31-113(r)(1)(ii), Annotated Code of Maryland, to hold an application counselor certification to provide the services set forth below.
Regulation .02 Definitions.LinkCopy Citation
A.
In this subtitle, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Applicant” means a community-based organization, health care provider, unit of State or local government, or other entity applying for designation as an application counselor sponsoring entity.
(2)
“Application counselor sponsoring entity” or “sponsoring entity” has the meaning set forth in Insurance Article, §31-101(a-2), Annotated Code of Maryland.
(3)
“Certified application counselor” has the meaning set forth in Insurance Article, §31-101(a-1), Annotated Code of Maryland.
(4)
“Commissioner” means the Maryland Insurance Commissioner.
(5)
“Consolidated Services Center” has the meaning set forth in Insurance Article, §31-101(c-2), Annotated Code of Maryland.
(6)
“Individual Exchange connector entity” has the meaning set forth in Insurance Article, §31-101(k), Annotated Code of Maryland.
(7)
“Individual Exchange navigator” has the meaning set forth in Insurance Article, §31-101(i), Annotated Code of Maryland.
(8)
“Insurance affordability programs” has the meaning set forth in 42 CFR §435.4.
(9)
“Maryland Health Benefit Exchange” has the meaning set forth in Insurance Article, §31-101(e), Annotated Code of Maryland.
Regulation .03 Eligibility Requirements.LinkCopy Citation
To qualify for an application counselor certification, an applicant shall:
A.
Be of good character and trustworthy;
B.
Be at least 18 years old;
C.
Be an agent, employee, or volunteer of an application counselor sponsoring entity;
D.
Not be an Individual Exchange navigator;
E.
Enter into a formal written agreement with an application counselor sponsoring entity agreeing to comply with the provisions of this chapter and 45 CFR §155.225;
F.
Successfully complete and comply with any ongoing requirements of the training program set forth under Regulation .06 of this chapter;
G.
Complete and submit to the Maryland Health Benefit Exchange an application counselor application set forth under Regulation .05 of this chapter;
H.
Agree to comply with the requirements set forth in the application counselor application; and
I.
Comply with any applicable requirements of the Maryland Department of Health and the Commissioner.
Regulation .04 Scope of Authority.LinkCopy Citation
A.
A certified application counselor may:
(1)
Provide information to consumers about the full range of qualified health plan and qualified dental plan options and insurance affordability programs, including advance premium tax credits and cost-sharing subsidies, the Maryland Medical Assistance Program, and the Maryland Children’s Health Program, for which they are eligible;
(2)
Assist consumers with the application process for determining eligibility for insurance affordability programs, including advance premium tax credits and cost-sharing subsidies, the Maryland Medical Assistance Program, and the Maryland Children’s Health Program;
(3)
Facilitate plan selection and enrollment of eligible individuals in qualified health plans, qualified dental plans, and access to advance premium tax credit and other cost-sharing subsidies; and
(4)
Provide to consumers uniform, factual, and unbiased information approved by the Maryland Medical Assistance Program about all participating managed care organizations, including report cards, lists of enhanced benefits and covered services, and participating providers.
B.
A certified application counselor may not express a personal or professional assessment about which Maryland Medical Assistance Program/Maryland Children’s Health Program managed care organization may be most appropriate for an eligible individual, may not make a managed care organization selection on the applicant’s behalf, and may not otherwise counsel an applicant about the selection of a managed care organization.
C.
If a Maryland Medical Assistance Program/Maryland Children’s Health Program eligible consumer seeks further counseling or additional assistance in choosing a managed care organization, a certified application counselor shall refer the consumer to the Consolidated Services Center or a local agency caseworker.
D.
A certified application counselor may not concurrently hold an Individual Exchange navigator certification.
Regulation .05 Application Procedures.LinkCopy Citation
A.
In order to obtain an application counselor certification, the applicant shall submit to the Maryland Health Benefit Exchange:
(1)
An application, on the form approved by the Maryland Health Benefit Exchange in consultation with the Commissioner and the Maryland Department of Health;
(2)
An attestation that the applicant will notify the Maryland Health Benefit Exchange of any changes to information that the applicant provides or to which the applicant attests on the application form within 30 days of such change;
(3)
An attestation that the applicant will not impose a fee on individuals to whom the applicant provides services;
(4)
An attestation that the applicant will disclose to the Maryland Health Benefit Exchange, the application counselor sponsoring entity, and individuals to whom the applicant provides services any relationships the applicant has with a carrier, an insurance producer, a third-party administrator, or a managed care organization that participates in the Maryland Medical Assistance Program/Maryland Children’s Health Program, as well as other potential conflicts of interest;
(5)
An attestation that the applicant will act in the best interest of the individuals for whom the applicant is authorized to provide services;
(6)
An attestation that the applicant will not receive compensation from a carrier, insurance producer, managed care organization or third-party administrator for application counselor services;
(7)
An attestation that the applicant will not receive compensation from the Maryland Health Benefit Exchange;
(8)
An attestation that the applicant will accept compensation for application counselor-related duties only from its application counselor sponsoring entity, as approved by the Maryland Health Benefit Exchange in consultation with the Commissioner and the Maryland Department of Health;
(9)
An attestation that the applicant will not provide monetary or other financial incentives to individuals to apply for health insurance coverage through Maryland Health Connection;
(10)
An attestation that the applicant will comply with the oversight plan adopted by its application counselor sponsoring entity approved by the Maryland Health Benefit Exchange, in consultation with the Commissioner and the Maryland Department of Health;
(11)
An attestation that the applicant will comply with all State requirements, restrictions, and conflict of interest rules applicable to Individual Exchange navigators;
(12)
An attestation that the applicant will comply with the required agreement set forth under Regulation .03A(5) of this chapter;
(13)
An attestation that the applicant will comply with all applicable federal and State privacy and security standards;
(14)
An attestation that the applicant will operate within the applicant’s scope of authority and ensure that he or she complies with the requirements set forth under Regulation .04 of this chapter;
(15)
An attestation that the applicant will comply with any applicable requirements of the Maryland Department of Health and the Commissioner;
(16)
An application fee if permitted by law and in the manner specified by the Maryland Health Benefit Exchange; and
(17)
Evidence that the applicant has successfully completed the Maryland Health Benefit Exchange application counselor certification training program specified under COMAR 14.35.02.04A and passed the examination specified under COMAR 14.35.02.04D.
B.
The Exchange may not consider an application to be complete until it has received all required materials.
C.
If the application is not completed with all required materials within 45 days after the Maryland Health Benefit Exchange receives the signed application form, the Maryland Health Benefit Exchange will reject the application.
Regulation .06 Training Requirements.LinkCopy Citation
In order to obtain application counselor certification, an individual shall meet the training and examination requirements specified under COMAR 14.35.02.04.
Regulation .07 Term.LinkCopy Citation
An application counselor certification expires 2 years after the date it is issued unless it is renewed.
Regulation .08 Renewal.LinkCopy Citation
A.
Notice.
(1)
At least 60 days before the expiration of an application counselor certification, the Maryland Health Benefit Exchange shall notify the application counselor using the address on file, including email address, with the Maryland Health Benefit Exchange, of the expiration date of an application counselor certification.
(2)
The notification shall include:
(a)
A renewal application;
(b)
The date by which the Maryland Health Benefit Exchange must receive the renewal application for the renewal to be issued before the certification expires; and
(c)
The amount of any renewal fee.
B.
Eligibility for Renewal. An application counselor certification may be renewed for an additional 2-year term if the holder:
(1)
Is otherwise entitled to receive application counselor certification, in accordance with the eligibility requirements set forth under Regulation .03 of this chapter;
(2)
Files a timely renewal application on the form approved by the Maryland Health Benefit Exchange, either by mail or electronically;
(3)
Pays to the Maryland Health Benefit Exchange a renewal fee to the extent permitted by law and in the manner specified by the Maryland Health Benefit Exchange; and
(4)
Has completed the education requirements set forth under COMAR 14.35.03.02B(4), 14.35.03.02C, and 14.35.03.02D, where determined to be applicable by the Maryland Health Benefit Exchange.
Regulation .09 Suspension or Revocation.LinkCopy Citation
A.
The Commissioner may suspend or revoke an application counselor certification for any reason set forth under Insurance Article, §31-113(l)(1), Annotated Code of Maryland, made applicable to application counselors pursuant to Insurance Article, §31-113(r), Annotated Code of Maryland, or for any reason set forth under 45 CFR §155.225.
B.
An application counselor’s certification is automatically suspended if his or her application counselor sponsoring entity’s designation expires or is withdrawn by the Maryland Health Benefit Exchange.
C.
An application counselor’s certification that has been suspended under §B of this regulation may be reinstated if the application counselor becomes an agent, employee, or volunteer of another application counselor sponsoring entity with a valid designation and executes the agreement required under Regulation .03A(5) of this chapter.
Chapter annotations
Authority: Insurance Article, §§31-106 and 31-113(r), Annotated Code of Maryland
History: Effective date: June 8, 2015 (42:11 Md. R. 726)
History: Chapter revised effective June 15, 2020 (47:12 Md. R. 597)
History: Regulation .06 amended effective August 18, 2025 (52:16 Md. R. 848)