Chapter 16. SHOP Exchange Navigators — Licensing
Regulation .01 Purpose.LinkCopy Citation
The purpose of this chapter is to establish certain requirements that must be satisfied in order to qualify for a SHOP Exchange navigator license.
Regulation .02 Applicability.LinkCopy Citation
This chapter applies to any person seeking to act as a SHOP Exchange navigator.
Regulation .03 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meaning indicated.
B.
Terms Defined.
(1)
“Administration” means the Maryland Insurance Administration.
(2)
“Applicant” means a person who is applying for a SHOP Exchange navigator license.
(3)
“Application” means a written request for a license in a form approved by the Commissioner.
(4)
“Commissioner” means the Maryland Insurance Commissioner.
(5)
“Effective Date” means the date on which a license takes effect.
(6)
“Examination” means the written pre-licensing examination given under the authority of the Commissioner pursuant to Insurance Article, §31-112(d), Annotated Code of Maryland.
(7)
“License” means a SHOP Exchange navigator license.
(8)
“Licensee” means a SHOP Exchange navigator.
(9)
“Maryland Health Benefit Exchange” means the public corporation established under Insurance Article, §31-102, Annotated Code of Maryland.
(10)
“SHOP Exchange” has the meaning set forth in Insurance Article, §31-101(w), Annotated Code of Maryland.
(11)
“SHOP Exchange navigator” has the meaning set forth in Insurance Article, §31-101(x), Annotated Code of Maryland.
(12)
“SHOP Exchange navigator license” has the meaning set forth in Insurance Article, §31-101(y), Annotated Code of Maryland.
(13)
“Training Program” means the educational program offered to an applicant by the SHOP Exchange that must be completed subject to Insurance Article, §31-112(c)(2)(v), Annotated Code of Maryland.
Regulation .04 Licensing Requirements.LinkCopy Citation
A.
Before a person may act as a SHOP Exchange navigator in the State, the person shall obtain a license issued by the Commissioner.
B.
To qualify for a license, an applicant:
(1)
Shall be at least 18 years of age;
(2)
Shall successfully complete the training program;
(3)
Shall complete and pass both sections of the examination;
(4)
Shall submit an application and any additional information the Commissioner deems necessary to the Administration;
(5)
Shall pay to the Administration initial license and application fees if permitted by law;
(6)
Shall be of good character and trustworthy; and
(7)
May not have committed any act the Commissioner finds would warrant suspension or revocation of a license under Insurance Article, §31-112(e), Annotated Code of Maryland.
Regulation .05 Examination.LinkCopy Citation
A.
To qualify to take the examination, an applicant must submit evidence of successful completion of the training program.
B.
The examination shall be:
(1)
Divided into a State-specific section and a general section;
(2)
Based on a content outline that is approved by the Commissioner in consultation with the Maryland Health Benefit Exchange;
(3)
Reviewed by the Commissioner on a periodic basis, in consultation with the Maryland Health Benefit Exchange, to ensure that it accurately measures an applicant’s competency in the required areas of knowledge;
(4)
In writing, but may be administered electronically to an applicant;
(5)
Conducted in specified locations throughout the State which have been approved by the Commissioner;
(6)
Conducted in facilities that comply with the Americans with Disabilities Act of 1990 as amended by 42 U.S.C. §12101, et seq.; and
(7)
Administered quarterly, or more frequently if deemed appropriate by the Commissioner.
C.
Each section of the examination shall be scored separately.
D.
The Commissioner shall establish a minimum passing score, in consultation with the Maryland Health Benefit Exchange, for each section of the examination.
E.
An applicant who fails a single section of the examination may retake the failed section of the examination within 1 year of the initial examination date. If the applicant does not pass the failed section within that time, the applicant must retake both sections of the examination to be eligible to pass the examination. The examination may be taken no more than three times in a 6-week period.
Regulation .06 Changes to Information in the Application.LinkCopy Citation
A.
Within 30 days after a change to any information in an initial or renewal application, a licensee shall file with the Commissioner, in a form required by the Commissioner, the change in information.
B.
If a licensee fails to timely file with the Commissioner a change to the information specified in §A of this regulation, the licensee is in violation of Insurance Article, §31-112(e)(1)(i), Annotated Code of Maryland.
Regulation .07 License Term.LinkCopy Citation
A.
An initial license expires on the last day of the licensee’s birth month following the second anniversary of the effective date of the initial license.
B.
A renewal license expires on the second anniversary of its effective date.
Regulation .08 License Renewal.LinkCopy Citation
A.
To qualify to renew a license, a licensee:
(1)
Shall submit to the Commissioner a renewal application approved by the Commissioner;
(2)
Shall pay a license renewal fee if permitted by law;
(3)
Shall submit to the Commissioner any additional information the Commissioner deems necessary;
(4)
Shall complete the continuing education requirements as set forth in §A(7) of this regulation;
(5)
Shall be of good character and trustworthy;
(6)
May not have committed any act the Commissioner finds would warrant suspension or revocation of a license under Insurance Article, §31-112(e), Annotated Code of Maryland;
(7)
Shall complete 16 credit hours of continuing education during the prior license period as approved by the Administration in consultation with the Maryland Health Benefit Exchange. The credit hours shall include the following:
(a)
A minimum of 9 credit hours in health insurance; and
(b)
A minimum of 3 credit hours in ethics;
(8)
Shall have paid all undisputed taxes and unemployment insurance contributions payable to the Comptroller of Maryland and the Secretary of Labor or have provided for payment in a manner satisfactory to the unit responsible for collection; and
(9)
Shall have paid any amount in arrears on an applicant’s child support obligation, if any, or have provided for payment in a manner satisfactory to the unit responsible for collection.
B.
A renewal application is considered timely filed if:
(1)
The application contains all of the required information;
(2)
The renewal license fee, if permitted by law, has been received by the Administration; and
(3)
The application is:
(a)
Mailed and postmarked on or before the expiration date of the license; or
(b)
Submitted electronically and received by an information processing system that the Administration has designated for the purpose of receiving electronic applications prior to the expiration date of the license.
C.
If, at least 2 calendar weeks before a license expires, the licensee makes sufficient application for renewal of the license, the license shall not expire until:
(1)
The Administration takes final action on the renewal application; and
(2)
The time for seeking judicial review of the action expires or any judicial stay of the Administration’s final action expires.
Regulation .09 Expired License Reinstatement.LinkCopy Citation
A.
An individual whose license has expired:
(1)
Is prohibited from acting as a SHOP Exchange navigator in the State; and
(2)
For up to 1 year after the expiration date of the license, may obtain reinstatement of the expired license by:
(a)
Submitting to the Commissioner a reinstatement application approved by the Commissioner;
(b)
Meeting all of the renewal requirements under Regulation .08(A) and (B) of this chapter; and
(c)
Paying to the Administration the reinstatement fee, if permitted by law.
B.
An individual who does not qualify for reinstatement under §A(2) of this regulation may apply for an initial license as described in Regulation .04 of this chapter.
C.
The Commissioner may waive the reinstatement procedures for a SHOP Exchange navigator who is unable to comply with the renewal and reinstatement procedures due to:
(1)
Military service; or
(2)
Other extenuating circumstances, including a long-term medical disability.
Chapter annotations
Authority: Insurance Article, §§2-109 and 31-112, Annotated Code of Maryland
History: Effective date: March 4, 2013 (40:4 Md. R. 348)