[Rev. 11/21/2013 1:20:12
PM--2013]
CHAPTER 695J - PERSONS WHO FACILITATE
ENROLLMENT IN CERTAIN QUALIFIED HEALTH PLANS
NRS 695J.010 Definitions.
NRS 695J.020 “Appointment”
defined.
NRS 695J.030 “Assister”
defined.
NRS 695J.040 “Exchange”
defined.
NRS 695J.050 “Exchange
enrollment facilitator” defined.
NRS 695J.060 “Navigator”
defined.
NRS 695J.070 “Qualified
health plan” defined.
NRS 695J.100 Applicability.
NRS 695J.110 Application
for initial certificate as exchange enrollment facilitator: Requirements; fee.
NRS 695J.120 Application
for certificate as exchange enrollment facilitator: Form; fingerprints;
expiration of certificate.
NRS 695J.130 Fee
for examination; failure to appear.
NRS 695J.140 Renewal
of certificate; application; fees; waiver of time limit and fine or sanction.
NRS 695J.150 Payment
of child support: Statement by applicant for certificate; grounds for denial of
certificate; duty of Commissioner. [Effective until the date of the repeal of
42 U.S.C. § 666, the federal law requiring each state to establish procedures
for withholding, suspending and restricting the professional, occupational and
recreational licenses for child support arrearages and for noncompliance with
certain processes relating to paternity or child support proceedings.]
NRS 695J.160 Suspension
of certificate for failure to pay child support or comply with certain
subpoenas or warrants; reinstatement of certificate. [Effective until the date
of the repeal of 42 U.S.C. § 666, the federal law requiring each state to
establish procedures for withholding, suspending and restricting the
professional, occupational and recreational licenses for child support
arrearages and for noncompliance with certain processes relating to paternity
or child support proceedings.]
NRS 695J.170 Application
for certificate must include social security number of applicant. [Effective
until the date of the repeal of 42 U.S.C. § 666, the federal law requiring each
state to establish procedures for withholding, suspending and restricting the
professional, occupational and recreational licenses for child support
arrearages and for noncompliance with certain processes relating to paternity
or child support proceedings.]
NRS 695J.180 Contents
of certificate; holder to inform Commissioner of locations of business.
NRS 695J.190 Temporary
certificate as exchange enrollment facilitator.
NRS 695J.200 Natural
person authorized to act for entity appointed by Exchange required to be
exchange enrollment facilitator.
NRS 695J.210 Prohibited
acts.
NRS 695J.220 Responsibilities
of exchange enrollment facilitator.
NRS 695J.230 Nonresident
exchange enrollment facilitator.
NRS 695J.240 Disciplinary
action.
NRS 695J.250 Suspension,
limitation or revocation of certificate.
NRS 695J.260 Surrender
of certificate in absence or upon termination of appointment by Exchange.
NRS 695J.270 Regulations.
NRS 695J.280 Engaging
in business of exchange enrollment facilitator without certificate prohibited;
penalty.
_________
NRS 695J.010 Definitions. As
used in this chapter, unless the context otherwise requires, the words and
terms defined in NRS 695J.020 to 695J.070, inclusive, have the meanings ascribed to them
in those sections.
(Added to NRS by 2013, 3590)
NRS 695J.020 “Appointment” defined. “Appointment”
means a contract, agreement or other arrangement under which a person may act
on behalf of the Exchange as an assister, navigator or any other designation
authorized or required by the Federal Act.
(Added to NRS by 2013, 3590)
NRS 695J.030 “Assister” defined. “Assister”
has the meaning ascribed to it by regulations adopted by the Board of Directors
of the Exchange pursuant to NRS 695I.370.
(Added to NRS by 2013, 3590)
NRS 695J.040 “Exchange” defined. “Exchange”
means the Silver State Health Insurance Exchange established by NRS 695I.200.
(Added to NRS by 2013, 3590)
NRS 695J.050 “Exchange enrollment facilitator” defined. “Exchange enrollment facilitator” means a
person certified pursuant to this chapter who is engaged in the business of
facilitating enrollment in qualified health plans offered by the Exchange.
(Added to NRS by 2013, 3590)
NRS 695J.060 “Navigator” defined. “Navigator”
means a person or entity that meets the requirements of 45 C.F.R. § 155.210 and
any other requirements of the Exchange.
(Added to NRS by 2013, 3590)
NRS 695J.070 “Qualified health plan” defined. “Qualified
health plan” has the meaning ascribed to it in NRS 695I.080.
(Added to NRS by 2013, 3590)
NRS 695J.100 Applicability.
1. The provisions of NRS 683A.341 and 683A.351 apply to exchange enrollment
facilitators.
2. For the purposes of subsection 1,
unless the context requires that NRS
683A.341 or 683A.351 apply only
to producers of insurance or insurers, any reference in those sections to
“producer of insurance” or “insurer” must be replaced by a reference to
“exchange enrollment facilitator.”
(Added to NRS by 2013, 3590)
NRS 695J.110 Application for initial certificate as exchange enrollment
facilitator: Requirements; fee.
1. An applicant for an initial certificate
as an exchange enrollment facilitator must:
(a) Be a natural person of not less than 18 years
of age;
(b) Apply on a form prescribed by the
Commissioner;
(c) Pass a written examination established by the
Commissioner by regulation;
(d) Successfully complete a course of instruction
established by the Commissioner by regulation;
(e) Submit fingerprints as required pursuant to NRS 695J.120; and
(f) Pay the nonrefundable:
(1) Application and certificate fee set
forth in NRS 680B.010;
(2) Initial fee set forth in NRS 680C.110; and
(3) Additional fee of not more than $15
for the processing of the application established pursuant to NRS 695J.270.
2. The additional fee for the processing
of applications pursuant to subparagraph (3) of paragraph (f) of subsection 1
must be deposited in the Insurance Recovery Account created pursuant to NRS 679B.305.
(Added to NRS by 2013, 3590)
NRS 695J.120 Application for certificate as exchange enrollment facilitator:
Form; fingerprints; expiration of certificate.
1. The Commissioner shall prescribe the
form for application for a certificate as an exchange enrollment facilitator.
The form must require the applicant to declare, under penalty of refusal to
issue, or suspension or revocation of, the certificate of the applicant, that
the statements made in the application are true, correct and complete to the
best of his or her knowledge and belief.
2. Before approving an application, the
Commissioner must find that the applicant:
(a) Meets the requirements of NRS 695J.110.
(b) Has not committed any act that is a ground
for refusal to issue, or suspension or revocation of a certificate pursuant to NRS 683A.451.
(c) Paid all applicable fees prescribed pursuant
to NRS 695J.110.
(d) Meets the requirements of subsections 3 and
5.
3. An applicant must, as part of his or
her application and at the applicant’s own expense:
(a) Arrange to have a complete set of his or her
fingerprints taken by a law enforcement agency or other authorized entity
acceptable to the Commissioner; and
(b) Submit to the Commissioner:
(1) A completed fingerprint card and
written permission authorizing the Commissioner to submit the applicant’s
fingerprints to the Central Repository for Nevada Records of Criminal History
for submission to the Federal Bureau of Investigation for a report on the
applicant’s background and to such other law enforcement agencies as the
Commissioner deems necessary; or
(2) Written verification, on a form
prescribed by the Commissioner, stating that the fingerprints of the applicant
were taken and directly forwarded electronically or by another means to the
Central Repository and that the applicant has given written permission to the
law enforcement agency or other authorized entity taking the fingerprints to
submit the fingerprints to the Central Repository for submission to the Federal
Bureau of Investigation for a report on the applicant’s background and to such
other law enforcement agencies as the Commissioner deems necessary.
4. The Commissioner may:
(a) Unless the applicant’s fingerprints are
directly forwarded pursuant to subparagraph (2) of paragraph (b) of subsection
3, submit those fingerprints to the Central Repository for submission to the
Federal Bureau of Investigation and to such other law enforcement agencies as
the Commissioner deems necessary;
(b) Request from each such agency any information
regarding the applicant’s background as the Commissioner deems necessary; and
(c) Adopt regulations concerning the procedures
for obtaining the information described in paragraph (b).
5. The Commissioner may require from the
applicant any document reasonably necessary to verify information contained in
an application.
6. Except as otherwise provided in NRS 695J.250, a certificate issued pursuant to this
chapter is valid for 3 years after the date of issuance unless it is suspended,
revoked or otherwise terminated.
(Added to NRS by 2013, 3591)
NRS 695J.130 Fee for examination; failure to appear.
1. A person taking the examination
required pursuant to NRS 695J.110 must apply to
the Commissioner to take the examination and pay a nonrefundable fee in an
amount prescribed in the regulations adopted pursuant to NRS 695J.270.
2. A person who fails to appear for the
examination as scheduled or fails to pass the examination must reapply for
examination and pay the required fees in order to be scheduled for another
examination.
(Added to NRS by 2013, 3592)
NRS 695J.140 Renewal of certificate; application; fees; waiver of time limit
and fine or sanction.
1. A certificate may be renewed for an
additional 3-year period by submitting to the Commissioner an application for
renewal and:
(a) If the application is made:
(1) On or before the expiration date of
the certificate, all applicable renewal fees and an additional fee established
by the Commissioner of not more than $15 for deposit in the Insurance Recovery
Account created pursuant to NRS 679B.305;
or
(2) Except as otherwise provided in
subsection 3:
(I) Not more than 30 days after the
expiration date of the certificate, all applicable renewal fees plus any late
fee required and an additional fee established by the Commissioner of not more
than $15 for deposit in the Insurance Recovery Account created pursuant to NRS 679B.305; or
(II) More than 30 days but not more
than 1 year after the expiration date of the certificate, all applicable
renewal fees plus a penalty of twice all applicable renewal fees, except for
any fee required pursuant to NRS 680C.110.
(b) Proof of the successful completion of
appropriate courses of study required for renewal, as established by the
Commissioner by regulation.
2. The fees specified in this section are
not refundable.
3. An exchange enrollment facilitator who
is unable to renew his or her certificate because of military service, extended
medical disability or other extenuating circumstance may request a waiver of
the time limit and of any fine or sanction otherwise required or imposed
because of the failure to renew.
(Added to NRS by 2013, 3592)
NRS 695J.150 Payment of child support: Statement by applicant for
certificate; grounds for denial of certificate; duty of Commissioner.
[Effective until the date of the repeal of 42 U.S.C. § 666, the federal law
requiring each state to establish procedures for withholding, suspending and
restricting the professional, occupational and recreational licenses for child
support arrearages and for noncompliance with certain processes relating to
paternity or child support proceedings.]
1. An applicant for the issuance or
renewal of a certificate to act as an exchange enrollment facilitator shall
submit to the Commissioner the statement prescribed by the Division of Welfare
and Supportive Services of the Department of Health and Human Services pursuant
to NRS 425.520. The statement must be
completed and signed by the applicant.
2. The Commissioner shall include the
statement required pursuant to subsection 1 in:
(a) The application or any other forms that must
be submitted for the issuance or renewal of the certificate; or
(b) A separate form prescribed by the
Commissioner.
3. A certificate to act as an exchange
enrollment facilitator may not be issued or renewed by the Commissioner if the
applicant is a natural person who:
(a) Fails to submit the statement required
pursuant to subsection 1; or
(b) Indicates on the statement submitted pursuant
to subsection 1 that the applicant is subject to a court order for the support
of a child and is not in compliance with the order or a plan approved by the
district attorney or other public agency enforcing the order for the repayment of
the amount owed pursuant to the order.
4. If an applicant indicates on the
statement submitted pursuant to subsection 1 that the applicant is subject to a
court order for the support of a child and is not in compliance with the order
or a plan approved by the district attorney or other public agency enforcing
the order for the repayment of the amount owed pursuant to the order, the
Commissioner shall advise the applicant to contact the district attorney or
other public agency enforcing the order to determine the actions that the
applicant may take to satisfy the arrearage.
(Added to NRS by 2013, 3592)
NRS 695J.160 Suspension of certificate for failure to pay child support or
comply with certain subpoenas or warrants; reinstatement of certificate.
[Effective until the date of the repeal of 42 U.S.C. § 666, the federal law
requiring each state to establish procedures for withholding, suspending and
restricting the professional, occupational and recreational licenses for child
support arrearages and for noncompliance with certain processes relating to
paternity or child support proceedings.]
1. If the Commissioner receives a copy of
a court order issued pursuant to NRS
425.540 that provides for the suspension of all professional, occupational
and recreational licenses, certificates and permits issued to a person who is
the holder of a certificate to act as an exchange enrollment facilitator, the
Commissioner shall deem the certificate issued to that person to be suspended
at the end of the 30th day after the date on which the court order was issued
unless the Commissioner receives a letter issued to the holder of the
certificate by the district attorney or other public agency pursuant to NRS 425.550 stating that the holder of the
certificate has complied with the subpoena or warrant or has satisfied the
arrearage pursuant to NRS 425.560.
2. The Commissioner shall reinstate a
certificate to act as an exchange enrollment facilitator that has been
suspended by a district court pursuant to NRS
425.540 if the Commissioner receives a letter issued by the district
attorney or other public agency pursuant to NRS
425.550 to the person whose certificate was suspended stating that the
person whose certificate was suspended has complied with the subpoena or
warrant or has satisfied the arrearage pursuant to NRS 425.560.
(Added to NRS by 2013, 3593)
NRS 695J.170 Application for certificate must include social security number
of applicant. [Effective until the date of the repeal of 42 U.S.C. § 666, the
federal law requiring each state to establish procedures for withholding,
suspending and restricting the professional, occupational and recreational
licenses for child support arrearages and for noncompliance with certain
processes relating to paternity or child support proceedings.] The application of a natural person who
applies for the issuance or renewal of a certificate as an exchange enrollment
facilitator must include the social security number of the applicant.
(Added to NRS by 2013, 3593)
NRS 695J.180 Contents of certificate; holder to inform Commissioner of
locations of business.
1. A certificate issued pursuant to this
chapter must state the certificate holder’s name, address, personal
identification number, the date of issuance and the date of expiration, and
must contain any other information the Commissioner considers necessary. The
certificate must be made available by the certificate holder for public
inspection upon request.
2. A certificate holder shall inform the
Commissioner of all locations from which he or she conducts business and of
each change of business or residence address, in writing or by other means
acceptable to the Commissioner, within 30 days after the date on which the
change takes place. If a certificate holder changes his or her business or
residence address without giving written notice and the Commissioner is unable
to locate the certificate holder after diligent effort, the Commissioner may
revoke the certificate without a hearing. The mailing of a letter by certified
mail, return receipt requested, addressed to the certificate holder at his or
her last mailing address appearing on the records of the Division, and the
return of the letter undelivered, constitutes a diligent effort by the
Commissioner.
(Added to NRS by 2013, 3593)
NRS 695J.190 Temporary certificate as exchange enrollment facilitator.
1. If the Commissioner believes that a
temporary certificate is necessary to carry on the business of facilitating
selection of a qualified health plan, the Commissioner may issue a temporary
certificate as an exchange enrollment facilitator for 180 days or less without
requiring an examination to:
(a) The surviving spouse, personal representative
or guardian of an exchange enrollment facilitator who dies or becomes incompetent,
to allow adequate time for the sale of the business, the recovery or return of
the exchange enrollment facilitator, or the training and certification of new
personnel to operate the business;
(b) A member or employee of a business
organization appointed by the Exchange, upon the death or disability of the
natural person designated in its application or certificate;
(c) The designee of an exchange enrollment
facilitator entering active service in the Armed Forces of the United States;
or
(d) A person in any other circumstance in which
the Commissioner believes that the public interest will be best served by
issuing the certificate.
2. The Commissioner may by order limit the
authority of a person who holds a temporary certificate as the Commissioner
believes necessary to protect persons insured and the public. The Commissioner
may require the person who holds a temporary certificate to have a suitable
sponsor who is an exchange enrollment facilitator and who assumes
responsibility for all acts of the person who holds the temporary certificate,
and may impose similar requirements to protect persons insured and the public.
The Commissioner may order revocation of a temporary certificate if the
interests of persons insured or the public are endangered. A temporary
certificate expires when the owner or the personal representative or guardian
of the owner disposes of the business.
(Added to NRS by 2013, 3593)
NRS 695J.200 Natural person authorized to act for entity appointed by
Exchange required to be exchange enrollment facilitator. An entity other than a natural person that is
appointed by the Exchange must require that each natural person who is
authorized to act for the entity be an exchange enrollment facilitator. Each
exchange enrollment facilitator must be named in the partnership’s or
corporation’s appointment.
(Added to NRS by 2013, 3594)
NRS 695J.210 Prohibited acts. An
exchange enrollment facilitator:
1. May not concurrently hold a license as
a producer of insurance, an insurance consultant or a surplus lines broker’s
license in any line.
2. Shall not:
(a) Sell, solicit or negotiate insurance;
(b) 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 health insurance plan; or
(c) Employ, be employed by or be in partnership
with, or receive any remuneration arising out of his or her activities as an
exchange enrollment facilitator from, any licensed producer of insurance,
insurance consultant or surplus lines broker or insurer.
(Added to NRS by 2013, 3594)
NRS 695J.220 Responsibilities of exchange enrollment facilitator. An exchange enrollment facilitator is
obligated under his or her certificate to:
1. Serve with objectivity and complete
loyalty the interests of his or her client; and
2. Render to his or her client
information, counsel and service which, to the best of the exchange enrollment
facilitator’s knowledge, understanding and opinion, best serves the client’s
insurance needs and interests.
(Added to NRS by 2013, 3594)
NRS 695J.230 Nonresident exchange enrollment facilitator.
1. A nonresident who is an exchange
enrollment facilitator shall appoint the Commissioner, in writing, as his or
her registered agent upon whom may be served all legal process issued in
connection with any action or proceeding brought or pending in this State
against or involving the nonresident certificate holder and relating to
transactions under his or her Nevada certificate. The appointment is
irrevocable and remains in force so long as such an action or proceeding exists
or may arise. Duplicate copies of process must be served upon the Commissioner,
or other person in apparent charge of the Division during the Commissioner’s
absence, accompanied by payment of the fee for service of process. Promptly
after any such service, the Commissioner shall forward a copy of the process by
certified mail, return receipt requested, to the nonresident certificate holder
at his or her business address of most recent record with the Division. Process
so served and the copy so forwarded constitutes personal service upon the
certificate holder for all purposes.
2. Each such nonresident certificate
holder shall also file with the Commissioner a written agreement to appear
before the Commissioner pursuant to notice of hearing, order to show cause or
subpoena issued by the Commissioner and sent by certified mail to the certificate
holder at his or her business address of most recent record with the Division,
and that if the nonresident certificate holder fails to appear, the nonresident
certificate holder thereby consents to any subsequent suspension, revocation or
refusal to renew his or her certificate.
(Added to NRS by 2013, 3594)
NRS 695J.240 Disciplinary action.
1. The Commissioner may place an exchange
enrollment facilitator on probation, suspend his or her certificate for not
more than 12 months, or revoke or refuse to renew his or her certificate, or
may impose an administrative fine or take any combination of the foregoing actions,
for one or more of the causes set forth in NRS
683A.451.
2. The provisions of NRS 683A.461 also apply to an exchange
enrollment facilitator.
(Added to NRS by 2013, 3595)
NRS 695J.250 Suspension, limitation or revocation of certificate.
1. Upon the suspension, limitation or
revocation of the certificate of an exchange enrollment facilitator, the
Commissioner shall immediately notify the certificate holder in person or by
mail addressed to the certificate holder at his or her most recent address of
record with the Division. Notice by mail is effective when mailed.
2. Upon the suspension, limitation or
revocation of the certificate of an exchange enrollment facilitator, the
Commissioner shall immediately notify the Executive Director of the Exchange.
Upon receipt of such notification, the Executive Director shall immediately
terminate the certificate holder’s appointment.
3. The Commissioner shall not again issue
a certificate under this chapter to any natural person whose certificate has
been revoked until at least 1 year after the revocation has become final, and
thereafter not until the person again qualifies for a certificate under this
chapter. A person whose certificate has been revoked twice is not eligible for
any certificate under this title.
(Added to NRS by 2013, 3595)
NRS 695J.260 Surrender of certificate in absence or upon termination of
appointment by Exchange.
1. If an exchange enrollment facilitator
fails to obtain an appointment by the Exchange within 30 days after the date on
which the certificate was issued, the exchange enrollment facilitator’s
certificate expires and the exchange enrollment facilitator shall promptly
deliver his or her certificate to the Commissioner.
2. If the Exchange terminates an exchange
enrollment facilitator’s appointment, the exchange enrollment facilitator is
prohibited from engaging in the business of an exchange enrollment facilitator
under his or her certificate until such time as the exchange enrollment
facilitator receives a new appointment by the Exchange. If the exchange
enrollment facilitator does not obtain a new appointment by the Exchange within
30 days after the date the appointment was terminated, the exchange enrollment
facilitator’s certificate expires and the exchange enrollment facilitator shall
promptly deliver his or her certificate to the Commissioner.
3. Except as otherwise provided in
subsection 4, if the Exchange terminates the appointment of an entity other
than a natural person:
(a) The appointments of exchange enrollment
facilitators named on the entity’s appointment also terminate; and
(b) The exchange enrollment facilitator is
prohibited from engaging in the business of an exchange enrollment facilitator
under his or her certificate until such time as the exchange enrollment
facilitator receives a new appointment by the Exchange. If the exchange
enrollment facilitator does not obtain a new appointment by the Exchange within
30 days after the date on which the appointment was terminated, the exchange
enrollment facilitator’s certificate expires and the exchange enrollment
facilitator shall promptly deliver his or her certificate to the Commissioner.
4. The provisions of subsection 3 do not
apply to any appointments the exchange enrollment facilitator may have
individually or through an entity other than the terminated entity.
5. Upon the termination of an appointment
for an entity or certificate holder, the Executive Director of the Exchange
shall notify the Commissioner of the effective date of the termination and the
grounds for termination.
(Added to NRS by 2013, 3595)
NRS 695J.270 Regulations.
1. The Commissioner shall adopt
regulations:
(a) For establishing and conducting an
examination required by this chapter for the initial issuance and renewal of a
certificate;
(b) For the establishment of a course of
instruction as required by this chapter for the initial issuance and renewal of
a certificate;
(c) Establishing the fee required by NRS 695J.110 for the processing of an application;
(d) Establishing the fee required by NRS 695J.130 for the administration of the
examination; and
(e) For carrying out the provisions of this
chapter.
2. The Commissioner may contract with a
person to perform functions required by this chapter, including, without
limitation:
(a) Administering examinations;
(b) Providing courses of instruction;
(c) Processing applications; and
(d) Collecting fees.
(Added to NRS by 2013, 3596)
NRS 695J.280 Engaging in business of exchange enrollment facilitator without
certificate prohibited; penalty.
1. No person may engage in the business of
an exchange enrollment facilitator unless a certificate has been issued to the
person by the Commissioner.
2. A person who violates subsection 1 is
subject to an administrative fine of not more than $1,000 for each act or
violation.
(Added to NRS by 2013, 3596)
