Ins 6.96Ins 6.96 Prohibited business practices. In addition to the prohibited acts contained in s. 628.95 (2), Stats., navigators, navigator entities, nonnavigator assisters and nonnavigator assister entities are prohibited from all of the following:

Ins 6.96(1)(1) Providing enrollment or other specific information regarding a health benefit plan that is not offered in the federal exchange.

Ins 6.96(2)(2) Providing a recommendation comparing health benefit plans that may be better or worse for the consumer or employer.

Ins 6.96(3)(3) Making misleading statements to a consumer or employer regarding or otherwise misrepresenting one’s qualifications or services.

Ins 6.96(4)(4) Offering a recommendation directly to a consumer or employer regarding a particular health benefit plan concerning deductible, coinsurance, or any substantive benefits, terms, or conditions of the contract.

Ins 6.96(5)(5) Asking or urging a consumer to apply for a particular health benefit plan from a particular insurance company.

Ins 6.96(6)(6) Distributing cards, documents or advertisements regarding a particular health insurer.

Ins 6.96(7)(7) Recommending a particular health benefit plan or insurer.

Ins 6.96(8)(8) Receiving consideration directly or indirectly from any health insurer in connection with the enrollment of individual or employees into a qualified health plan as defined 45 CFR 155.20, as amended.

Ins 6.96(9)(9) Using a single appointment for selling, soliciting or advising a consumer or employer about a product other than health benefit plans by a navigator or nonnavigator assister who is also a licensed insurance agent. Insurance agents shall make a separate appointment with the consumer or employer for selling, soliciting, or advising about a product other than a health benefit plan.

Ins 6.96 HistoryHistory: EmR1314: emerg. cr. eff. 9-10-13; CR 13-113: cr. Register August 2014 No. 704, eff. 9-1-14; correction in (8) made under s. 13.92 (4) (b) 7. Register August 2014 No. 704.

Ins 6.97Ins 6.97 Navigator, nonnavigator assister, navigator entity, and nonnavigator assister entity records.

Ins 6.97(1)(1) Purpose. This section protects consumers by prescribing minimum standards and techniques of accounting and data handling of navigators, nonnavigator assisters, navigator entities and nonnavigator assister entities to ensure that timely and reliable information will exist, if applicable, and be available to the commissioner. This section implements and interprets ss. 601.42 and 628.34, Stats., by establishing the minimum records that are to be maintained.

Ins 6.97(2)(2) Recordkeeping requirements.

Ins 6.97(2)(a)(a) Records, generally. Beginning October 1, 2013, each navigator, nonnavigator assister, navigator entity or nonnavigator assister entity shall maintain, for at least a 3-year period, unless a specific period is provided elsewhere, all of the following financial, consumer, and employee records arising from or related to the activities of the navigator or nonnavigator assister, as applicable:

Ins 6.97(2)(b)(b) Cash disbursed record. The cash disbursed record shall show the name of the party to whom the payment was made, date of payment, and reason for payment.

Ins 6.97(2)(c)(c) Cash receipts record. The cash receipts record shall show the name of the party who remitted the money, date of receipt, and reason for payment.

Ins 6.97(2)(d)(d) Personnel records. Personnel records shall include dates of employment, supervision, or affiliation; position held; description of principal duties; name and last known address and telephone number of employee, supervisee or affiliated person.

Ins 6.97(3)(3) Place of maintaining records.

Ins 6.97(3)(a)(a) The navigator or navigator entity shall maintain records, if any, required by sub. (2) at the business address of the navigator or the navigator entity, or at another location only if the navigator provides written notice of the other location to the commissioner.

Ins 6.97(3)(b)(b) The nonnavigator assister or nonnavigator assister entity shall maintain records, if any, required by sub. (2), at the business address of the nonnavigator assister entity or at another location only if the nonnavigator assister entity provides written notice of the other location to the commissioner.

Ins 6.97(4)(4) Updating records. The navigator, navigator entity, and nonnavigator assister entity shall maintain financial records, if any, all records of compliance with prelicensing training completion, successful passage of the examination and continuing education completion, compliance with federal training and other federal requirements for the navigators and nonnavigator assisters it employs, supervises, or is affiliated with, as applicable for at least 3 years from the transaction of an insurance business.

Ins 6.97 HistoryHistory: EmR1314: emerg. cr. eff. 9-10-13; CR 13-113: cr. Register August 2014 No. 704, eff. 9-1-14; (2) (a) (title) added under s. 13.92 (4) (b) 2., Stats., Register August 2014 No. 704.