Ins 6.95(3) (3) Entity reporting of updates. A nonnavigator assister entity shall comply with s. 628.96 (1), Stats., reporting in an electronic format as prescribed by the commissioner, any updates to the list of nonnavigator assisters that the nonnavigator assister entity provided when it first registered with the commissioner, including additions, deletions, or modifications. The information shall be provided within 30 days of the addition, deletion, or modification to the list of nonnavigator assisters.

Ins 6.95(4) (4) Entity liability. A nonnavigator assister entity assumes legal responsibility, in accordance with s. 628.96 (3), Stat., for the acts of the nonnavigator assisters, on behalf of the entity, that the entity employs, supervises or is formally affiliated with, that are performed in this state and that are within the scope of the apparent authority to act as a nonnavigator assister.

Ins 6.95(5) (5) Revocation of entity registration. The commissioner may deny, suspend or revoke a nonnavigator assister entity registration if the nonnavigator assisters it employs, supervises or is affiliated with, fail to comply with s. Ins 6.92 (3), or the nonnavigator assister entity fails to comply with any provision contained in this section or by failing to comply with requests of the commissioner.

Ins 6.95(6) (6) Investigation and review.

Ins 6.95(6)(a) (a) The commissioner, or designated examiner, may investigate and review all nonnavigator entities under ss. 601.43 and 601.44, Stats. The method and timing of the reviews shall be determined by the commissioner in each case and may consist of any of the following:

Ins 6.95(6)(a)1. 1. Consideration of information available from state, federal, or local agencies, private organizations or agencies, or interested persons.

Ins 6.95(6)(a)2. 2. Investigation upon receipt of a complaint from any person.

Ins 6.95(6)(a)3. 3. Any other information the commissioner deems relevant to the investigation.

Ins 6.95(6)(b) (b) If, after the investigation the commissioner suspends, denies, or revokes the registration, written notification shall be given with reasons for such action. The suspension, denial or revocation constitutes an order pursuant to s. 601.62 (3) (a), Stats., and the nonnavigator entity may request a hearing before the commissioner under that section.

Ins 6.95 History History: EmR1314: emerg. cr. eff. 9-10-13; CR 13-113: cr. Register August 2014 No. 704, eff. 9-1-14; (1g) and (1r) renumbered from (intro.) and (1) under s. 13.92 (4) (b) 1., Stats., (1g) (title) added under s. 13.92 (4) (b) 2., Stats., correction in (2) (intro.) made under s. 13.92 (4) (b) 7. Register August 2014 No. 704.

Ins 6.96 Ins 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 History History: 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 6.97 Ins 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)(a)1. 1. Business checking account.

Ins 6.97(2)(a)2. 2. Cash disbursed records.

Ins 6.97(2)(a)3. 3. Cash receipts records.

Ins 6.97(2)(a)4. 4. Personnel records.