NRS: CHAPTER 695J - PERSONS WHO FACILITATE ENROLLMENT IN CERTAIN QUALIFIED HEALTH PLANS

[Rev. 6/29/2024 5:03:16 PM--2023]

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; period of validity of certificate.

NRS 695J.130 Examination: Application; fee; failure to appear or pass.

NRS 695J.140 Renewal of certificate: Application; fees; waiver of time limit and fine or sanction; expiration.

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.180 Contents of certificate; holder required to make certificate available for public inspection and 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: Service of process; agreement to appear.

NRS 695J.240 Disciplinary action.

NRS 695J.250 Suspension, limitation or revocation of certificate.

NRS 695J.260 Expiration of certificate in absence of appointment by Exchange; termination of appointment by Exchange; notice to Commissioner by Executive Director of Exchange.

NRS 695J.270 Regulations; authority of Commissioner to contract for the performance of certain functions.

NRS 695J.280 Engaging in business of exchange enrollment facilitator without certificate prohibited; penalty.

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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. An applicant for an initial certificate as an exchange enrollment facilitator must:

1. Be a natural person of not less than 18 years of age;

2. Apply on a form prescribed by the Commissioner;

3. Pass a written examination established by the Commissioner by regulation;

4. Successfully complete a course of instruction established by the Commissioner by regulation;

5. Submit fingerprints as required pursuant to NRS 695J.120; and

6. Pay the nonrefundable:

(a) Application and certificate fee set forth in NRS 680B.010; and

(b) Initial fee set forth in NRS 680C.110.

(Added to NRS by 2013, 3590; A 2015, 2843)

NRS 695J.120 Application for certificate as exchange enrollment facilitator: Form; fingerprints; period of validity 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.

(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

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 Examination: Application; fee; failure to appear or pass.

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; expiration.

1. A certificate may be renewed by submitting to the Commissioner an application for renewal and:

(a) If the application is made:

(1) On or before the renewal date of the certificate, all applicable renewal fees; or

(2) Except as otherwise provided in subsection 3:

(I) Not more than 30 days after the renewal date of the certificate, a renewal fee of 150 percent of all applicable renewal fees otherwise required, except for any fee required pursuant to NRS 680C.110; or

(II) More than 30 days but not more than 1 year after the renewal 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.

4. A certificate which:

(a) Is not renewed pursuant to this section on or before the renewal date expires on the renewal date.

(b) Is renewed pursuant to this section continues in effect until the next renewal date unless it is suspended, revoked or otherwise terminated.

5. As used in this section, “renewal date” means:

(a) For the first renewal of the certificate, the last day of the month which is 3 years after the month in which the Commissioner originally issued the certificate.

(b) For each renewal after the first renewal of the certificate, the last day of the month which is 3 years after the month in which the certificate was last due to be renewed.

(Added to NRS by 2013, 3592; A 2015, 2843; 2021, 2998)

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)

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 required to make certificate available for public inspection and 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 or incapacitated, 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.

3. A temporary certificate issued pursuant to this section may be renewed for one additional period of 180 days if:

(a) The person who holds the temporary certificate, on or before a date specified by the Commissioner as the last day in which the temporary certificate is renewable, submits to the Commissioner a written request which includes, without limitation, sufficient justification for the renewal; and

(b) The Commissioner approves the request.

(Added to NRS by 2013, 3593; A 2023, 2644)

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: Service of process; agreement to appear.

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 Expiration of certificate in absence of appointment by Exchange; termination of appointment by Exchange; notice to Commissioner by Executive Director of 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.

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.

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.

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; A 2019, 1723, 3039)

NRS 695J.270 Regulations; authority of Commissioner to contract for the performance of certain functions.

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;

(d) 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;

(d) Collecting fees.

(Added to NRS by 2013, 3596; A 2015, 2844)

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)