Michigan Laws 500.1262a – Certified application counselor; certification; application; funding from exchange prohibited; powers; prohibited conduct; disclosure of potential conflict of interest
Current as of: 2023 | Check for updates
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Terms Used In Michigan Laws 500.1262a
- Affordable care act: means the patient protection and affordable care act, Public Law 111-148, as amended by the health care and education reconciliation act of 2010, Public Law 111-152. See Michigan Laws 500.1261
- Certified application counselor: means an individual who is certified as a certified application counselor under this chapter and is authorized by the United States department of health and human services to perform the duties described in 45 C. See Michigan Laws 500.1261
- Exchange: means an American health benefits exchange established or operating under the affordable care act. See Michigan Laws 500.1261
- Insurance: means any of the kinds of insurance described in chapter 6. See Michigan Laws 500.1261
- Navigator: means a person that receives any funding from an exchange or the federal government and is designated or selected by an exchange or the federal government to perform any of the duties described in 42 USC 18031(i)(3). See Michigan Laws 500.1261
- Negotiate: means the act of conferring directly with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance concerning any of the substantive benefits, terms, or conditions of the contract, provided that the person engaged in that act either sells insurance or obtains insurance from insurers for purchasers. See Michigan Laws 500.1261
- Qualified health plan: means that term as defined in section 1301 of the affordable care act. See Michigan Laws 500.1261
- Sell: means to exchange a contract of insurance by any means, for money or its equivalent, on behalf of an insurance company. See Michigan Laws 500.1261
- Solicit: means attempting to sell insurance or asking or urging a person to apply for a particular kind of insurance from a particular company. See Michigan Laws 500.1261
- state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o
(1) An individual shall not act as a certified application counselor unless he or she has filed an application under section 1263(2) and is certified with this state as a certified application counselor.
(2) Unless certified as a certified application counselor, an individual shall not receive funding from an exchange.
(3) Subject to the affordable care act, a certified application counselor may do all of the following:
(a) Conduct public education activities to raise awareness of the availability of qualified health plans.
(b) Distribute fair and impartial information about all qualified health plans offered within the exchange and the availability of the premium tax credits under section 36B of the internal revenue code of 1986, 26 USC 36B, and cost-sharing reduction under section 1402 of the affordable care act.
(c) Assist individuals applying for coverage in a qualified health plan.
(d) Facilitate selection of eligible individuals in a qualified health plan.
(e) Provide information in a manner that is culturally and linguistically appropriate to the needs of the population served by the exchange.
(f) Refer an individual with limited English proficiency to a navigator, insurance producer, or other source of assistance.
(4) A certified application counselor shall not do any of the following:
(a) Sell, solicit, or negotiate health insurance.
(b) Recommend a particular qualified health benefit plan.
(c) Provide any information or services related to insurance regulated under this act other than qualified health benefit plans or other products offered in the exchange.
(5) Before providing services to or acting for an individual under subsection (3), a certified application counselor shall disclose any potential conflict of interest to the individual.