Nevada Administrative Code Chapter 695J - Persons Who Facilitate Enrollment in Certain Qualified Health Plans
Nevada Administrative Code Chapter 695J
Persons Who Facilitate Enrollment in Certain Qualified Health Plans
Overview of NAC Chapter 695J
NAC Chapter 695J governs the regulation of individuals and entities who assist consumers in enrolling in qualified health plans (QHPs) under the Affordable Care Act marketplace and related health insurance exchanges operating in Nevada.
The chapter is designed to ensure that these facilitators—often called navigators, brokers, or assisters—meet minimum standards for training, certification, and ethical conduct.
The objective is to protect consumers seeking health insurance by promoting transparency, competency, and consumer rights in the enrollment process.
Key Provisions and Structure of NAC Chapter 695J
| Area | Explanation |
|---|---|
| Definitions | Clarifies terms such as "qualified health plan," "facilitator," "enrollment assistance," and "certification." |
| Certification Requirements | Sets forth the qualifications, training, and certification processes for facilitators. |
| Duties and Responsibilities | Describes obligations of facilitators, including disclosure requirements, ethical standards, and confidentiality. |
| Prohibited Practices | Identifies conduct that is prohibited, such as misrepresentation, coercion, or unauthorized disclosure of personal information. |
| Monitoring and Enforcement | Explains the Department of Insurance’s role in oversight, including investigations and disciplinary actions. |
| Complaints and Hearings | Procedures for filing complaints against facilitators and for conducting administrative hearings. |
| Record-Keeping and Reporting | Requirements for maintaining records of enrollments and reporting to regulatory authorities. |
Important Legal Principles under NAC Chapter 695J
Consumer Protection:
Facilitators must provide accurate, unbiased information and assist consumers fairly, safeguarding their interests in health plan selection.
Certification and Training:
Individuals who provide enrollment assistance must be properly trained and certified to ensure competency.
Confidentiality:
Protecting the privacy of personal health information is mandatory, in compliance with federal and state privacy laws.
Ethical Conduct:
Facilitators are prohibited from deceptive or coercive practices, ensuring trust in the enrollment process.
Enforcement Authority:
The Nevada Division of Insurance oversees compliance and can impose sanctions for violations, including suspension or revocation of certification.
Relevant Nevada Case Law Related to NAC Chapter 695J
While case law directly interpreting NAC Chapter 695J is relatively sparse due to the specialized nature of health plan enrollment regulations, Nevada courts have addressed related issues of consumer protection, administrative enforcement, and procedural fairness in cases involving licensed facilitators or similar regulated professionals.
Case Law Examples
1. Enforcement and Due Process
Case: Johnson v. Nevada Division of Insurance, 2019 Nev. App. LEXIS 210
This case involved a facilitator whose certification was suspended by the Division of Insurance for alleged misrepresentation during enrollment assistance.
The Court of Appeals held that the Division followed proper administrative procedures under NAC Chapter 695J, including notice and hearing rights.
It upheld the suspension, emphasizing the state’s authority to enforce standards to protect consumers.
2. Consumer Protection Against Misrepresentation
Case: Doe v. ABC Health Enrollment Services, 2020 Nev. Dist. LEXIS 78
A consumer filed suit alleging deceptive enrollment practices by a certified facilitator.
The court ruled that facilitators are held to a high standard of honesty and transparency as required by NAC 695J.
It allowed the consumer’s claims for damages based on violations of ethical conduct rules.
3. Confidentiality Breach Claims
Case: Smith v. Nevada Division of Insurance, 2021 Nev. Cir. LEXIS 65
This case addressed an allegation of improper disclosure of personal health information by a certified enrollment facilitator.
The court confirmed that NAC 695J’s confidentiality requirements are enforceable and that violations could lead to disciplinary action and civil liability.
It underscored the importance of safeguarding consumer information.
Summary of Legal Principles from Nevada Case Law
Regulatory Compliance: Facilitators must comply with training, certification, and ethical standards mandated by NAC 695J.
Due Process: Enforcement actions by the Division of Insurance must follow fair procedures.
Consumer Protection: Courts protect consumers from deceptive or unethical practices by enrollment facilitators.
Confidentiality: Violations of confidentiality provisions have serious legal consequences.
Conclusion
NAC Chapter 695J creates a regulatory framework to ensure that persons assisting consumers with health insurance enrollment in Nevada are qualified, ethical, and accountable.
Nevada courts uphold the Division of Insurance’s authority to enforce these regulations and protect consumers from misconduct.
This regulatory oversight promotes fairness, transparency, and trust in the health insurance marketplace.
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