Wisconsin Administrative Code
Office of the Commissioner of Insurance
Chapter Ins 6 - General
Section Ins 6.92 - Individual navigators
Universal Citation: WI Admin Code ยง Ins 6.92
Current through August 26, 2024
(1) PURPOSE. This section protects insurance consumers by establishing procedures for the licensing of navigators when transacting the business of insurance, prescribing minimum standards and requirements to ensure timely and reliable information will exist and be available to the commissioner. This section implements and interprets ss. 628.095, 628.097, 628.10, 628.90 to 628.95, Stats., as applicable.
(2) PROCEDURE.
(a)
Application for
navigator license. An individual applying for a navigator license
shall submit an application to the office in the form prescribed by the
commissioner. A completed application shall include: the navigator's name; the
navigator's residence; contact email address; mailing and business addresses;
confirmation of successful completion of prelicensing training; fingerprints
provided in a format specified by the commissioner to complete; an electronic
confirmation of criminal history from the Wisconsin department of justice,
crime information bureau, and the federal bureau of investigation completed not
more than 180 days prior to the licensing examination date; payment of the
nonrefundable fees to the testing vendor; an electronic photograph of the
applicant taken by the test vendor at the time of testing; confirmation of
previous navigator licensure in another state, if applicable; payment of the
fee under s.
601.31(1) (nm), Stats.; proof of financial
responsibility under sub. (7); and any documentation required in answer to
questions on the application.
Note: A copy of the navigator license application form OCI 11-090, required in par. (a), may be obtained at no cost from the Office of the Commissioner of Insurance at 125 S. Webster Street, Madison WI 53703, or at the Office's web address: oci.wi.gov.
(b)
Prelicensing Training.
An individual seeking a navigator license, in addition to any training
requirements of the federal government, shall complete at least 16 hours of
commissioner-approved navigator prelicensing training. Training required under
this subsection must be approved by the commissioner and provided by an
education provider that is approved by the commissioner.
(c)
Scheduling the navigator
licensing examination. An applicant must schedule an examination with
the testing vendor at least twenty-four hours prior to the desired navigator
licensing examination date. The written examination will test the applicant's
knowledge of the duties and responsibilities of a navigator; the insurance laws
and regulations of this state; and the state's public assistance programs and
eligibility. The written examination shall be approved by the commissioner and
offered through a commissioner-approved testing vendor.
(d)
Exception.
1. An insurance agent who holds an active
resident license with the accident and health line of authority and is in
compliance with continuing education requirements may apply to be licensed as a
navigator if the currently licensed insurance agent demonstrates all of the
following:
a. Compliance as set forth in s.
628.92(1),
Stats., including competence and trustworthiness.
b. Satisfactory completion of 4 hours of
navigator training specific to public assistance programs, including Medicaid,
in addition to the completion of any federally required navigator training and
compliance with federal restrictions and requirements including those set forth
in
45 CFR
155.205(d),
155.210,
155.215(b)
and (c), and
155.260(b),
as amended. The state training required under this subsection must be approved
by the commissioner and provided by an education provider that is approved by
the commissioner.
2. A
currently licensed insurance agent who is in compliance with subd. 1. is exempt
from passing the navigator examination and photograph requirements described in
par. (a). The currently licensed insurance agent shall provide new fingerprints
unless the office has received current, valid fingerprint results provided in a
format specified by the commissioner and an electronic confirmation of criminal
history from the Wisconsin department of justice, crime information bureau, and
the federal bureau of investigation that were completed not more than 180 days
prior to the date of the application. The currently licensed insurance agent
shall submit a completed application as described in par. (a) and pay the
licensing fee in accordance with s.
601.31(1) (nm), Stats., to the
commissioner.
(e)
Issuance of license. The commissioner shall issue a navigator
license to an applicant who completes and satisfies the requirements in pars.
(a) and (b), in addition to any federal training or requirements including the
requirements set forth in
45 CFR
155.205(d),
155.210,
155.215(b)
and (c), and
155.260(b),
as amended, has passed the commissioner-approved written examination with a
satisfactory grade, and meets the standards of competence and trustworthiness
as described in sub. (3). Examination scores are valid for 180 days. Failure to
apply for a license within 180 days will require the applicant to re-take the
examination. Determination of the acceptance or rejection of a completed
application shall be made within 90 days of receipt by the commissioner of the
completed application, which is tolled until receipt of any additional required
or requested documentation.
(3) COMPETENCE AND TRUSTWORTHINESS. The following criteria may be used by the commissioner in assessing trustworthiness and competence of a navigator; failure to meet trustworthiness and competence is cause for denial, suspension or revocation or a license:
(a)
Criminal record. The
conviction for crimes which are substantially related to the circumstances of
holding an insurance or navigator license, including a felony or misdemeanor
conviction under the law of Wisconsin or any other state or under federal
law.
(b)
Accuracy of
information. Any material misrepresentation in the information
submitted on the application form.
(c)
Regulatory action. Any
formal regulatory action taken in any jurisdiction with regard to any
occupational license held, such as insurance licenses in other states, real
estate licenses and security licenses.
(d)
Other criteria. Other
criteria which the commissioner considers evidence of untrustworthiness or
incompetence, including:
1. Providing
incorrect, misleading, incomplete or materially untrue information in the
licensing application.
2. Violating
any insurance laws, or violating any regulation, subpoena or order of the
insurance commissioner or of another state's insurance commissioner, or of the
federal government.
3. Obtaining or
attempting to obtain a license through misrepresentation or fraud;
4. Improperly withholding, misappropriating
or converting any monies or properties received in the course of acting as a
navigator or insurance agent.
5.
Intentionally misrepresenting the terms of an actual or proposed insurance
contract or application for insurance.
6. Having admitted or been found to have
committed any insurance unfair trade practice or fraud.
7. Using fraudulent, coercive, or dishonest
practices in the conduct of business in this state or elsewhere.
8. Demonstrating incompetence,
untrustworthiness or financial irresponsibility in the conduct of personal
financial transactions or professional business in this state or
elsewhere.
9. Having an insurance
producer license, or its equivalent, denied, suspended, or revoked in any other
state, province, district or territory.
10. Forging another's name to an application
for insurance or to any document related to an insurance transaction.
11. Improperly using notes or any other
reference material to complete an examination for an insurance or navigator
license.
12. Failing to comply with
an administrative or court order imposing a child support obligation.
13. Failing to pay state income tax or comply
with any administrative or court order directing payment of state income
tax.
(e)
Minimum
Age and Residency. An applicant for navigator licensure shall have
attained at least eighteen (18) years of age and shall be a resident of this
state or maintain his or her principal place of business in this
state.
(4) CHANGE OF NAME OR ADDRESS.
(a) A licensed navigator shall,
within 30 days, notify the commissioner in a manner prescribed by the
commissioner of any change in the navigator's name, residence address,
principal place of business, contact email address or mailing
address.
(b) A navigator who is not
employed or supervised by or affiliated with a navigator entity and changes
residency to a location outside of this state or changes his or her principal
place of business to an address outside this state and is not a resident of
this state shall have his or her navigator license terminated effective 60 days
after the change of address.
(c)
Criteria used by the commissioner to evaluate state residency shall include:
1. Jurisdiction for payment of state
taxes.
2. Jurisdiction for
automobile driver's license and motor vehicle registration.
3. Location of voter registration.
4. Location of principal residence, such as
owned or rented dwelling, condominium, or apartment.
5. Location of principal place of
business.
(5) APPLICABILITY OF OTHER LAWS. Licensed navigators are subject to the requirements contained at ss. 628.095, 628.097, and 628.10, Stats., as applicable to individual navigators.
(6) LICENSE RENEWALS.
(a) The nonrefundable renewal fee of $ 35.00
is due before October 1 of each year. The commissioner shall send notice of the
renewal fee in a manner prescribed by the commissioner at least 60 days prior
to the fee due date to each navigator. Applications for navigator license
renewal shall be submitted before the October 1 renewal deadline. The navigator
shall provide proof financial responsibility under sub. (7).
(b) An individual navigator is required to
complete at least 8 hours of accident and health insurance continuing education
training before October 1 of each year. Training must be completed prior
seeking annual renewal of a navigator license. Recurring training shall be
completed and reported at a rate of not less than 8 hours each 12 months of
each compliance period. Training required under this subsection must be
approved by the commissioner and provided by an education provider that is
approved by the commissioner.
(c)
Any navigator whose license is terminated for failing to pay renewal fees or
failing to complete required annual navigator continuing education or revoked
for failing to pay unemployment insurance contributions or failing to pay
delinquent taxes may, within 12 months from the termination or revocation date,
apply to reinstate for the same navigator license without completing
prelicensing navigator training or passing a written examination. The navigator
must satisfy the requirement of s.
628.10(2) (a), (am), or (cm), Stats., satisfactorily complete a
reinstatement application and pay twice the amount of the license renewal fee
under par. (a). If a navigator license has been terminated or revoked for more
than 12 months, the navigator shall, in order to be relicensed, satisfy the
examination and other licensing requirements established by subs. (2) to
(4).
(7) FINANCIAL RESPONSIBILITY REQUIREMENTS. Each individual navigator not affiliated with a navigator entity shall comply with the requirements of s. 628.92(5) (b), Stats., by submitting the original bond and form to the office in the form prescribed by the commissioner or by providing evidence of an equivalent coverage alternative subject to the commissioner's prior approval.
A copy of a sample navigator and navigator entity bond form OCI 11-093, required in sub. (7), may be obtained at no cost from the Office of the Commissioner of Insurance at 125 S. Webster Street, Madison WI 53703, or at the Office's web address: oci.wi.gov.
Disclaimer: These regulations may not be the most recent version. Wisconsin may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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