{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-6513.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-6513.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-6513.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-6513.html"}],"law_id":80784,"edition_id":1,"section_id":80784,"structure_id":12800,"section_number":"38.2-6513","catch_line":"Navigators","history":"2020, cc. 916, 917.","full_text":"A\n\nNo person shall act as a Navigator unless the person is registered pursuant to Article 7 (§ 38.2-3455 et seq.) of Chapter 34 and is certified by either the U.S. Department of Health and Human Services or the Exchange.B\n\nThe Exchange shall establish a program under which it shall award grants to Navigators to carry out the following duties:1\n\nConduct public education activities to raise awareness of the availability of qualified health plans, qualified dental plans, the State Medicaid Program, and FAMIS;2\n\nDistribute fair and impartial information concerning enrollment in qualified health plans, qualified dental plans, the State Medicaid Program, and FAMIS and the availability of premium tax credits under § 36B of the Internal Revenue Code of 1986 and cost-sharing reductions under § 1402 of the Federal Act;3\n\nProvide in-person assistance to facilitate enrollment in qualified health plans, qualified dental plans, the State Medicaid Program, and FAMIS;4\n\nProvide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under § 2793 of the PHSA, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding his health benefit plan, coverage, or a determination under that plan or coverage;5\n\nProvide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange and ensure accessibility and usability of Navigator tools and functions for individuals with disabilities in accordance with the Americans with Disabilities Act (P.L. 101-336) and § 504 of the Rehabilitation Act as required by 45 C.F.R. § 155.210; and6\n\nAssist consumers with post-enrollment activities, including completing verification requests, accessing Special Enrollment Periods, accessing health insurance related tax forms, and assisting with complex cases and appeals.C\n\nTo be eligible to receive a grant under subsection B, a Navigator shall demonstrate to the Exchange involved that it has existing relationships, or could readily establish relationships, with employers and employees, consumers, including uninsured and underinsured consumers, or self-employed individuals likely to be qualified to enroll in a qualified health plan.D\n\nThe Exchange shall develop standards, consistent with any standards developed by the Secretary, to ensure that information made available by Navigators is fair, accurate, and impartial.E\n\nNavigators shall comply with all requirements of Article 7 (§ 38.2-3455 et seq.) of Chapter 34, including successful completion of training programs established by the Exchange for individual Navigators.","order_by":null,"text":{"0":{"id":289559,"text":"No person shall act as a Navigator unless the person is registered pursuant to Article 7 (§ 38.2-3455 et seq.) of Chapter 34 and is certified by either the U.S. Department of Health and Human Services or the Exchange.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":289560,"text":"The Exchange shall establish a program under which it shall award grants to Navigators to carry out the following duties:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"B1"},"2":{"id":289561,"text":"Conduct public education activities to raise awareness of the availability of qualified health plans, qualified dental plans, the State Medicaid Program, and FAMIS;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"3":{"id":289562,"text":"Distribute fair and impartial information concerning enrollment in qualified health plans, qualified dental plans, the State Medicaid Program, and FAMIS and the availability of premium tax credits under § 36B of the Internal Revenue Code of 1986 and cost-sharing reductions under § 1402 of the Federal Act;","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"4":{"id":289563,"text":"Provide in-person assistance to facilitate enrollment in qualified health plans, qualified dental plans, the State Medicaid Program, and FAMIS;","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B4"},"5":{"id":289564,"text":"Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under § 2793 of the PHSA, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding his health benefit plan, coverage, or a determination under that plan or coverage;","type":"section","prefixes":["B","4"],"prefix":"4","entire_prefix":"B4","prefix_anchor":"B4","level":2,"prior_prefix":"B3","next_prefix":"B5"},"6":{"id":289565,"text":"Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange and ensure accessibility and usability of Navigator tools and functions for individuals with disabilities in accordance with the Americans with Disabilities Act (P.L. 101-336) and § 504 of the Rehabilitation Act as required by 45 C.F.R. § 155.210; and","type":"section","prefixes":["B","5"],"prefix":"5","entire_prefix":"B5","prefix_anchor":"B5","level":2,"prior_prefix":"B4","next_prefix":"B6"},"7":{"id":289566,"text":"Assist consumers with post-enrollment activities, including completing verification requests, accessing Special Enrollment Periods, accessing health insurance related tax forms, and assisting with complex cases and appeals.","type":"section","prefixes":["B","6"],"prefix":"6","entire_prefix":"B6","prefix_anchor":"B6","level":2,"prior_prefix":"B5","next_prefix":"C"},"8":{"id":289567,"text":"To be eligible to receive a grant under subsection B, a Navigator shall demonstrate to the Exchange involved that it has existing relationships, or could readily establish relationships, with employers and employees, consumers, including uninsured and underinsured consumers, or self-employed individuals likely to be qualified to enroll in a qualified health plan.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B6","next_prefix":"D"},"9":{"id":289568,"text":"The Exchange shall develop standards, consistent with any standards developed by the Secretary, to ensure that information made available by Navigators is fair, accurate, and impartial.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"10":{"id":289569,"text":"Navigators shall comply with all requirements of Article 7 (§ 38.2-3455 et seq.) of Chapter 34, including successful completion of training programs established by the Exchange for individual Navigators.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D"}},"ancestry":[{"id":12800,"edition_id":1,"name":"Virginia Health Benefit Exchange","identifier":"65","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:43:53","date_modified":"2026-06-26 03:43:53","permalink":{"id":218345,"object_type":"structure","relational_id":12800,"identifier":"65","token":"38.2\/65","url":"\/38.2\/65\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":75766,"structure_id":12800,"section_number":"38.2-6500","catch_line":"Definitions","url":"\/38.2-6500\/","token":"38.2\/65\/38.2-6500","metadata":false},{"id":84565,"structure_id":12800,"section_number":"38.2-6501","catch_line":"Exchange objectives","url":"\/38.2-6501\/","token":"38.2\/65\/38.2-6501","metadata":false},{"id":59610,"structure_id":12800,"section_number":"38.2-6502","catch_line":"Division established; Exchange created","url":"\/38.2-6502\/","token":"38.2\/65\/38.2-6502","metadata":false},{"id":74872,"structure_id":12800,"section_number":"38.2-6503","catch_line":"Advisory Committee","url":"\/38.2-6503\/","token":"38.2\/65\/38.2-6503","metadata":false},{"id":55843,"structure_id":12800,"section_number":"38.2-6504","catch_line":"Exchange requirements","url":"\/38.2-6504\/","token":"38.2\/65\/38.2-6504","metadata":false},{"id":76462,"structure_id":12800,"section_number":"38.2-6505","catch_line":"Duties of Exchange","url":"\/38.2-6505\/","token":"38.2\/65\/38.2-6505","metadata":false},{"id":81163,"structure_id":12800,"section_number":"38.2-6506","catch_line":"Certification of health benefit plans as qualified health plans","url":"\/38.2-6506\/","token":"38.2\/65\/38.2-6506","metadata":false},{"id":81440,"structure_id":12800,"section_number":"38.2-6507","catch_line":"Appeal of decertification or denial of certification","url":"\/38.2-6507\/","token":"38.2\/65\/38.2-6507","metadata":false},{"id":67396,"structure_id":12800,"section_number":"38.2-6508","catch_line":"Open enrollment periods","url":"\/38.2-6508\/","token":"38.2\/65\/38.2-6508","metadata":false},{"id":84381,"structure_id":12800,"section_number":"38.2-6509","catch_line":"Choice","url":"\/38.2-6509\/","token":"38.2\/65\/38.2-6509","metadata":false},{"id":67117,"structure_id":12800,"section_number":"38.2-6510","catch_line":"Health Insurance Exchange Fund; assessment","url":"\/38.2-6510\/","token":"38.2\/65\/38.2-6510","metadata":false},{"id":62589,"structure_id":12800,"section_number":"38.2-6511","catch_line":"Procurement, contracting, and personnel","url":"\/38.2-6511\/","token":"38.2\/65\/38.2-6511","metadata":false},{"id":77639,"structure_id":12800,"section_number":"38.2-6512","catch_line":"Confidentiality","url":"\/38.2-6512\/","token":"38.2\/65\/38.2-6512","metadata":false},{"id":80784,"structure_id":12800,"section_number":"38.2-6513","catch_line":"Navigators","url":"\/38.2-6513\/","token":"38.2\/65\/38.2-6513","metadata":false},{"id":85399,"structure_id":12800,"section_number":"38.2-6514","catch_line":"Certified application counselors","url":"\/38.2-6514\/","token":"38.2\/65\/38.2-6514","metadata":false},{"id":82556,"structure_id":12800,"section_number":"38.2-6515","catch_line":"Regulations","url":"\/38.2-6515\/","token":"38.2\/65\/38.2-6515","metadata":false},{"id":53968,"structure_id":12800,"section_number":"38.2-6516","catch_line":"Reports","url":"\/38.2-6516\/","token":"38.2\/65\/38.2-6516","metadata":false},{"id":58428,"structure_id":12800,"section_number":"38.2-6517","catch_line":"Relation to other laws","url":"\/38.2-6517\/","token":"38.2\/65\/38.2-6517","metadata":false}],"previous_section":{"id":77639,"structure_id":12800,"section_number":"38.2-6512","catch_line":"Confidentiality","url":"\/38.2-6512\/","token":"38.2\/65\/38.2-6512","metadata":false},"next_section":{"id":85399,"structure_id":12800,"section_number":"38.2-6514","catch_line":"Certified application counselors","url":"\/38.2-6514\/","token":"38.2\/65\/38.2-6514","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-6513\/","history_text":"

This law was first created in 2020. The record of its establishment is cataloged in chapters 916<\/a> and 917<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year.<\/p>","references":[{"id":76462,"section_number":"38.2-6505","catch_line":"Duties of Exchange","order_by":null,"url":"\/38.2-6505\/"}],"refers_to":[{"id":64550,"section_number":"38.2-3455","catch_line":"Definitions","order_by":null,"url":"\/38.2-3455\/"}],"permalink":{"id":218399,"object_type":"law","relational_id":80784,"identifier":"38.2-6513","token":"38.2\/65\/38.2-6513","url":"\/38.2-6513\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-6513\/","token":"38.2\/65\/38.2-6513","dublin_core":{"Title":"Navigators","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-6513","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> No person<\/span> shall act as a Navigator<\/span> unless the person<\/span> is registered pursuant to Article 7 (§ 38.2-3455<\/a> et seq.) of Chapter 34 and is certified by either the U.S. Department of Health and Human Services or the Exchange. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The Exchange shall establish a program under which it shall award grants to Navigators<\/span> to carry out the following duties: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Conduct public education activities to raise awareness of the availability of qualified health plans<\/span>, qualified dental plans<\/span>, the State Medicaid Program<\/span>, and FAMIS<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Distribute fair and impartial information concerning enrollment in qualified health plans<\/span>, qualified dental plans<\/span>, the State Medicaid Program<\/span>, and FAMIS<\/span> and the availability of premium tax credits under § 36B of the Internal Revenue Code of 1986 and cost-sharing reductions under § 1402 of the Federal Act<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Provide in-person<\/span> assistance to facilitate enrollment in qualified health plans<\/span>, qualified dental plans<\/span>, the State Medicaid Program<\/span>, and FAMIS<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Provide referrals to any applicable office of health insurance<\/span> consumer assistance or health insurance<\/span> ombudsman established under § 2793 of the PHSA<\/span>, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding his health benefit plan<\/span>, coverage, or a determination under that plan or coverage; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange and ensure accessibility and usability of Navigator<\/span> tools and functions for individuals with disabilities in accordance with the Americans with Disabilities Act (P.L. 101-336) and § 504 of the Rehabilitation Act as required by 45 C.F.R. § 155.210; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> Assist consumers with post-enrollment activities, including completing verification requests, accessing Special Enrollment Periods, accessing health insurance<\/span> related tax forms, and assisting with complex cases and appeals<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> To be eligible to receive a grant under subsection B, a Navigator<\/span> shall demonstrate to the Exchange involved that it has existing relationships, or could readily establish relationships, with employers and employees, consumers, including uninsured and underinsured consumers, or self-employed individuals likely to be qualified to enroll in a qualified health plan<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> The Exchange shall develop standards, consistent with any standards developed by the Secretary<\/span>, to ensure that information made available by Navigators<\/span> is fair, accurate, and impartial. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> Navigators<\/span> shall comply with all requirements of Article 7 (§ 38.2-3455<\/a> et seq.) of Chapter 34, including successful completion of training programs established by the Exchange for individual Navigators<\/span>. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nNAVIGATORS (\u00a7 38.2-6513)\n\nA. No person shall act as a Navigator unless the person is registered pursuant\nto Article 7 (§ 38.2-3455 et seq.) of Chapter 34 and is certified by either\nthe U.S. Department of Health and Human Services or the Exchange.\n\nB. The Exchange shall establish a program under which it shall award grants to\nNavigators to carry out the following duties:\n\n 1. Conduct public education activities to raise awareness of the availability\n of qualified health plans, qualified dental plans, the State Medicaid Program,\n and FAMIS;\n\n 2. Distribute fair and impartial information concerning enrollment in\n qualified health plans, qualified dental plans, the State Medicaid Program,\n and FAMIS and the availability of premium tax credits under § 36B of the\n Internal Revenue Code of 1986 and cost-sharing reductions under § 1402 of\n the Federal Act;\n\n 3. Provide in-person assistance to facilitate enrollment in qualified health\n plans, qualified dental plans, the State Medicaid Program, and FAMIS;\n\n 4. Provide referrals to any applicable office of health insurance consumer\n assistance or health insurance ombudsman established under § 2793 of the\n PHSA, or any other appropriate state agency or agencies, for any enrollee with\n a grievance, complaint, or question regarding his health benefit plan,\n coverage, or a determination under that plan or coverage;\n\n 5. Provide information in a manner that is culturally and linguistically\n appropriate to the needs of the population being served by the Exchange and\n ensure accessibility and usability of Navigator tools and functions for\n individuals with disabilities in accordance with the Americans with\n Disabilities Act (P.L. 101-336) and § 504 of the Rehabilitation Act as\n required by 45 C.F.R. § 155.210; and\n\n 6. Assist consumers with post-enrollment activities, including completing\n verification requests, accessing Special Enrollment Periods, accessing health\n insurance related tax forms, and assisting with complex cases and appeals.\n\nC. To be eligible to receive a grant under subsection B, a Navigator shall\ndemonstrate to the Exchange involved that it has existing relationships, or\ncould readily establish relationships, with employers and employees, consumers,\nincluding uninsured and underinsured consumers, or self-employed individuals\nlikely to be qualified to enroll in a qualified health plan.\n\nD. The Exchange shall develop standards, consistent with any standards developed\nby the Secretary, to ensure that information made available by Navigators is\nfair, accurate, and impartial.\n\nE. Navigators shall comply with all requirements of Article 7 (§ 38.2-3455\net seq.) of Chapter 34, including successful completion of training programs\nestablished by the Exchange for individual Navigators.\n\nHISTORY: 2020, cc. 916, 917.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}