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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>80784</law_id><section_number>38.2-6513</section_number><catch_line>Navigators</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>38.2-6505</reference></referred_to_by><structure><unit label="title" level="1" order_by="1" identifier="38.2">Insurance</unit><unit label="chapter" level="2" order_by="1" identifier="65">Virginia Health Benefit Exchange</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> No <span class="dictionary">person</span> shall act as a <span class="dictionary">Navigator</span> unless the <span class="dictionary">person</span> is registered pursuant to Article 7 (&#xA7; <a class="law" title="Definitions" href="/38.2-3455/">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. <a id="paragraph-289559" class="section-permalink" href="https://vacode.org/38.2-6513/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> The Exchange shall establish a program under which it shall award grants to <span class="dictionary">Navigators</span> to carry out the following duties: <a id="paragraph-289560" class="section-permalink" href="https://vacode.org/38.2-6513/#B"><i class="fa fa-link"/></a></p></section>
						<section id="B1" class="indent-1"><p><span class="prefix-number">1.</span> Conduct public education activities to raise awareness of the availability of <span class="dictionary">qualified health plans</span>, <span class="dictionary">qualified dental plans</span>, the <span class="dictionary">State Medicaid Program</span>, and <span class="dictionary">FAMIS</span>; <a id="paragraph-289561" class="section-permalink" href="https://vacode.org/38.2-6513/#B1"><i class="fa fa-link"/></a></p></section>
						<section id="B2" class="indent-1"><p><span class="prefix-number">2.</span> Distribute fair and impartial information concerning enrollment in <span class="dictionary">qualified health plans</span>, <span class="dictionary">qualified dental plans</span>, the <span class="dictionary">State Medicaid Program</span>, and <span class="dictionary">FAMIS</span> and the availability of premium tax credits under &#xA7; 36B of the Internal Revenue Code of 1986 and cost-sharing reductions under &#xA7; 1402 of the <span class="dictionary">Federal Act</span>; <a id="paragraph-289562" class="section-permalink" href="https://vacode.org/38.2-6513/#B2"><i class="fa fa-link"/></a></p></section>
						<section id="B3" class="indent-1"><p><span class="prefix-number">3.</span> Provide in-<span class="dictionary">person</span> assistance to facilitate enrollment in <span class="dictionary">qualified health plans</span>, <span class="dictionary">qualified dental plans</span>, the <span class="dictionary">State Medicaid Program</span>, and <span class="dictionary">FAMIS</span>; <a id="paragraph-289563" class="section-permalink" href="https://vacode.org/38.2-6513/#B3"><i class="fa fa-link"/></a></p></section>
						<section id="B4" class="indent-1"><p><span class="prefix-number">4.</span> Provide referrals to any applicable office of health <span class="dictionary">insurance</span> consumer assistance or health <span class="dictionary">insurance</span> ombudsman established under &#xA7; 2793 of the <span class="dictionary">PHSA</span>, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding his <span class="dictionary">health benefit plan</span>, coverage, or a determination under that plan or coverage; <a id="paragraph-289564" class="section-permalink" href="https://vacode.org/38.2-6513/#B4"><i class="fa fa-link"/></a></p></section>
						<section id="B5" class="indent-1"><p><span class="prefix-number">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 <span class="dictionary">Navigator</span> tools and functions for individuals with disabilities in accordance with the Americans with Disabilities Act (P.L. 101-336) and &#xA7; 504 of the Rehabilitation Act as required by 45 C.F.R. &#xA7; 155.210; and <a id="paragraph-289565" class="section-permalink" href="https://vacode.org/38.2-6513/#B5"><i class="fa fa-link"/></a></p></section>
						<section id="B6" class="indent-1"><p><span class="prefix-number">6.</span> Assist consumers with post-enrollment activities, including completing verification requests, accessing Special Enrollment Periods, accessing health <span class="dictionary">insurance</span> related tax forms, and assisting with complex cases and <span class="dictionary">appeals</span>. <a id="paragraph-289566" class="section-permalink" href="https://vacode.org/38.2-6513/#B6"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> To be eligible to receive a grant under subsection B, a <span class="dictionary">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 <span class="dictionary">qualified health plan</span>. <a id="paragraph-289567" class="section-permalink" href="https://vacode.org/38.2-6513/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> The Exchange shall develop standards, consistent with any standards developed by the <span class="dictionary">Secretary</span>, to ensure that information made available by <span class="dictionary">Navigators</span> is fair, accurate, and impartial. <a id="paragraph-289568" class="section-permalink" href="https://vacode.org/38.2-6513/#D"><i class="fa fa-link"/></a></p></section>
						<section id="E"><p><span class="prefix-number">E.</span> <span class="dictionary">Navigators</span> shall comply with all requirements of Article 7 (&#xA7; <a class="law" title="Definitions" href="/38.2-3455/">38.2-3455</a> et seq.) of Chapter 34, including successful completion of training programs established by the Exchange for individual <span class="dictionary">Navigators</span>. <a id="paragraph-289569" class="section-permalink" href="https://vacode.org/38.2-6513/#E"><i class="fa fa-link"/></a></p></section></text><history>2020, cc. 916, 917.</history><metadata></metadata></law>
