The Virginia Health Benefit Exchange is excited to be transitioning it’s Exchange from healthcare.gov to its own State-based Exchange platform – Virginia’s Insurance Marketplace! The Virginia Health Benefit Exchange has been eagerly preparing for this transition for Plan Year 2024 and is excited to partner with navigators to meet the needs of Virginians. To learn more about preparations, see the FAQs and Town Hall meeting archive below.
Virginia’s Insurance Marketplace is a marketplace for Virginia, by Virginia. Our collaboration will focus on:
- Meeting the health coverage needs of Virginians
- Supporting consumer choice and education
- Assisting consumers with access to programs and financial assistance
- Supporting continuity of coverage
- Reducing the number of uninsured in Virginia
The Assister-Navigator FAQs file provides a cumulative record of questions and answers. The file is updated frequently, but will always include all existing content so everyone has access to all the information.
Town Hall Meetings
- HBE Agent & Assister Town Hall – Nov.15, 2023
- HBE Agent & Assister Town Hall – Oct. 18, 2023
- HBE Agent & Assister Town Hall – Sept. 20, 2023
- HBE Assister-Navigator Town Hall – Aug. 23, 2023
- HBE Assister-Navigator Town Hall – July 28, 2023
- HBE Assister-Navigator Town Hall – June 28, 2023
- HBE Assister-Navigator Town Hall – May 24, 2023
- HBE Assister-Navigator Town Hall – Apr. 27, 2023
- HBE Assister-Navigator Town Hall – Mar. 28, 2023
“Navigator” is an individual or entity selected to perform activities and duties identified in 42 U.S.C. 18031 (i) in the Commonwealth. A “Navigator” can assist with the insurance application and enrollment processes through the Exchange, but is not permitted to sell, solicit, or negotiate contracts of insurance or annuity.
Individual Navigator Certification Requirements:
- Apply for (or maintain) a registration through the Virginia Bureau of Insurance. Navigators in Virginia must maintain a registration with BOI in accordance with Title 38.2 Chaper 34 Article 7 of the Code of Virginia. Visit the Virginia Portal at Sircon to submit an application for registration with the Bureau of Insurance or to check the status of a license. The application includes fees: $15 Application Fee and $8.55 Sircon Service Fee (approximate).
Note that as part of the BOI registration navigators must submit a Criminal History Request Report (CHRR) that is less than 90 days old.
- Virginia Residents will need to download form (SP-167) from Virginia State Police and have the results mailed back to them.
- Non-residents will need a CHRR from their home state less than 90 days old and have the results mailed back to them.
- Complete navigator and assister training through Virginia's Insurance Marketplace (VIM) Learning Management System (LMS).
- Current Virginia-certified Navigators will be eligible to complete a shorter training program for plan year 2024. You would have received an auto-generated email from email@example.com providing your login ID. Visit VIM LMS to begin.
- Navigators new to the Virginia Exchange will be required to take the full VIM training program for plan year 2024. Navigators without LMS accounts will need to send a request for a new LMS account along with their name, navigator organization name, unique email, unique cell number, and certification number (if applicable) to MarketplaceLMS@scc.virginia.gov.
- Training will be completed at VIM LMS.
- To receive certification of training completion, you must receive a passing score of 80 on module tests. Complete training and pass the tests by October 10 for November 1 Exchange Certification.
- Your navigator organization will create an assister portal account on the VIM Platform on your behalf.
- Verify your profile information in collaboration with your organization.
Navigator Grantee Requirements:
Navigator organizations apply annually for grants awarded by the Exchange pursuant to § 38.2-6513 of the Code of Virginia by submitting the Navigator Request for Applications (RFA). Grants are issued annually by September 1. Once a navigator organization is selected for grant award, it can proceed with the following steps.
The Exchange will create a navigator portal account on the VIM Platform for your organization.
- Verify the information on this portal account is accurate.
- Create assister portal accounts on the VIM Platform for all navigators operating under your organization.
- Require navigators to complete (or maintain) required registration through the Virginia Bureau of Insurance, complete navigator and assister training through the VIM Learning Management System and create portal accounts.
- Navigator Grantees will provide Navigator Program Services to the SCC in accordance with the RFA, the grantee’s executed Navigator Agreement, and applicable federal and state law. Questions regarding the Navigator Program should be sent to Navigatorprogram@scc.virginia.gov.
Registered navigators are required to report the following to the Commission at Assisterprograms@scc.virginia.gov within 30 days:
- Any felony convictions (include facts and circumstances around conviction)
- Any administrative action taken against the navigator in another state or by another governmental agency in the Commonwealth
Standards of ConductA navigator shall not:
- Engage in any activity that would require an insurance agent license
- Offer advice about which qualified health or dental plan is better or worse for an individual or employer
- Act as an intermediary between employer and insurer that offers qualified health or dental plans offered through an exchange
- Violate any unfair trade practice and privacy requirements applicable to the activities of navigators
- Receive compensation for services or duties as a navigator, including compensation from health carriers
- Being selected as such in accordance with federal or state law
- Having evidence of successful completion of all navigator requirements prescribed by the Virginia Exchange
- Meeting additional requirements outlined in §38.2-3457
If any individual or entity engages in one or more of the prohibited activities above, a complaint may be filed with the Commission. If the complaint is verified after investigation, the individual or entity may be ordered to cease and desist further prohibited conduct.