CMS funds GAPHC under the Affordable Care Act as part of national efforts to assist and educate eligible consumers with selecting a health care plan. Navigator duties include:
Maintain expertise in eligibility, enrollment, and program specifications.
Conduct public education activities to raise awareness about the Exchange.
Provide information and services in a fair, accurate, and impartial manner. Such information must acknowledge other health programs (such as Medicaid and the Children’s Health Insurance Program (CHIP).
Facilitate selection of a Qualified Health Plan.
Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under Section 2793 of the Public Health Service Act, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage.
Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange, including individuals with limited English proficiency, and ensure accessibility and usability of Navigator tools, such as fact sheets, and functions for individuals with disabilities in accordance with the Americans with Disabilities Act and Section 504 of the Rehabilitation Act.
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