skip to content

Navigator Payment Policy

Scope

This policy applies to navigators.

Terms and Definitions

Insurance Affordability Program (IAP): Insurance Affordability Programs (IAPs) include Medical Assistance, MinnesotaCare and Advanced Premium Tax Credit (APTC).

Auto Renew: This term applies to those enrolled in an IAP where there was sufficient information available to automatically renew coverage

Need to Renew: This term applies to those enrolled in an IAP where there was not sufficient information to automatically renew coverage. The individual must complete and sign a pre-populated renewal form within 30 days to avoid loss of coverage.

Passive renewal: This term applies to a consumer who is enrolled in a qualified health plan (QHP) through MNsure for the current plan year and MNsure can automatically renew the consumer into the same QHP for the next plan year.

Paper application: Unless otherwise specified, paper application refers to the Application for Health Coverage and Help Paying Costs (DHS-6696) and the Application for Health Coverage (DHS-6741).

Policy Details

MNsure will pay navigator organizations for each individual successfully enrolled in an Insurance Affordability Program (IAP) or qualified health plan (QHP) resulting from the submission of an application through MNsure by a certified navigators.

Effective October 1, 2013, the payment rate is:

  • Seventy and 00/100 dollars ($70.00) per successful enrollment in a QHP.
  • Twenty Five and 00/100 dollars ($25.00) per successful enrollment in Medical Assistance (MA).
  • Seventy and 00/100 dollars ($70.00) per successful enrollment in MinnesotaCare.

Payment rates are set by the MNsure board and any changes to the rate must be published in the State Register. Payments are based on the availability of funding.

Navigator organizations are eligible for payments for:

  • An application (online or paper) that results in a QHP determination (with or without assistance).
  • An application (online or paper) that results in a MA enrollment.
  • An application (online or paper) that results in a MinnesotaCare enrollment.
  • A paper Application for Certain Populations (DHS-3876) that results in a MA enrollment.
  • Assisting with the following renewal actions:
    • MA member in a Need to Renew status that results in a successful renewal.
    • MinnesotaCare member in a Need to Renew status that results in a successful renewal.
    • QHP enrollee in a Need to Renew status that results in a successful renewal.
    • QHP enrollee who actively changes plans for the new plan year.

Navigator organization are not eligible for payment for assisting with:

  • MA member that is auto renewed.
  • MinnesotaCare member that is auto renewed.
  • QHP enrollee that passively renews.
  • Reporting life event changes for those enrolled in an IAP.

Procedures

If a certified navigator assists a consumer with submitting an online application through MNsure, the navigator will be associated for the purposes of payment if any one of the following is true:

  • The consumer enters the navigator's Assister ID and organization on the signature page of the online application.
  • The consumer has an active association with the navigator through the assister portal at the time the application is submitted.
  • The navigator completes an Assister Case Association Form and submits it to the ARC within 30 days of the application submission date.

If a certified navigator assists a consumer with enrolling in a QHP through MNsure (but did not assist with submitting the application, or the consumer was renewing), the navigator will be associated for the purposes of payment if any one of the following is true:

  • The consumer has an active association with the navigator through the assister portal at the time the consumer enrolls in a QHP.
  • The navigator completes an Assister Case Association Form and submits it to the ARC within 30 days of the consumer enrolling in a QHP.

If a certified navigator assists a consumer with submitting a paper application, including the Application for Certain Populations (DHS-3876), the navigator will be associated for the purposes of payment if any one of the following is true:

  • The navigator completes the assister portion of Appendix C on the paper application (note: this option is not available on the DHS-3876).
  • The navigator completes an Assister Case Association Form and submits it to the ARC within 30 days of the application submission date.

If a certified navigator assists a consumer in a Need to Renew status with submitting a renewal form, including the Application for Certain Populations (DHS-3876), the navigator will be associated for the purposes of payment if:

  • The navigator completes an Assister Case Association Form and submits it to the ARC within 30 days of the renewal submission date.

Refer to the Assister Case Association policy for procedures on how to associate with a consumer.

References and Related Documents

Assister Case Association Form (PDF)

Assister Case Association policy

MNsure Grant Services Contract Navigator/In-Person Assister Attachment A (PDF)

MNsure Joint Powers Agreement Navigator/In-Person Assister Attachment A (PDF)

MNsure Grant Services Contract with Tribal Nation Navigator/In-Person Assister Attachment A (PDF)

back to top