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2005-030
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2005-030
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Last modified
7/5/2016 2:27:35 PM
Creation date
9/30/2015 7:40:02 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Addendum
Approved Date
01/18/2005
Control Number
2005-030
Agenda Item Number
11.D.1
Entity Name
Blue Cross and Blue Shield of Florida
Symetra :Life Insurance Co.
Subject
HIPAA-AS Addendum to Agreement
Archived Roll/Disk#
4000
Supplemental fields
SmeadsoftID
3862
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address to file your complaint with the U . S . Department of Health and Human Services upon <br /> request . <br /> We support your right to protect the privacy of your PHI . We will not retaliate in any way if you <br /> choose to file a complaint with us or with the U . S . Department of Health and Human Services , <br /> Contact Office : The Corporate Compliance Office of Blue Cross and Blue Shield of Florida , <br /> administrative service provider for your group health plan . <br /> Telephone : 888- 574-2583 <br /> Address : P . O . Box 44283 , Jacksonville , FL 322034283 <br /> Si usted desea una Copia de esta notiricacion en espanol, por favor comuniquese con un <br /> representante de servicio al cliente utilizando el numero telefonico indicado en su tarjeta <br /> de asegurado. <br /> 15 <br /> HIPAA\BA Amend to ASO Agmt - tini <br /> August 12 , 2004 <br />
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