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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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EXHIBIT 2—EMPLOYER ' S CERTIFICATION <br /> PART 1 – Employer to Amend Plan Documents for Privacy provisions <br /> Employer certifies that Employer has amended GHP ' s Plan Document to incorporate the provisions <br /> required by 45 C . F . R . § 164 . 504(f)(2 ), as set forth below, and agrees to comply with GHP <br />' s Plan <br /> Document as amended. <br /> 1 . Neither use nor further disclose Protected Health Information, except as permitted or required by <br /> GHP ' s Plan Document or as required by law. <br /> 2 . Neither use nor disclose Protected Health Information for any employment-related action or <br /> decision, or in connection with any other benefit or employee benefit plan of Employer. <br /> 3 . Ensure adequate separation between Employer and GHP by (a) describing those employees or <br /> classes of employees or other persons under Employer ' s control who will be given access to <br /> Protected Health Information to perform plan administration functions for GHP , (b) restricting the <br /> access to and use of Protected Health Information by such employees or other persons to the plan <br /> administration functions that Employer will perform for GHP , and ( c) instituting an effective <br /> mechanism for resolving any noncompliance with GHP ' s Plan Document by such employees or <br /> other persons . <br /> 4 . Ensure that any subcontractor or agent to which Employer provides Protected Health Information <br /> agrees to the restrictions and conditions of GHP ' s Plan Document with respect to Protected Health <br /> Information. <br /> 5 . Report to GHP any use or disclosure of Protected Health Information of which Employer becomes <br /> aware that is inconsistent with the uses and disclosures allowed by GHP ' s Plan Document , <br /> 6 , Make Protected Health Information available to GHP or, at GHP ' s direction, to the Covered <br /> Person who is the subject of Protected Health Information (or the Covered Person ' s Personal <br /> Representative) so that GHP can meet its access obligations under 45 C . F . R. § 164 . 524 . <br /> 7 , Make Protected Health Information available to GHP for amendment and, on notice from GHP , <br /> amend Protected Health Information, so that GHP can meet its amendment obligations under 45 <br /> C . F . R. § 164 . 526 . <br /> 8 , Record Disclosure Information as defined above for each disclosure that Employer makes of <br /> Protected Health Information that is not excepted from disclosure accounting and provide that <br /> Disclosure Information to GHP on request so that GHP can meet its disclosure accounting <br /> obligations under 45 C . F . R. § 164 . 528 . <br /> 9 . Make its internal practices, books, and records relating to its use and disclosure of Protected <br /> Health Information available to GHP and to DHHS to determine GHP ' s compliance with 45 <br /> C . F . R . Part 164, Subpart E "Privacy of Individually Identifiable Health Information. " <br /> 10 . Return to GHP or destroy if feasible all Protected Health Information in whatever form or medium <br /> that Employer ( and any subcontractor or agent of Employer) received from GHP or Administrator, <br /> 16 <br /> HIPAA\BA Amend to ASO Agmt - fini <br /> August 12 , 2004 <br />
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