HomeMy WebLinkAboutAddenda - RFP - P832 BENEFITS (4)AMENDMENT NUMBER 4 TO THE
CITY OF FORT COLLINS GROUP COMPREHENSIVE DENTAL PLAN
GROUP #1857
Effective April 14, 2003, the City of Fort Collins Group Dental Plan is amended to add Part 8 for
the purpose of complying with the privacy requirements of the Health Insurance Portability and
Accountability Act (HIPAA) of 1986.
Part 8 HIPAA PRIVACY COMPLIANCE
8.1 Pu�ose
This article is intended to adopt Plan policies and procedures consistent with the Standards
for Privacy of Individually Identifiable Health Information of the Health Insurance Portability
and Accountability Act of 1996 (HIPAA), and the Final Rules as published by the Office of
the Secretary, Department of Health and Human Services in the Federal Register and found
at 45 C.F.R. Part 160 and Part 164 ("Privacy Regulations"), and any amendments thereto.
8.2 Use and Disclosure of Protected Health Information by Plan Sponsor
The Plan Sponsor may use and disclose protected health information, as that term is defined
in 45 C.F.R. , 164.501, only as expressly provided under the Privacy Regulations and the
terms and conditions of this Plan Document.
8.3 Disclosures by the Plan to the Plan Sponsor.
The Plan Sponsor will:
(A) Not use or further disclose the information other than as permitted or required by the
plan documents or as required by law;
(B) Ensure that any agents, including subcontractors, to whom it provides protected
health information received from the Plan agree to the same restrictions and
conditions that apply to the Plan Sponsor with respect to such information;
(C) Not use or disclose the information for employment -related actions and decisions or
in connection with any other benefit or employee benefit Plan of the Plan Sponsor
without the written authorization of the Participant;
(D) Report to the Plan any use or disclosure of the information that is inconsistent with
the uses or disclosures provided for herein of which it becomes aware;
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B. Appropriate Safeguards. The Parties will establish and maintain appropriate safeguards to prevent
any use or disclosure of the Protected Information other than as provided for by this Contract.
C. Reports of Disclosures. The Parties shall maintain information related to its disclosures of
Protected Information sufficient to provide each other with any necessary accounting of such
disclosures and shall promptly notify the other of any such disclosures in a manner acceptable to
the Parties.
D. Reports of Improper Use or Disclosure. The Parties hereby agree that they shall promptly report to
each other any use or disclosure of Protected Information not provided for or allowed by this
Contract.
E. Subcontractors and Agents. The Parties hereby agree that anytime Protected Information is
provided or made available to any subcontractors or agents, the disclosing Party must enter into a
subcontract with the subcontractor or agent that contains the same terns, conditions and
restrictions on the use and disclosure of Protected Information as contained in this Contract.
F. Right of Access to Protected Information. To the extent required by the federal regulations
regarding privacy and promulgated with respect to HIPAA, found at Title 45 CFR Parts 160 and
164, the Parties hereby agree to make available and provide a right of access to Protected
Information by an Individual. This right of access shall conform with and meet all of the
requirements of 45 C.F.R. 164.524 to the same extent as if the Party were directly subject to 45
C.F.R.164.524.
G. Amendment and Incorporation of Amendments. To the extent required by the federal regulations
regarding privacy and promulgated with respect to HIPAA, found at Title 45 CFR Parts 160 and
164, the Parties agree to make Protected Information available for amendment and to incorporate
any amendments to Protected Information in accordance with 45 C.F.R.164.526 to the same extent
as if the Party were directly subject to 45 C.F.R. 164.526.
H. Provide Accounting. To the extent required by the federal regulations regarding privacy and
promulgated with respect to HIPAA, found at Title 45 CFR Parts 160 and 164, the Parties agree to
make Protected Information available as required to provide an accounting of disclosures in
accordance with 45 C.F.R. 164.528 to the same extent as if the Party were directly subject to 45
C.F.R. 164.528.
I. Access to Books and Records. The Parties hereby agree to make their respective internal practices,
books, and records relating to the use or disclosure of Protected Information available to the
Secretary or the Secretary's designee for purposes of determining compliance with the HHS
Privacy Regulations. The Parties hereby agree to make their internal practices, books, and records
relating to the use or disclosure of Protected Information reasonably available to each other.
J. Return or Destruction of Protected Information. At termination of this Contract each Party hereby
agrees to return or destroy all Protected Information received from, or created or received by the
other, and not to retain any copies of the Protected Information after termination of this Contract,
if reasonably feasible. If return or destruction of the Protected Information is not feasible, the
Parties agree to extend the protections of this Contract for as long as necessary to safeguard the
Protected Information and to limit any further use or disclosure consistently with the intent of this
Contract. If a Party elects to destroy the Protected Information, it shall certify to the other Party
that the Protected Information has been destroyed.
K. Mitigation Procedures. The Parties agree to have procedures in place, and to implement those
procedures as necessary, for mitigating, to the extent practicable, any deleterious effect from the
use or disclosure of Protected Information in a manner not consistent with this Contract.
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L. Minimum Necessary. When using or disclosing Protected Information under this Contract, or
when requesting Protected Information from another party for purposes related to this Contract, a
Party shall make reasonable efforts to limit Protected Information to the minimum necessary to
accomplish the intended purpose of the use, disclosure or request.
Termination of Contract. The Parties agree that each party has the right to terminate this Contract and
seek relief under section 12 of this Contract if it determines that the other Party has violated a material
term of this Contract.
10. Choice of Law. This Contract shall be governed by the law of the State of Colorado except that for
purposes of privacy rights of individuals, the law of the state in which the individual resided during the
event(s) giving rise to the need to determine the individual's rights related to disclosures under this
Contract shall apply, except to the extent that HHS Privacy Regulations may supersede such state law..
11. In
iunctive Relief. Notwithstanding any rights or remedies provided for in this Contract, each Party
retains all rights to seek injunctive relief to prevent or stop the unauthorized use or disclosure of
Protected Information by the other Party or any agent, contractor or third party that received Protected
Information.
12. Indemnification. To the extent allowed by law, each party hereby agrees to hold the other Party
harmless and to indemnify the other Party against any claim, assertion, or allegation brought against
the indemnified Party, and related damages, awards, expense, court costs, reasonable attorney's fees,
and fines or penalties, arising from the indemnifying Party's wrongful use or disclosure of Protected
Information and against the indemnifying Party's failure to maintain adequate safeguards for Protected
Information or other breach of this Contract.
13. Miscellaneous:
A. Binding Nature and Assignment. This Contract shall be binding on the Parties hereto and their
successors and assigns, but neither Party may assign this Agreement without the prior written
consent of the other, which consent shall not be unreasonably withheld.
B. Notices. Whenever under this Contract one Party is required to give notice to the other, such
notice shall be deemed given if mailed by First Class United States mail, postage prepaid, and
addressed as follows:
Great -West Life & Annuity Insurance Company
8515 E. Orchard Road
Greenwood Village, Colorado 80111
James B. O'Neill 11, CPPO
Director of Purchasing and Risk Management
City of Fort Collins
PO Box 580
Fort Collins, CO 80522-0580
Either Party may at any time change its address for notification purposes by mailing a notice
stating the change and setting forth the new address.
C. Good Faith. The Parties agree to exercise good faith in the performance of this Contract.
D. Article Headings. The article headings used are for reference and convenience only, and shall
not enter into the interpretation of this Contract.
E. Force Majeure. A Party shall be excused from performance under this Contract for any period
that Party is prevented from performing any services pursuant hereto, in whole or in part, as a
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result of an Act of God, war, civil disturbance, court order, labor dispute or other cause
beyond its reasonable control, and such nonperformance shall not be grounds for termination.
F. Attorney's fees. Except as otherwise specified in this Contract, if any legal action or other
proceeding is brought for the enforcement of this Contract, or because of an alleged dispute,
breach, default, misrepresentation, or injunctive action, in connection with any of the
Provisions of this Contract, each Party shall bear its own legal expenses and the other cost
incurred in that action or proceeding.
G. Entire Agreement. This Contract consists of this document, and constitutes the entire
agreement between the Parties for HIPAA privacy issues only. There are no understandings or
agreements relating to this Agreement which are not fully expressed in this Contract and no
change, waiver or discharge of obligations arising under this Contract shall be valid unless in
writing and executed by the Party against whom such change, waiver or discharge is sought to
be enforced.
IN WITNESS WHEREOF, the Parties have caused this Contract to be signed and delivered by their duly
authorized representatives, as of the date set forth above.
CONTRACTOR
B0`e:
� " v
P James B. O'Neill II, CPPO
Title: Director of Purchasing and Risk Mgt.
Contractholder Name: City of Fort Collins
Contractholder Address: PO Box 580
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COMPANY
By:
Print Name: e Z
G
Title:
Fort Collins, CO 80522-0580
(E) Make available protected health information in accordance with ' 164.524 of the
Privacy Regulations that provides individuals a right of access to inspect and obtain
copies of protected health information about the individual contained in a designated
record set;
(F) Make available protected health information for amendment and incorporate any
amendments to protected health information in accordance with ' 164.526 of the
Privacy Regulations;
(G) Make available the information required to provide an accounting of disclosures in
accordance with ' 164.528 of the Privacy Regulations;
(H) Make its internal practices, books, and records relating to the use and disclosure of
protected health information received from the Plan available to the Secretary of the
Department of Health and Human Services or those acting under the authority or at
the direction of the Secretary for purposes of determining compliance by the Plan
with the Privacy Regulations;
(n If feasible, return or destroy all protected health information received from the Plan
that the Plan Sponsor still maintains in any form and retain no copies of such
information when no longer needed for the purpose for which disclosure was made,
except that, if such return or destruction is not feasible, the Plan Sponsor will limit
Further uses and disclosures to those purposes that make the return or destruction of
the information infeasible; and
(J) Ensure that the adequate separation required in ' 164.504(0(2)(iii) of the Privacy
Regulations is established.
8.4 Disclosures by Others to the Plan Sponsor
The Plan Sponsor shall be entitled to receive protected health information from:
(A) the Plan;
(B) any business associate of the Plan;
(C) any person or entity that contracts with such business associate;
(D) any person or entity that contracts with the Plan Sponsor to provide services to or on
behalf of the Plan;
(E) any health insurer or health insurance issuer or HMO that provides health benefits
coverage or services to or on behalf of the Plan;
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(F) any health care clearinghouse that provides services to or on behalf of the Plan or
with respect to Plan Participants; and
(G) any other person or entity that maintains, or has the authority to direct the disclosure
of, protected health information related to any Plan Participant.
8.5 Adequate Separation
(A) Only those persons or classes of persons described below that are under the control
of the Plan Sponsor shall be given access to protected health information that is
disclosed to or otherwise obtained by the Plan Sponsor; provided that any employee
or person under the control of the Plan Sponsor who receives protected health
information relating to payment under, health care operations of, or other matters
pertaining to, the Plan in the ordinary course of business shall be included and treated
as such a person or as within the class of persons described below:
(1) the Benefits Administrator;
(2) the Director of Human Resources;
(3) the Benefits work group within the Human Resources Department;
(4) the employees who perform functions related to the Plan, including
but not limited to legal and systems personnel.
(B) The persons and classes of persons described in paragraph (A) above shall be given
access to and permitted to use protected health information that is disclosed to or
otherwise obtained by the Plan Sponsor solely for Plan purposes and functions set
forth in this article.
(C) Any person or class of persons described in paragraph (A) above who obtains access
to or uses protected health information in a manner that it contrary to the
requirements of this article shall be subject to the Plan Sponsor's disciplinary policies
and procedures up to and including termination of employment. Regardless of
whether a person is disciplined or terminated pursuant to this article or the Plan
Sponsor's disciplinary policies and procedures, the Plan reserves the right to direct
that the Plan Sponsor, and upon receipt of such direction the Plan Sponsor shall,
modify or revoke any person's access to or use of protected health information.
8.6 Permitted and Required Use and Disclosure of Protected Health Information
(A) Permitted Uses and Disclosures. The Plan Sponsor is and shall be entitled to use and
disclose any protected health information obtained pursuant to the authority set forth
in this Plan Document, and any other information that may reasonably be deemed to
be protected health information, regardless of the source of such information, that
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comes into the possession of the Plan Sponsor, without the Participant's
authorization, only for the following purposes:
(1) to provide treatment to you;
(2) to provide payment -related activities, such as, to make or receive payment or
to process claims;
(3) to conduct business -related activities, such as, to evaluate the service
provided by a Plan administrator or other business associate, improve Plan
provisions, reduce health costs, request proposals for services to be provided
to or on behalf of the Plan, investigate allegations of fraud or other unlawful
acts related to the Plan, or audit payments for claims incurred under the Plan;
(4) for public health activities, such as, to report suspected child abuse, the
occurrence of certain diseases, or adverse reactions to a drug or medical
device;
(5) to report concerning victims of abuse, neglect, or domestic violence if the
Plan or Plan Sponsor are required or authorized by law to do so;
(6) to authorized health oversight government agencies to audit or investigate
Plan operations;
(7) for lawsuits and disputes, in response to a subpoena or other lawful request,
but only if efforts have been made to tell you about the request or to obtain
a court order that will protect the personal health information requested;
(8) to law enforcement if asked to do so by a law enforcement official, in the
following circumstances: (a) in response to a court order, subpoena, warrant,
summons, or similar process; (b) to identify or locate a suspect, fugitive,
material witness or missing person; (c) about the victim of a crime if, under
certain limited circumstances, the Plan is unable to obtain the person's
agreement; (d) about a death the Plan believes may be due to criminal
conduct; (e) about criminal conduct at a facility used by the Plan; and (f) in
emergency circumstances, to report a crime, its location or victims, or the
identity, description or location of the person who committed the crime;
(9) to coroners, medical examiners and funeral directors to facilitate the duties
of those individuals;
(10) to organ procurement organizations in order to facilitate organ donation and
transportation;
(11) for approved medical research; but, with very limited exceptions, such
disclosures must be cleared through a special approval process before any
personal health information is disclosed to the researchers, who will be
required to safeguard the personal health information they receive;
(12) to avert a serious threat to your health or safety or to the health or safety of
another person or the public;
(13) for specialized government functions, such as, to authorized federal officials
for intelligence and national security activities that are authorized by law, or
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so that they may provide protective services to the President or foreign heads
of state or conduct special investigations authorized by law;
(14) to workers' compensation or similar programs that provide benefits for work -
related injuries or illness without regard to fault;
(15) to the parent or guardian of a minor; but, the Plan or Plan Sponsor may deny
such disclosure in some situations, such as when a court order prohibits such
disclosure; or
(16) when required by federal, state, or local law.
(B) Required Uses and Disclosures of Protected Health Information. The Plan Sponsor
shall be required to use and/or disclose protected health information:
(1) to an individual, when requested under, and required by 45 C.F.R. ' 164.524,
in order to provide an individual with access to his or her own protected
health information;
(2) to an individual, when requested under, and required by 45 C.F.R. ' 164.528,
in order to provide an individual with an accounting of disclosures of that
individual's protected health information; and
(3) when required by the Secretary of the Department of Health and Human
Services or those acting under the authority or at the direction of the Secretary
to investigate or determine the Plan's compliance with the Privacy
Regulations.
8.7 Uses and Disclosures That Require the Plan to Give the Opportunit to o Object
Unless the Participant objects, the Plan Sponsor may provide relevant portions of your
personal health information to a family member, friend, or other person the Participant
indicates is involved in the Participant's health care or in helping the Participant get payment
for the Participant's health care. In an emergency or when the Participant is not capable of
agreeing or objecting to these disclosures, the Plan Sponsor will disclose personal health
information as it determines is in the Participant's best interest, but will tell the Participant
about it later, after the emergency, and give the Participant the opportunity to object to future
disclosures to family and friends. Unless the Participant objects, the Plan Sponsor may also
disclose the Participant's personal health information to persons performing disaster relief
notification activities.
8.8 Other Uses and Disclosures of Personal Health Information
Uses and disclosures of a Participant's personal health information that are not specified in
this article or by the laws that apply to the Plan will be made only with the Participant's
written authorization. If the Participant gives the Plan or Plan Sponsor written authorization
for a use or disclosure of the Participant's personal health information, the Participant may
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-- revoke that authorization in writing at any time. If the Participant revokes the authorization,
the Plan Sponsor will no longer use or disclose the personal health information for the
purposes specified in the written authorization, except that the Plan Sponsor is unable to take
back any disclosures that have already been made with your permission, and the Plan is
required to retain certain records of the uses and disclosures made when the authorization
was in effect.
8.9 Prohibited Uses and Disclosures
The Plan Sponsor shall not be entitled to use or disclose protected health information for any
purpose for which use and disclosure is not expressly allowed under this Plan Document,
including but not limited to:
(A) using or disclosing protected health information other than as permitted or required
under this document or applicable law, or in a manner inconsistent with the Privacy
Regulations; and
(B) taking adverse employment action against any plan Participant who is an employee
of the Plan Sponsor, except with respect to any fraud or unlawful act related to the
Plan and committed or reasonably suspected to have been committed by such person.
8.10 Minimum Necess
When using or disclosing protected health information or when requesting protected health
information from another party, the Plan Sponsor must make reasonable efforts to limit
protected health information to the minimum necessary to accomplish the intended purpose
of the use or disclosure, and limit any request for protected health information to the
minimum necessary to satisfy the purpose of the request.
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The undersigned of the City of Fort Collins Group Dental Plan hereby certify that the foregoing
Amendment was duly adopted.
THE CITY OF FORT COLLINS
By:
... Q=�, I -
City Wnager
ATTEST:
City Clerk
DELTA DENTAL PLAN OF COLORADO
Authorized Signature
APPROVED:
4�oo . Hvin-a Resource Director
APPROVED AS TO FORM:
AAttome
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Privacy Agreement
THIS CONTRACT is entered into on this 14th day of April, 2003, between Great -West Life & Annuity
Insurance Company ("Company"), 8515 E. Orchard Road, Greenwood Village, Colorado 80111 and The
City of Fort Collins ("Contractor"), PO Box 580, Fort Collins, Colorado on behalf of the City of Fort
Collins Group Health Plan
WHEREAS, COMPANY and CONTRACTOR each may make available and/or transfer or cause to be
transferred to the other certain Protected Information; and
WHEREAS, COMPANY and CONTRACTOR may obtain access to, through, or receive from, or at the
direction of,, or on behalf of, the other's customer or contractor, certain Protected Information;
NOW, THEREFORE, COMPANY and CONTRACTOR agree as follows:
1. Definitions. The following terms shall have the meaning ascribed to them in this Section.
A. "Applicable Law" shall mean any such item listed below in this sub -section A as it may apply
to any particular Protected Information, including any amendments to any such item as such
may become effective;
(i) the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"),
(ii) the federal regulations regarding privacy and promulgated with respect to
HIPAA, found at Title 45 CFR Parts 160 and 164, and
(iii) any state statute or regulation or other bulletin or document that has the force of
law that has been issued by a state in furtherance of that state's protection of the
privacy of an individual's health information to the extent that such statute or
regulation or other bulletin or document that has the force of law is not
otherwise pre-empted by any federal law; and
(iv) any statute or regulation or other bulletin or document that has the force of law
that has been issued in furtherance of a governmental entity's ability to obtain
health information for health oversight purposes, investigatory, administrative,
judicial or law enforcement proceedings or other lawful purpose.
B. "Contract" shall refer to this document.
C. "Great -West Life" shall include those affiliates of Great -West that control, or are controlled
by, or are under common control with Great -West, and shall also include any party for which
Great -West has the authority to administer or direct the business of that entity whether
through a reinsurance, administration or other agreement.
D. "Individual" shall mean the person who is the subject of the Protected Information or a person
who qualifies as the personal representative of the individual.
E. "Protected Information" shall mean any information that relates to the past, present, or future
physical or mental health or condition of an individual, the provision of health care to an
individual, or the past, present or future payment for the provision of health care to an
individual, including demographic information collected from an individual, that is created by
a health care provider, health plan, employer or health care clearing house, or by a Party and
NonBA09162002
that identifies the individual, or with respect to which there is a reasonable basis to believe
that the information can be used to identify the individual, and that is related to goods or
services provided by a party on behalf of the other Party, or is related to goods or services
provided by a Party on behalf of or at the direction of a customer of the other Party.
Protected Information shall not include records that the Contractor holds for employment
purposes, in accordance with 45 C.F.R. 164.501(2)(iii).
F. "Party" or "Parties" shall mean CONTRACTOR and COMPANY.
G. "Secretary" shall mean the Secretary of the Department of Health and Human Services
("HHS") and any other officer or employee of HHS to whom the authority involved has been
delegated.
2. Term and Termination. The term of this Contract shall commence as of April 14, 2003, and shall
terminate when all of the Protected Information made available and/or transferred or caused to be
transferred to a Party, or obtained, accessed by, or received by a Party from or at the direction of or on
behalf of the other Party or a customer of either Party is destroyed, rendered inaccessible, or returned to the
appropriate Party.
3. Limits on Use and Disclosure Established by Terms of Contract. The Parties shall be prohibited from
using or disclosing the Protected Information for any purpose other than as expressly permitted or required
by this Contract.
4. Permitted and Required Uses and Disclosures. Except as otherwise set forth in this Contract, the Parties
shall be permitted to use and/or disclose Protected Information only for the purpose of conducting the
transactions contemplated under this Contract and only for purposes within the scope of that Party's
representation of, or work conducted on behalf of the other Party or a customer of the other Party.
5. Use of Protected Information for Management. Administration and Legalal Rrmonsmbmhties. The Parties
are permitted to use Protected Information if necessary for the proper management and administration of
their respective businesses and to carry out their respective legal responsibilities.
6. Disclosure of Protected Information for M=11ement, Administration and Le ag l ReMonsibihhes. The
Parties are permitted to disclose Protected Information for the proper management and administration of
their respective businesses and to carry out their respective legal responsibilities, provided:
A. The disclosure is required by Applicable Law; or
B. The disclosing Party obtains reasonable assurances from the person to whom the Protected
Information is disclosed that it will be held confidentially and used or further disclosed only
as required by Applicable Law or for the purposes for which it was disclosed to the person,
the person will use appropriate safeguards to prevent use or disclosure of the Protected
Information, and the person will immediately notify the disclosing Party of any instance of
which it is aware in which the confidentiality of the Protected Information has been breached.
7. Data Agimegation Services. Each Party is permitted to use or disclose Protected Information to provide
data aggregation services, as that term is defined by 45 C.F.R. 164.501, relating to the health care
operations of that Party.
A. Limits on Use and Further Disclosure Established by Contract and Law. The Parties hereby agree
that the Protected Information shall not be further used or disclosed other than as permitted or
required by this Contract or as required by Applicable Law.
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