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HomeMy WebLinkAboutAddenda - RFP - P832 BENEFITS (3)AMENDMENT NUMBER 3 TO THE CITY OF FORT COLLINS GROUP BASIC DENTAL PLAN GROUP #1858 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 P 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; Page 1 of 7 (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; (I) 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(f)(2)(iii) of the Privacy Regulations is established. 8.4 Disclosures by Others to the Plan S onsor 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; Page 2 of 7 (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 Page 3 of 7 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 (12) required to safeguard the personal health information they receive; 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 Page 4 of 7 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. 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 authorization written authorization. If the Participant gives the Plan or Plan Sponsor written for a use or disclosure of the Participant's personal health information, the Participant may Page 5 of 7 i 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 NecessM 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 intend of the use or disclosure, and limit any request for protected health information to the ed purpose minimum necessary to satisfy the purpose of the request. Page 6 of 7 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: Qzq- City AMnager ATTEST: - 4%1 City Clerk DELTA DENTAL PLAN OF Page 7 of 7 APPROVED: !j-+ Huai Resource Director APPROVED AS TO FORM: City Attorn�lt