These written assurances are given by PHYSICIANS’ RECIPROCAL INSURERS (“PRI”) to persons and organizations insured by PRI (each a “Covered Entity”) because in the course of fulfilling its obligations under the applicable insurance policy, PRI may require access, or be exposed, to certain information that is protected by law.
The following terms used in these assurances shall have the same meaning as those terms in the HIPAA Rules: breach, data aggregation, designated record set, disclosure, health care operations, individual, minimum necessary, notice of privacy practices, protected health information, required by law, secretary, security incident, subcontractor, unsecured protected health information, and use.
(a) Business Associate. “Business Associate” shall generally have the same meaning as the term “business associate” at 45 CFR 160.103, and in reference to these assurances, shall mean PRI.
(b) Covered Entity. “Covered Entity” shall generally have the same meaning as the term “covered entity” at 45 CFR 160.103, and in reference to these assurances, shall mean the person or organization insured by PRI.
(c) HIPAA Rules. “HIPAA Rules” shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164.
Obligations and Activities of Business Associate
Business Associate agrees to:
(a) Not use or disclose protected health information other than as permitted or required by the applicable insurance policy, this document, or as required by law;
(b) Use appropriate safeguards, and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information, to prevent use or disclosure of protected health information other than as provided for by the applicable insurance policy or this document;
(c) Report to Covered Entity, promptly but no later than fifteen (15) business days, any use or disclosure of protected health information not provided for by the Agreement of which it becomes aware, including breaches of unsecured protected health information as required at 45 CFR 164.410, and any security incident of which it becomes aware;
(d) In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any subcontractors that create, receive, maintain, or transmit protected health information on behalf of the Business Associate agree to the same restrictions, conditions, and requirements that apply to the Business Associate with respect to such information;
(e) Make available protected health information in a designated record set to the Covered Entity as necessary to satisfy Covered Entity’s obligations under 45 CFR 164.524;
(f) Make any amendment(s) to protected health information in a designated record set as directed or agreed to by the Covered Entity pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy Covered Entity’s obligations under 45 CFR 164.526;
(g) Maintain and make available the information required to provide an accounting of disclosures to the Covered Entity as necessary to satisfy Covered Entity’s obligations under 45 CFR 164.528;
(h) To the extent the Business Associate is to carry out one or more of Covered Entity’s obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the Covered Entity in the performance of such obligation(s); and
(i) Make its internal practices, books, and records available to the Secretary for purposes of determining compliance with the HIPAA Rules.
Permitted uses and Disclosures by Business Associate
(a) Business Associate may only use or disclose protected health information as necessary to perform the services set forth in the applicable insurance policy.
(b) Business Associate may use or disclose protected health information as required by law.
(c) Business Associate agrees to make uses and disclosures and requests for protected health information consistent with Covered Entity’s minimum necessary policies and procedures.
(d) Business Associate may not use or disclose protected health information in a manner that would violate Subpart E of 45 CFR Part 164 if done by Covered Entity except for the specific uses and disclosures set forth below.
(e) Business Associate may use protected health information for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate.
Term and Termination
(a) Term. These assurances begin at the time a Covered Entity applies for a PRI policy and shall continue for as long as PRI is in possession of any Protected Health Information provided by or on behalf of the Covered Entity. PRI will not revoke or change these assurances unless required to do so by law or regulation.
(b) Termination for Cause. Business Associate authorizes termination of the applicable insurance policy or this document, at the option of the insured, if Covered Entity determines Business Associate has violated a material term of these assurances.
(c) Obligations of Business Associate Upon Termination. Upon termination of the applicable insurance policy and the final disposition of any claims reported pursuant to that insurance policy, Business Associate shall:
1. Retain only that protected health information which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities;
2. Destroy, if practicable, the remaining protected health information that the Business Associate still maintains in any form;
3. Continue to use appropriate safeguards and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information to prevent use or disclosure of the protected health information, other than as provided for in this Section, for as long as Business Associate retains the protected health information;
4. Not use or disclose the protected health information retained by Business Associate other than for the purposes for which such protected health information was retained and subject to the same conditions set out at paragraph (e) above under “Permitted Uses and Disclosures By Business Associate” which applied prior to termination; and
5. Destroy, if practicable, the protected health information retained by Business Associate when it is no longer needed by Business Associate for its proper management and administration or to carry out its legal responsibilities.
6. With respect to any protected health information that cannot practicably be destroyed, to continue measures stated herein to safeguard such information and prevent its use or disclosure except as provided for above.
(d) Survival. The obligations of Business Associate under this section shall survive the termination of the applicable insurance policy and this document.
Nothing in these assurances shall limit or diminish PRI’s liability to any party in the event of a breach of these assurances or the HIPAA rules.
PHYSICIANS’ RECIPROCAL INSURERS