DISTRICT SCHOOL BOARD OF PASCO COUNTY Health Reimbursement Arrangement

Transcription

1 DISTRICT SCHOOL BOARD OF PASCO COUNTY Health Reimbursement Arrangement

2 TABLE OF CONTENTS Page ARTICLE I PREAMBLE... 1 ARTICLE II DEFINITIONS... 2 ARTICLE III ELIGIBILITY... 5 ARTICLE IV AMOUNT OF BENEFITS... 7 ARTICLE V PAYMENT OF BENEFITS... 8 ARTICLE VI COBRA CONTINUATION COVERAGE... 9 ARTICLE VII PLAN ADMINISTRATION ARTICLE VIII CLAIMS & APPEALS PROCEDURES ARTICLE IX AMENDMENT OR TERMINATION OF PLAN ARTICLE X GENERAL PROVISIONS \373507\1 - # v1 -i-

3 ARTICLE I PREAMBLE THIS INSTRUMENT, made and published by District School Board of Pasco County, Inc. (hereinafter called District ), creates the Health Reimbursement Arrangement ("HRA"), which supplements and is a part of the Group Health Insurance Benefit, as follows: Establishment of HRA The District named above hereby establishes a self-funded health reimbursement arrangement as of the Effective Date specified in Article II, below Purpose of HRA This HRA has been established to reimburse the eligible Employees of the District for the costs of certain medical expenses incurred by them, their Spouses and Dependents. It is intended that the HRA meet the requirements for qualification under Code Sec. 106, so that the District's contributions on behalf of participating Employees will be excludable from gross income for federal income tax purposes, and Code Sec. 105, so that benefits paid Employees hereunder will be excludible from their gross incomes. \373507\1 - # v1 1

4 ARTICLE II DEFINITIONS The following words and phrases as used herein shall have the following meanings, unless a different meaning is plainly required by the context: Benefits means any amounts paid to a Participant in the HRA as reimbursement for Eligible Medical Expenses incurred by the Participant during a Coverage Period by him, his Spouse, or his Dependents Code means the Internal Revenue Code of 1986, as amended Coverage Period means the Plan Year, during which period the benefits provided by this HRA shall be available to a Participant hereunder Dependent means any individual who is a dependent of the Participant within the meaning of Code Sec. 152 without regard to subsections (b)(1), (b)(2), and (d)(1)(b). This includes an individual who satisfies the requirements to be a qualifying child due to student status or who ceases to be a student for up to one year due to a medically necessary leave of absence, as required by Michelle s Law. In addition, any child of a Participant who is covered under an insurance contract, as defined in the Contract, as allowed by the Patient Protection and Affordable Care Act District means District School Board of Pasco County, Inc., or any affiliate or successor thereof that subsequently adopts this HRA. Such term includes any other organization that is a member of a controlled group of businesses within the meaning of Code Sec. 414(b), (c) and (m). Such term shall include any organization that is exempt from federal taxation under Code Sec Effective Date means January 1, The original effective date of the Plan is January 1, Eligible Medical Expenses means those expenses incurred by the Employee, or the Employee's Spouse or Dependents for medical care, as defined by Code Sec. 213(d) on or after the Participant s Entry Date and on or before the earlier of a loss of eligibility or the end of the Plan Year, but shall not include an expense incurred for: (a) (b) (c) (d) the payment of premiums under a District-sponsored group health plan; an illness or injury (or aggravation of an illness or injury) incurred by an Employee during a period of duty with the Uniformed Services; any prescription drug obtained outside of the United States; or any medical expense that is reimbursable from any group health plan, including medical insurances and health flexible spending accounts, but not including health savings accounts. \373507\1 - # v1 2

5 For purposes of this HRA, an expense is incurred when the Participant or beneficiary is furnished the medical care or services giving rise to the claimed expense Employee means any individual who is considered to be in a legal Districtemployee relationship with the District for federal withholding tax purposes Reserved Entry Date means the Effective Date, with respect to those who meet the eligibility requirements of Article III as of such Date, or the date the employee completes the requirements of Article III, with respect to those meeting the requirements at a future date ERISA means the Employee Retirement Income Security Act of 1974, as amended. The HRA is not subject to ERISA, and any references to ERISA are for illustrative purposes only Flexible Dollars means the District s contributions made available by the District for Participants to purchase Benefits from an array of options made available by the District each Plan Year. seq.) FMLA means the Family and Medical Leave Act of 1993 (29 USCS 2601 et FMLA Leave means a leave of absence that the District is required to extend to an Employee under the provisions of the FMLA Participant means any Employee who has met the eligibility requirements set forth in Article III Plan Administrator is the District which has been granted the authority and responsibility to manage and direct the operation and administration of the HRA Plan Year means the annual accounting period of the HRA, which begins January 1, and ends on December "Related Health Plan" or "RHP" means the health insurance benefit providing primary coverage that is sponsored by the District Spouse means an individual who is legally married to a Participant, but shall not include an individual separated from the Participant under a legal separation decree Uniformed Services means the Armed Forces, the Army National Guard, and the Air National Guard when engaged in active duty for training, inactive duty training, or fulltime National Guard duty, the commissioned corps of the Public Health Service, and any other category of persons designated by the President of the United States in time of war or emergency. \373507\1 - # v1 3

6 2.21. Qualified Medical Child Support Orders or QMCSOs refers to medical child support orders that the Plan Administrator determines are qualified. This HRA honors National Medical Support Notices and medical child support orders that are determined to constitute QMCSOs. A copy of the procedures used to determine whether such orders are qualified can be obtained free of charge by contacting the Plan Administrator Unallocated Flexible Dollars means Flexible Dollars that are not specifically allocated towards a benefit by a Participant. All other defined terms in this HRA shall have the meanings specified in the various Articles of the HRA in which they appear. \373507\1 - # v1 4

7 ARTICLE III ELIGIBILITY General requirements Each Employee who (a) is eligible to participate in the District's RHP, (b) is entitled to District Flexible Dollars and (c) fails to allocate some or all of their Flexible Dollars ( Unallocated Flexible Dollars ) to pay for another benefit in accordance with the terms of the District s Cafeteria Plan is eligible to participate in this HRA as of the Effective Date or any subsequent Entry Date coincident with or subsequent to eligibility for the RHP. If eligibility for the District's RHP is interrupted or ceases, eligibility for this HRA shall be interrupted or cease, accordingly Reentry After Uniformed Service Duty No reentry eligibility requirements will be imposed on any Employee who returns to active employment within 90 days of completing a period of absence from employment for duty in the Uniformed Services Termination of a Participant's coverage Except as provided in Article VI, coverage of a Participant shall terminate automatically on the date that the Participant (a) (b) (c) (d) no longer is actively engaged in working for the District; no longer is eligible to participate in a RHP sponsored by the District; is no longer in a class of Employees that is eligible for HRA coverage; or is not covered because the provisions of the HRA terminated Termination of coverage of an Eligible Dependent Except as provided in Article VI, an Eligible Dependent's coverage shall terminate (a) on the date described in Subsections 3.03; (b) for a Dependent or Spouse of a Participant, coverage shall automatically terminate when an individual who had been a Dependent or Spouse no longer qualifies as such Certificates of Creditable Coverage \373507\1 - # v1 5

8 A Certificate of Creditable Coverage will be issued under the RHP, and a separate certificate for the HRA is not required and will not be provided, except upon request by a Participant or the Spouse or Beneficiary of a Participant who did not participate in the RHP. \373507\1 - # v1 6

9 ARTICLE IV AMOUNT OF BENEFITS Annual benefits provided by the HRA Each Participant shall be entitled to reimbursement for his documented, Eligible Medical Expenses incurred during the Plan Year in an annual amount not to exceed the amount of Unallocated Flexible Dollars and any Unallocated Flexible Dollars remaining from the prior Plan Year. At the beginning of each Plan Year, the District shall credit each Participant s account with the amount of Unallocated Flexible Dollars for such Plan Year Cost of coverage The District shall bear the entire expense of providing the benefits set out in Section Available benefits Benefits under this HRA are available on a prorata payroll basis. Available benefits are equal to A + B C, where A = the amount of unused benefits from prior Plan Years; B = the prorata portion of the current Plan Year benefits; and C = reimbursements made during the current Plan Year. Notwithstanding the limits provided herein, a Participant's available balance may never exceed the total Unallocated Flexible Dollars allocated to this HRA for the current Plan Year and the amount of benefits carried over from the prior Plan Year in accordance with Section Carryover of unused balances If, in the event that at the end of the Plan Year, a Participant's substantiated claims for reimbursement of medical expenses are less than the available benefits as described in section 4.03, any remaining amount shall remain in the Participant s account and be carried over for use by the Participant to pay for future Eligible Medical Benefits. \373507\1 - # v1 7

10 5.01. Eligibility for benefits ARTICLE V PAYMENT OF BENEFITS Each Participant in the HRA shall be entitled to a benefit hereunder for all Eligible Medical Expenses incurred by the Participant on or after the effective date of his participation (and after the effective date of the HRA), subject to the limitations contained in Article V, below, regardless whether the mental or physical condition for which the Participant makes application for benefits under this HRA was detected, diagnosed, or treated before the Participant became covered by the HRA Claims for benefits The Participant must first submit a written claim for benefits to the Plan Administrator on a form specified by or otherwise acceptable to the Plan Administrator, and pursuant to the procedures set out in Article VIII, below. Upon receipt of a properly documented claim, the District shall pay the Participant the benefits provided under this HRA as soon as is administratively feasible. A Participant may submit a claim for reimbursement for an Eligible Medical Expense as defined in Section 2.07 arising during the Plan Year at any time during the period that begins when the expense is incurred, and ends ninety (90) days after the close of the Plan Year Termination of benefits Coverage under this HRA shall cease as of the dates determined in accordance with Sections 3.03 and 3.04 of this HRA. Such Participant shall have the right to submit a claim for reimbursement for any Eligible Medical Expense arising during the Coverage Period at any time prior to the expiration of the 90-day period following the earlier of the following two time periods: (a) (b) the close of the Plan Year in which the expense arose; or the date of that Participant's or Spouse's or Dependent's loss of eligibility, and right to accrue benefits hereunder. \373507\1 - # v1 8

11 ARTICLE VI COBRA CONTINUATION COVERAGE COBRA Continuation Coverage after termination of normal participation This HRA will comply with COBRA's continuing coverage requirements as provided in that RHP. \373507\1 - # v1 9

12 7.01. Allocation of authority ARTICLE VII PLAN ADMINISTRATION Except as to those functions reserved within the HRA to the District or the District's board of directors (the Board ), the Plan Administrator shall control and manage the operation and Administration of the HRA. The Plan Administrator shall have the exclusive right (except as to matters reserved to the Board by the HRA or that the Board may reserve to itself) to interpret the HRA and to decide all matters arising thereunder, including the right to remedy possible ambiguities, inconsistencies, or omissions. All determinations of the Plan Administrator or the Board with respect to any matter hereunder shall be conclusive and binding on all persons. Without limiting the generality of the foregoing, the Plan Administrator shall have the following powers and duties: (a) (b) (c) (d) (e) To require any person to furnish such reasonable information as it may request for the purpose of the proper administration of the HRA as a condition to receiving any benefits under the HRA; To make and enforce such rules and regulations and prescribe the use of such forms as he shall deem necessary for the efficient administration of the HRA; To decide on questions concerning the HRA and the eligibility of any Employee to participate in the HRA, in accordance with the provisions of the HRA; To determine the amount of benefits that shall be payable to any person in accordance with the provisions of the HRA; to inform the District, as appropriate, of the amount of such Benefits; and to provide a full and fair review to any Participant whose claim for benefits has been denied in whole or in part; and To designate other persons to carry out any duty or power that would otherwise be a fiduciary responsibility of the Plan Administrator, under the terms of the HRA Provision for third-party administrative service providers The Plan Administrator, subject to approval of the Board, may employ the services of such persons as it may deem necessary or desirable in connection operation of the HRA. The Plan Administrator, the District (and any person to whom it may delegate any duty or power in connection with the administration of the HRA), and all persons connected therewith may rely upon all tables, valuations, certificates, reports and opinions furnished by any duly appointed actuary, accountant, (including Employees who are actuaries or accountants), consultant, third party administration service provider, legal counsel, or other specialist, and they shall be fully protected in respect to any action taken or permitted in good faith in reliance thereon. All actions so taken or permitted shall be conclusive and binding as to all persons Several fiduciary liability \373507\1 - # v1 10

13 To the extent permitted by law, neither the Plan Administrator nor any other person shall incur any liability for any acts or for failure to act except for his own willful misconduct or willful breach of this HRA Compensation of Plan Administrator Unless otherwise agreed to by the Board, the Plan Administrator shall serve without compensation for services rendered in such capacity, but all reasonable expenses incurred in the performance of his duties shall be paid by the District Bonding Unless otherwise determined by the Board, or unless required by any Federal or State law, the Plan Administrator shall not be required to give any bond or other security in any jurisdiction in connection with the administration of this HRA Payment of administrative expenses All reasonable expenses incurred in administering the HRA, including but not limited to administrative fees and expenses owing to any third party administrative service provider, actuary, consultant, accountant, attorney, specialist, or other person or organization that may be employed by the Plan Administrator in connection with the administration thereof shall be paid by the District; provided however, that each Participant shall bear the monthly cost (if any) charged by a third party administrator for maintenance of his Benefit Account unless otherwise paid by the District Funding policy This HRA is intended to be an unfunded arrangement. Nevertheless, the District shall have the right to enter into a contract with one or more insurance companies for the purposes of providing any benefits under the HRA and to replace any of such insurance companies or contracts. Any dividends, retroactive rate adjustments, or other refunds of any type that may become payable under any such insurance contract shall not be assets of the HRA but shall be the property of, and shall be retained by, the District Source of benefit payments The District shall cause the Plan Administrator to pay any non-insurance benefits to which a Participant is entitled under this HRA Disbursement reports The Plan Administrator shall issue directions to the District concerning all benefits that are to be paid from the District's general assets pursuant to the provisions of the HRA Timeliness of benefit payments \373507\1 - # v1 11

14 Payments shall be made as soon as administratively feasible after the required forms and documentation have been received by the Plan Administrator, subject to the Claims Procedure requirements set out in Article VIII. \373507\1 - # v1 12

15 8.01. Claims for benefits ARTICLE VIII CLAIMS & APPEALS PROCEDURES Any Participant (who, for purposes of obtaining benefits under this HRA is called a Claimant ), may file a Claim for benefits to which the Claimant believes that he is entitled. Such a Claim must be in writing on a Benefit Claim Form provided by the Plan Administrator, and delivered to the Plan Administrator, in person or by mail, postage prepaid. No Benefit will be paid unless a Claimant has first submitted a written Claim for Benefits to the Plan Administrator. Upon receipt of a properly documented claim, the Plan Administrator shall pay the Claimant the Benefits provided under this HRA as soon as is administratively feasible Required information Each Participant s claim for HRA Benefits shall contain a written statement containing the following information or the information necessary for the Plan Administrator to determine: (a) (b) (c) (d) the person or persons on whose behalf Eligible Medical Expenses have been incurred; the nature of the Eligible Medical Expenses incurred; the amount of the Eligible Medical Expenses incurred; and that such expenses have not been paid or reimbursed through insurance or any other source. The Claimant also must submit such evidence as the Plan Administrator shall reasonably require to substantiate the nature, the amount, and the timeliness of any Eligible Medical Expenses incurred for which HRA Benefits are claimed Notifications of decisions on benefit claims The Plan Administrator shall notify the Claimant of the HRA's denial of a Claim ( Denial Notice ) within a reasonable period of time. This period may be extended one time by the Plan Administrator, provided that the Plan Administrator both determines that such an extension is necessary due to matters beyond the control of the HRA and notifies the Claimant of the circumstances requiring the extension of time and the date by which the HRA expects to render a decision. If such an extension is necessary due to a failure of the Claimant to submit the information necessary to decide the claim, the notice shall specifically describe the required information, and the Claimant shall be given at least forty-five (45) days from receipt of the notice within which to provide the specified information. For purposes of the various time periods set out in this section, the period of time within which a Claim must be reimbursed or denied shall begin at the time a Claim is filed in accordance with Section 8.02, above, regardless of whether all the information necessary to \373507\1 - # v1 13

16 make a Claim is included with the filing. In the event that a period of time is extended as permitted by this section due to the failure of a Claimant to submit information necessary to decide a Claim, this time period shall be tolled from the date on which the notification of the extension is sent to the Claimant until the date on which the Claimant responds to the request for additional information Method and Contents of Denial Notices Any Denial Notice shall be given the Claimant in written form and may be provided electronically. The Denial Notice must include: (a) (b) (c) (d) (e) the specific reason or reasons for the denial of the Claim; reference to the specific HRA provisions on which the determination is based; a description of any additional material or information necessary for the Claimant to perfect the claim and an explanation of why such material or information is necessary; a description of the review procedures set out in this Article VIII and the time limits applicable to such procedures; if an internal rule, guideline, protocol, or other similar criterion was relied upon, either the specific rule, guideline, protocol, or other similar criterion; or a statement that such a rule, guideline, protocol, or other similar criterion was relied upon in denying the Claim and that a copy of such rule, guideline, protocol, or other criterion will be provided free of charge to the Claimant upon request; Appealing a Claim Denial Upon receipt of a Denial Notice, Participants shall have 30 days from the date that Denial Notice was mailed or sent to submit an appeal of that denial. The appeal should provide any additional relevant information that became available to the Participant after the initial claims submission or an explanation of why the denial notice is incorrect. Appeals are to be delivered to the Plan Administrator Preservation of other remedies After exhaustion of the claims procedures provided under this HRA, nothing shall prevent any person from pursuing any other legal or equitable remedy otherwise available except to the extent any such person has agreed to binding arbitration. \373507\1 - # v1 14

17 9.01. Permanency ARTICLE IX AMENDMENT OR TERMINATION OF PLAN While the District fully expects that this HRA will continue indefinitely, due to unforeseen, future business contingencies, permanency of the HRA will be subject to the District's right to amend or terminate the HRA, as provided in Sections 9.02 and 9.03, below District's right to amend The District reserves the right to amend the HRA in whole or in part at any time and from time-to-time, and retroactively if deemed necessary or appropriate to meet the requirements of Code Sec. 105, 106 or any other laws, rules, or regulations in effect. Any amendment shall be effected by a written resolution adopted by a majority of the Board District's right to terminate The District reserves the right to discontinue or terminate the HRA at any time without prejudice, provided that plan termination must be effected by a written resolution adopted by the District. This HRA also shall terminate automatically if the District (1) is legally dissolved, (2) makes a general assignment for the benefit of its creditors, (3) files for liquidation under the Bankruptcy Code, (4) merges or consolidates with any other entity and it is not the surviving entity, or if it sells or transfers substantially all of its assets, or goes out of business, unless the District's successor in interest agrees to assume the liabilities under this HRA as to the Participants and Eligible Dependents. \373507\1 - # v1 15

18 ARTICLE X GENERAL PROVISIONS No employment rights conferred Neither this HRA nor any action taken with respect to it shall confer upon any person the right to be continued in the employment of the District Payments to beneficiary Any benefits otherwise payable to a Participant following the date of death of such Participant shall be paid to his spouse, or, if there is no surviving spouse, to his estate Nonalienation of benefits No benefit under the HRA shall be subject in any manner to anticipation, alienation, sale, transfer, assignment, pledge, encumbrance or charge, and any attempt to do so shall be void. No benefit under the HRA shall in any manner be liable for or subject to the debts, contracts, liabilities, engagements or torts of any person. If any person entitled to benefits under the HRA becomes bankrupt or attempts to anticipate, alienate, sell, transfer, assign, pledge, encumber or charge any benefit under the HRA, or if any attempt is made to subject any such benefit to the debts, contracts, liabilities, engagements or torts of the person entitled to any such benefit, except as specifically provided in the HRA, then such benefit shall cease and terminate in the discretion of the Plan Administrator, and he may hold or apply the same or any part thereof to the benefit of any dependent or beneficiary of such person, in such manner and proportion as he may deem proper Mental or physical incompetency If the Plan Administrator determines that any person entitled to payments under the HRA is incompetent by reason of physical or mental disability, he may cause all payments thereafter becoming due to such person to be made to any other person for his benefit, without responsibility to follow the application of amounts so paid. Payments made pursuant to this Section shall completely discharge the Plan Administrator and the District Inability to locate payee If the Plan Administrator is unable to make payment to any Participant or other person to whom a payment is due under the HRA because he cannot ascertain the identity or whereabouts of such Participant or other person after reasonable efforts have been made to identity or locate such person (including a notice of the payment so due mailed to the last known address of such Participant or other person as shown on the records of the District), such payment and all subsequent payments otherwise due to such Participant or other person shall be forfeited seven (7) years after the date such payment first became due Requirement of proper forms \373507\1 - # v1 16

19 All communications in connection with the HRA made by a Participant shall become effective only when duly executed on forms provided by and filed with the Plan Administrator Source of payments The District shall be the sole source of benefits under the HRA. No Employee or beneficiary shall have any right to, or interest in, any assets of the District upon termination of employment or otherwise, except as provided from time to time under the HRA, and then only to the extent of the benefits payable under the HRA to such Employee or beneficiary Tax effects Neither the District nor the Plan Administrator makes any warranty or other representation as to whether any payments received by a Participant hereunder will be treated as includible in gross income for federal or state income tax purposes Multiple functions Any person or group of persons may serve in more than one fiduciary capacity with respect to the HRA Gender and number Masculine pronouns include the feminine as well as the neuter gender, and the singular shall include the plural, unless indicated otherwise by the context Headings The Article and Section headings contained herein are for convenience of reference only, and shall not be construed as defining or limiting the matter contained thereunder Applicable laws The provisions of the HRA shall be construed, administered and enforced according to applicable federal law and the laws of the State of Florida Severability Should any part of this HRA subsequently be invalidated by a court of competent jurisdiction, the remainder thereof shall be given effect to the maximum extent possible Family and Medical Leave Act Notwithstanding anything in the Plan to the contrary, in the event that this HRA becomes subject to the requirements of the Family and Medical Leave Act and regulations thereunder, it shall so comply USERRA and HEART \373507\1 - # v1 17

20 Notwithstanding any provision of this HRA to the contrary, contributions, benefits and service credit with respect to qualified military service shall be provided in accordance with the Uniform Services Employment and Reemployment Rights Act (USERRA), the Heroes Earnings Assistance and Relief Tax Act ( HEART ) and the regulations thereunder Mental Health Parity and Addiction Equity Act Notwithstanding anything in the Plan to the contrary, the Plan will comply with the Mental Health Parity and Addiction Equity Act Genetic Information Nondiscrimination Act (GINA) Notwithstanding anything in the Plan to the contrary, the Plan will comply with the Genetic Information Nondiscrimination Act Women s Health and Cancer Rights Act Notwithstanding anything in the Plan to the contrary, the Plan will comply with the Women s Health and Cancer Rights Act of Newborns and Mothers Health Protection Act Notwithstanding anything in the Plan to the contrary, the Plan will comply with the Newborns and Mothers Health Protection Act Health Insurance Portability and Accountability Act Notwithstanding anything in this HRA to the contrary, this HRA shall be operated in accordance with HIPAA and regulations thereunder Compliance With HIPAA Privacy Standards (a) Application. If the Health Reimbursement Account is subject to the Standards for Privacy of Individually Identifiable Health Information (45 CFR Part 164, the "Privacy Standards"), then this Section shall apply. (b) Disclosure of PHI. The HRA shall not disclose Protected Health Information to any member of the District's workforce unless each of the conditions set out in this Section are met. "Protected Health Information" shall have the same definition as set forth in the Privacy Standards but generally shall mean individually identifiable information about the past, present or future physical or mental health or condition of an individual, including information about treatment or payment for treatment. (c) PHI disclosed for administrative purposes. Protected Health Information disclosed to members of the District's workforce shall be used or disclosed by them only for purposes of HRA administrative functions. The HRA's \373507\1 - # v1 18

21 administrative functions shall include all HRA payment functions and health care operations. The terms "payment" and "health care operations" shall have the same definitions as set out in the Privacy Standards, but the term "payment" generally shall mean activities taken to determine or fulfill HRA responsibilities with respect to eligibility, coverage, provision of benefits, or reimbursement for health care. Genetic information will not be used or disclosed for underwriting purposes. (d) PHI disclosed to certain workforce members. The HRA shall disclose Protected Health Information only to members of the District's workforce who are authorized to receive such Protected Health Information, and only to the extent and in the minimum amount necessary for that person to perform his or her duties with respect to the HRA. "Members of the District's workforce" shall refer to all employees and other persons under the control of the District. Individual requests to further restrict uses or disclosures of protected health information will be considered and granted on a case-by-case basis. No grant of an additional restriction is final without it being in writing. In general, request for additional restrictions are more likely to be approved in relation to Protected Health Information generated from services paid exclusively outside the HRA. The District shall keep an updated list of those authorized to receive Protected Health Information. (1) An authorized member of the District's workforce who receives Protected Health Information shall use or disclose the Protected Health Information only to the extent necessary to perform his or her duties with respect to the HRA. (2) In the event that any member of the District's workforce uses or discloses Protected Health Information other than as permitted by this Section and the Privacy Standards, the incident shall be reported to the HRA's privacy officer. The privacy officer shall take appropriate action, including: (i) investigation of the incident to determine whether the breach occurred inadvertently, through negligence or deliberately; whether there is a pattern of breaches; and the degree of harm caused by the breach; (ii) appropriate sanctions against the persons causing the breach which, depending upon the nature of the breach, may include oral or written reprimand, additional training, or termination of employment; (iii) mitigation of any harm caused by the breach, to the extent practicable; and \373507\1 - # v1 19

22 (iv) documentation of the incident and all actions taken to resolve the issue and mitigate any damages. (e) Certification. The District certifies to the HRA that it agrees to: (1) Not use or further disclose the information other than as permitted or required by the HRA documents or as required by law; (2) Ensure that any agent or subcontractor, to whom it provides Protected Health Information received from the HRA, agrees to the same restrictions and conditions that apply to the District with respect to such information; (3) Not use or disclose Protected Health Information for employmentrelated actions and decisions or in connection with any other benefit or employee benefit plan of the District; (4) Report to the HRA any use or disclosure of the Protected Health Information of which it becomes aware that is inconsistent with the uses or disclosures permitted by this Section, or required by law; (5) Make available Protected Health Information to individual HRA members in accordance with Section of the Privacy Standards; (6) Make available Protected Health Information for amendment by individual HRA members and incorporate any amendments to Protected Health Information in accordance with Section of the Privacy Standards; (7) Make available the Protected Health Information required to provide an accounting of disclosures to individual HRA members in accordance with Section of the Privacy Standards; (8) Make its internal practices, books and records relating to the use and disclosure of Protected Health Information received from the HRA available to the Department of Health and Human Services for purposes of determining compliance by the HRA with the Privacy Standards; (9) If feasible, return or destroy all Protected Health Information received from the HRA that the District 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, limit further uses and disclosures to those purposes that make the return or destruction of the information infeasible; \373507\1 - # v1 20

23 (10) Ensure the adequate separation between the HRA and members of the District's workforce, as required by Section (f)(2)(iii) of the Privacy Standards and set out in (d) above; (11) Not allow uses and disclosures of psychotherapy notes without an individual's authorization; (12) Not allow disclosures of Protected Health Information for marketing purposes, or any disclosures that constitute a sale of Protected Health Information without an individual's authorization; (13) Not use or allow the HRA to use genetic information for underwriting purposes; and (14) Provide an individual with access to the electronic information in the electronic form and format requested by the individual, if it is readily producible, or, if not, in a readable electronic form and format as agreed to by the covered entity and the individual Compliance With HIPAA Electronic Security Standards Under the Security Standards for the Protection of Electronic Protected Health Information (45 CFR Part et. seq., the "Security Standards"): (a) Implementation. The District agrees to implement reasonable and appropriate administrative, physical and technical safeguards to protect the confidentiality, integrity and availability of Electronic Protected Health Information that the District creates, maintains or transmits on behalf of the HRA. "Electronic Protected Health Information" shall have the same definition as set out in the Security Standards, but generally shall mean Protected Health Information that is transmitted by or maintained in electronic media. (b) Agents or subcontractors shall meet security standards. The District shall ensure that any agent or subcontractor to whom it provides Electronic Protected Health Information shall agree, in writing, to implement reasonable and appropriate security measures to protect the Electronic Protected Health Information. (c) District shall ensure security standards. The District shall ensure that reasonable and appropriate security measures are implemented to comply with the conditions and requirements set forth in Section (d) Notification. Notification to affected individuals, HHS, and the media (when required) if the HRA or one of its business associates discovers a breach of unsecured Protected Health Information. Individuals who want to be notified of breaches that are not otherwise required by law may request to be so notified. \373507\1 - # v1 21

24