Business Associate Agreement printable pdf download

BUSINESS ASSOCIATE AGREEMENT

This agreement (“Agreement”) is effective on the date executed by Business Associate and is between

the Brokerage/Broker/Agency/Agent named in the execution process of this Agreement (“Business

Associate”) and Golden West Health Plan, Inc. and its affiliated companies who are Covered Entities or

Business Associates and who have a business relationship with Business Associate, if any (hereinafter

collectively “Company”). The purpose of this Agreement is to comply with the requirements of the

Health Insurance Portability and Accountability Act of 1996 and its implementing regulations (45 C.F.R.

Parts 160-64), any applicable state privacy laws, any applicable state security laws, any applicable

implementing regulations issued by the Insurance Commissioner or other regulatory authority having

jurisdiction and the requirements of the Health Information Technology for Economic and Clinical Health

Act, as incorporated in the American Recovery and Reinvestment Act of 2009 (the “HITECH Act”) and

any regulations adopted or to be adopted pursuant to the HITECH Act that relate to the obligations of

business associates. Business Associate recognizes and agrees it is obligated by law to meet the

applicable provisions of the HITECH Act.

All capitalized terms in this Agreement that are not defined in this Agreement will have the meaning

ascribed to those terms by 45 C.F.R. Parts 160-164, or applicable insurance regulations that are

applicable to Company’s relationship with Business Associate.

A. Privacy of Protected Health Information and Nonpublic Personal Financial Information.

1. Permitted and Required Uses and Disclosures. Business Associate is permitted or required to

Use or disclose Protected Health Information (“PHI”) it requests, creates or receives for or from

Company (or another business associate of Company) only as follows:

a) Functions and Activities on Company’s Behalf. Business Associate is permitted to request, Use

and disclose PHI it creates or receives for or from Company (or another business associate of

Company), consistent with the Privacy Rule and the HITECH Act, only as described in this

Agreement, or other agreements during their term that may exist between Company and

Business Associate.

b) Business Associate’s Operations. Business Associate may Use PHI it creates or receives for

or from Company as necessary for Business Associate’s proper management and

administration or to carry out Business Associate’s legal responsibilities. Business Associate

may disclose such PHI as necessary for Business Associate’s proper management and

administration or to carry out Business Associate’s legal responsibilities only if:

(i)

The Disclosure is Required by Law; or

(ii)

Business Associate obtains reasonable assurance evidenced by written contract, from

any person or organization to which Business Associate will disclose such PHI that the

person or organization will:

a. Hold such PHI in confidence and Use or further disclose it only for the purpose

for which Business Associate disclosed it to the person or organization or as

Required by Law; and

b. Notify Business Associate (who will in turn promptly notify Company) of any

instance of which the person or organization becomes aware in which the

confidentiality of such PHI was breached.

c) Data Aggregation Services. If specifically directed by the Company, the Business Associate

will provide Data Aggregation services relating to the Health Care Operations of the Company.

Broker BA Agreement (Template revised October 2009)

Form No: BKR0003

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Business Associate Agreement

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