2012-09-26 CC Packet - Laserfiche WebLink

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TAs c TM BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( "Agreement ") is made this day of , in the year 20 12 by and between City of Centerville as plan sponsor and plan administrator acting on behalf of City of Centerville ("Covered Entity ") and Total Administrative Employer Plon Services Corporation, a Wisconsin corporation ( "Business Associate "). RECITALS WHEREAS, Covered Entity is a group health plan ( "Plan ") and wishes to engage the services of Business Associate with respect to certain administrative aspects of the Plan as more specifically set forth in a Service Level Agreement ( "SLA "); WHEREAS, Covered Entity wishes to disclose certain information to Business Associate pursuant to the terms of the SLA, some of which may constitute Protected Health Information ( "PHI ") (defined below). WHEREAS, Covered Entity and Business Associate intend to protect the privacy and provide for the security of PHI disclosed to Business Associate pursuant to the SLA in compliance with the Health Insurance Portability and Accountability Act of 1996, Public Law 104 -191 ( "HIPAA "), the Health Information Technology for Economic and Clinical Health Act, Public Law 111 -005 (the "HITECH Act "), and regulations promulgated thereunder by the U.S. Department of Health and Human Services (the "HIPAA Regulations ") and other applicable laws. WHEREAS, as part of the HIPAA Regulations, the Privacy Rule and the Security Rule (defined below) require Covered Entity to enter into a contract containing specific requirements with Business Associate prior to the disclosure of PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of Federal Regulations ( "C.F.R. ") and contained in this Agreement. NOW THEREFORE, in consideration of the mutual promises below and the exchange of information pursuant to this Agreement, the parties agree as follows: The general terms and conditions attached hereto are incorporated herein and deemed part of this Agreement. IN WITNESS WHEREOF, the parties hereto have duly executed this Agreement as of the date first written above. COVERED ENTITY: BUSINESS ASSOCIATE: City of Centerville TOTAL ADMINISTRATIVE SERVICES CORPORATION SS/ #16."-N By: By: Print Name: Dallas Larson Print Name: Brad Hoffman Title: Administrator Title: Executive Vice President, Customer Service TC-3923-080111 Employer Initial , `TASC' 27