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ARTICLE XIII. <br />HIPAA PROVISIONS <br />The Privacy Rules and Security Rules under HIPAA apply to certain Optional Benefits Deleted: the <br />that constitute "covered entities" within the meaning of HIPAA (e.g., employer sponsored health Deleted: - <br /> Deleted: plans). <br /> <br />13.1 Use and Disclosure of PHI. The will use PHI to the extent of and in accordance with the Deleted: Plan <br />uses and disclosures permitted by HIPAA. Specifically, the will use and disclose PHI for Deleted: Plan <br />purposes related to health care treatment, payment for health care and health care operations. <br /> Deleted: (a) <br />Payment includes activities undertaken by the to obtain premiums or determine or <br />fulfill its responsibility for coverage and provision of benefts that relate to an Deleted: Plan <br />individual to whom health care is provided. These activities include, but are not limited Deleted: Plan <br />to, the following: <br />of eligibility, coverage and cost sharing amounts (for example, Deleted: (1) Determination <br />cost of a benefit, plan maximums and co-payments as determined for an <br />individual's claim); <br />Of benefits; Deleted: (2) Coordination <br />of health benefts claims (including appeals and other payment Deleted: (3) Adjudication <br />disputes); <br />of health benefit claims; Deleted: (4) Subrogation <br />employee contributions; Deleted: (5) Establishing <br />adjusting amounts due based on enrollee health status and demographic Deleted: (6) Risk <br />characteristics; <br />collection activities and related health care data processing; Deleted: (7) Billing, <br />management and related health care data processing, including auditing Deleted: (8) claims <br />payments, investigating and resolving payment disputes and responding to <br />participant inquiries about payments; <br />payment under a contract for reinsurance (including stop-loss and Deleted: (9) obtaining <br />excess of loss insurance); <br />necessity reviews or reviews of appropriateness of care or justification of Deleted: (10) Medical <br />charges; <br />review, including pre-certification, preauthorization, concurrent review Deleted: (11) utilization <br />and retrospective review; <br />to consumer reporting agencies related to the collection of premiums Deleted: (12) Disclosure <br />or reimbursement (the following PHI may be disclosed for payment purposes: <br />name and address, date of birth, Social Security number, payment history, <br />account number and name and address of provider and/or health and Deleted: plan; <br />to the Deleted: (13) Reimbursement <br /> Deleted: Plan. <br />© 2009 Hitesman & Associates, P.A. 33 Elk River Munibpal Utilities <br />Flexible Benefits Plan (No. 8.0.0.0) <br />