COBRA Administration. If you want isolved Benefit Services to process premium remittances and carry out other related activities, please complete the following information. Providing this information allows for quicker reimbursements. • On a monthly basis, isolved Benefit Services will generate and deliver Premium Remittance Reports through our secure website (i.e., the Download Center). These reports will be available to the client on the first business day of each month and will identify the remittance amount that will be sent by direct deposit. • isolved Benefit Services will send direct deposits of premiums within five business days of the delivery of the Premium Remittance Report. isolved Benefit Services will also generate and deliver any Voucher Premium Invoice Reports through the Download Center on the first business day of each month. • isolved Benefit Services may deduct fees from your remittance (saving you time and cost of generating a check back to us) in the event that funds are required from the company for payment of remittance related activity, including but not limited to, Voucher Premium Invoice Adjustment, Refund Adjustment or NSF Adjustment. In the case where fees are deducted from your remittance, please refer to additional report documentation(s) at the time of the deduction. Company name (Employer): isolved Benefit Services Company #: Opt Out: I request Premium Remittances via a paper check. I am aware of a $10 fee, per check, as a handling charge will be deducted for each remittance that is sent via a paper check. Depository Name: Branch: City: State: Zip: Transit/ABA Number (Must be 9 digits): Account Number: This Banking Authorization is hereby incorporated into the service agreement between the parties, and this Banking Authorization supersedes the terms and conditions of the service agreement to the extent that it contradicts any provisions related to premium collection services. This authority is to remain in full force and effect until isolved Benefit Services has received written notification from the above name d company of its termination in such time and in such manner as to afford isolved Benefit Services and depository a reasonable opportunity to act on it. By your signature below, you agree that isolved Benefit Services is not responsible for any unauthorized access to an account that is beyond its reasonable control. Signed: Date: Printed Name Title Phone This form must be returned by the 20th of the month to enable direct deposit for the following month. HIPAA Business Associate Agreement 1. PREAMBLE AND DEFINITIONS. 1.1. 1.2. 1.3. 1.4. 1.5. Pursuant to the Health Insurance Portability and Accountability Act of 1996, as amended ("HIPAA"), ("Covered Entity") and isolved, Inc. , or any of its corporate affiliates ("Business Associate"), a Michigan corporation, enter into this Business Associate Agreement ("BAA") as of (the "Effective Date") that addresses the HIPAA requirements with respect to "Business Associates," as defined under the privacy, security, breach notification, and enforcement rules at 45 C.F.R. Part 160 and Part 164 ("HIPAA Rules") to the extent applicable to the services provided by Business Associate to Covered Entity. A reference in this BAA to a section in the HIPAA Rules means the section as in effect or as amended. This BAA is intended to describe the steps that Business Associate will take to implement appropriate safeguards for the Protected Health Information ("PHI") (as defined under the HIPAA Rules) to the extent that Business Associate may receive, create, maintain, use, or disclose PHI in connection with the functions, activities, and services that Business Associate performs for Covered Entity. The functions, activities, and services that Business Associate performs for Covered Entity are defined in the administrative services agreement (the "Underlying Agreement"). Pursuant to changes required under the Health Information Technology for Economic and Clinical Health Act of 2009 (the "HITECH Act") and under the American Recovery and Reinvestment Act of 2009 ("ARRA"), this BAA also reflects federal breach notification requirements imposed on Business Associate when "Unsecured PHI" (as defined under the HIPAA Rules) is acquired by an unauthorized party, and the expanded privacy and security provisions imposed on business associates. Unless the context clearly indicates otherwise, the following terms in this BAA shall have the same meaning as those terms in the HIPAA Rules: Breach, Data Aggregation, Designated Record Set, disclosure, Electronic Media, Electronic Protected Health Information (ePHI), Health Care Operations, individual, Minimum Necessary, Notice of Privacy Practices, Required by Law, Secretary, Security Incident, Subcontractor, Unsecured PHI, and use. A reference in this BAA to the Privacy Rule means the Privacy Rule, in conformity with the regulations at 45 C.F.R. Parts 160-164 (the "Privacy Rule") as interpreted under applicable regulations and guidance of general application published by HHS, including all amendments thereto for which compliance is required, as amended by the HITECH Act, ARRA, and the HIPAA Rules.
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COBRA Administration. If you want isolved Benefit Services to process premium remittances and carry out other related activities, please complete the following information. Providing this information allows for quicker reimbursements. • On a monthly basis, isolved Benefit Services will generate and deliver Premium Remittance Reports through our secure website (i.e., the Download Center). These reports will be available to the client on the first business day of each month and will identify the remittance amount that will be sent by direct deposit. • isolved Benefit Services will send direct deposits of premiums within five business days of the delivery of the Premium Remittance Report. isolved Benefit Services will also generate and deliver any Voucher Premium Invoice Reports through the Download Center on the first business day of each month. • isolved Benefit Services may deduct fees from your remittance (saving you time and cost of generating a check back to us) in the event that funds are required from the company for payment of remittance related activity, including but not limited to, Voucher Premium Invoice Adjustment, Refund Adjustment or NSF Adjustment. In the case where fees are deducted from your remittance, please refer to additional report documentation(s) at the time of the deduction. Company name (Employer): isolved Benefit Services Company #: Opt Out: I request Premium Remittances via a paper check. I am aware of a $10 fee, per check, as a handling charge will be deducted for each remittance that is sent via a paper check. Depository Name: Branch: City: State: Zip: Transit/ABA Number (Must be 9 digits): Account Number: This Banking Authorization is hereby incorporated into the service agreement between the parties, and this Banking Authorization supersedes the terms and conditions of the service agreement to the extent that it contradicts any provisions related to premium collection services. This authority is to remain in full force and effect until isolved Benefit Services has received written notification from the above name d company of its termination in such time and in such manner as to afford isolved Benefit Services and depository a reasonable opportunity to act on it. By your signature below, you agree that isolved Benefit Services is not responsible for any unauthorized access to an account that is beyond its reasonable control. Signed: Date: Printed Name Title Phone This form must be returned by the 20th of the month to enable direct deposit for the following month. HIPAA Business Associate Agreement 1. PREAMBLE AND DEFINITIONS. 1.1. 1.2. 1.3. 1.4. 1.5. Pursuant to the Health Insurance Portability and Accountability Act of 1996, as amended ("HIPAA"), ("Covered Entity") and isolved, Inc. , or any of its corporate affiliates ("Business Associate"), a Michigan corporation, enter into this Business Associate Agreement ("BAA") as of (the "Effective Date") that addresses the HIPAA requirements with respect to "Business Associates," as defined under the privacy, security, breach notification, and enforcement rules at 45 C.F.R. Part 160 and Part 164 ("HIPAA Rules") to the extent applicable to the services provided by Business Associate to Covered Entity. A reference in this BAA to a section in the HIPAA Rules means the section as in effect or as amended. This BAA is intended to describe the steps that Business Associate will take to implement appropriate safeguards for the Protected Health Information ("PHI") (as defined under the HIPAA Rules) to the extent that Business Associate may receive, create, maintain, use, or disclose PHI in connection with the functions, activities, and services that Business Associate performs for Covered Entity. The functions, activities, and services that Business Associate performs for Covered Entity are defined in the administrative services agreement (the "Underlying Agreement"). Pursuant to changes required under the Health Information Technology for Economic and Clinical Health Act of 2009 (the "HITECH Act") and under the American Recovery and Reinvestment Act of 2009 ("ARRA"), this BAA also reflects federal breach notification requirements imposed on Business Associate when "Unsecured PHI" (as defined under the HIPAA Rules) is acquired by an unauthorized party, and the expanded privacy and security provisions imposed on business associates. Unless the context clearly indicates otherwise, the following terms in this BAA shall have the same meaning as those terms in the HIPAA Rules: Breach, Data Aggregation, Designated Record Set, disclosure, Electronic Media, Electronic Protected Health Information (ePHI), Health Care Operations, individual, Minimum Necessary, Notice of Privacy Practices, Required by Law, Secretary, Security Incident, Subcontractor, Unsecured PHI, and use. A reference in this BAA to the Privacy Rule means the Privacy Rule, in conformity with the regulations at 45 C.F.R. Parts 160-164 (the "Privacy Rule") as interpreted under applicable regulations and guidance of general application published by HHS, including all amendments thereto for which compliance is required, as amended by the HITECH Act, ARRA, and the HIPAA Rules.Phone
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Samples: Isolved Benefit Services Service Agreement, Isolved Benefit Services Service Agreement
