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<br />~'<v- <br />, " I <br />.... <br />Discovery Benefits <br /> <br />Plan Sponsor Certification <br /> <br />Cass County Government / Personnel ("Employer") sponsors a group health plan <br />known as Cass County Government / Personnel Cafeteria Plan (the "Plan"). Certain <br />members of Employer's workforce perform service in connection with administration of <br />the Plan. Employer acknowledges and agrees that the Standards for Privacy of <br />Individually Identified Health Information (45 CFR Part 164, the "Privacy Standards"), <br />prohibit the Plan or its business associates from disclosing Protected Health Information <br />(as defined in 9 164.501 of the Privacy Standards) to members of the Employer's <br />workforce unless the Employer agrees to the conditions and restrictions set out below. To <br />induce the Plan to disclose Protected Health Information to members of Employer's <br />workforce as necessary for them to perform administrative functions for the Plan, <br />Employer hereby accepts these conditions and restrictions and certifies that the Plan <br />documents have been amended to reflect these conditions and restrictions. Employer <br />agrees to: <br /> <br />a. Not use or further disclose the information other than as permitted or <br />required by the Plan documents or as required by law; <br />b. Ensure that any agent or subcontractor, to whom it provides Protected <br />Health Information received from the Plan, agrees to the same restrictions <br />and conditions that apply to the Employer with respect to such <br />information; <br />c. Not use or disclose Protected Health Information for employment-related <br />actions and decisions or in connection with any other benefit or employee <br />benefit plan of the Employer; <br />d. Report to the Plan any use or disclosure of the Protected Health <br />Information of which it becomes aware that is inconsistent with the uses or <br />disclosures permitted by the Plan or required by law; <br />e. Make available Protected Health Information to individual Plan members in <br />accordance with 9 164.524 of the Privacy Standards; <br />f. Make available Protected health Information for amendment by individual <br />Plan members and incorporate any amendments to Protected Health <br />Information in accordance with 9 164.526 of the Privacy Standards; <br />g. Make available the Protected Health Information required to provide an <br />accounting of disclosures to individual Plan members in accordance with <br />9 164.528 of the Privacy Standards; <br />h. Make its internal practices, books and records relating to the use and <br />disclosure of Protected Health Information received from the Plan available <br />to the Department of Health and Human Services for purposes of <br />determining compliance by the Plan with the Privacy Standards. <br />i. If feasible, return or destroy all Protected Health Information received <br />from the Plan that the Employer still maintains in any form, and retain no <br />copies of such Information when no longer needed for the purpose for <br />which disclosure was made, except that, if such return or destruction is <br />not feasible, limit further uses and disclosures to those purposes that <br />make the return or destruction of the information infeasible; and <br />j. Ensure the adequate separation between the Plan and members of the <br />Employer's workforce, as required by 9 164.504(f)(2)(iii) of the Privacy <br />Standards. <br />