E-PHI Agreement

User Roles:

AM

AR

D

There are three versions of the E-PHI Agreement that display in the RDS Secure Website depending on the screen accessed.

Example 1:

The View/Send/Receive Retiree Data privilege, Report Costs privilege, and Request Payment privilege permit the Designee to access certain Electronic Protected Health Information (E-PHI) associated with this Plan Sponsor's RDS Application.

Electronic Protected Health Information (E-PHI) is subject to protection under the Federal privacy and security regulations established at 45 C.F.R. §160 and 164 and promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act, as incorporated in the American Recovery and Reinvestment Act of 2009 (HITECH Act). E-PHI is intended for the access and use by individuals only as authorized by the Plan Sponsor. Disclosure of this E-PHI to any other party, unless authorized by the Plan Sponsor or required to do so by law, is prohibited.

Click Accept to authorize the Designee to access or use E-PHI associated with this Plan Sponsor's RDS Application or click Decline to modify the privileges that you want to assign to this Designee.

Example 2:

Electronic Protected Health Information (E-PHI) is subject to protection under the Federal privacy and security regulations established at 45 C.F.R. §160 and 164 and promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act, as incorporated in the American Recovery and Reinvestment Act of 2009 (HITECH Act). E-PHI is intended for the access and use by individuals only as authorized by the Plan Sponsor. Disclosure of this E-PHI to any other party, unless authorized by the Plan Sponsor or required to do so by law, is prohibited.

The Plan Sponsor has authorized you to access and use the E-PHI associated with this RDS Application. Click Accept to confirm that you agree to comply with the Plan Sponsor's policies concerning E-PHI. Click Decline, to return to the Manage Retirees page.

Example 3:

NOTE: The privileges ("View/Send/Receive Retiree Data" and/or "Report Costs" and/or "Request Payment") permit the Designee to access certain Electronic Protected Health Information (E-PHI) associated with this Plan Sponsor's RDS application. E-PHI is subject to protection under the federal privacy and security regulations established at 45 CFR Parts 160 and 164 and promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and is intended for the access and use by individuals only as authorized by the Plan Sponsor. Disclosure of this E-PHI to any other party, unless authorized by the Plan Sponsor or required to do so by law, is prohibited.

By clicking on "I accept" button below, you hereby authorize the Designee to access or use E-PHI associated with this Plan Sponsor's RDS application. Clicking the "Cancel" button will allow you to modify the privileges that you want to assign to this Designee.