Page 71 - Dental Benefit Plan Summary

TEXAS MUTUAL INSURANCE COMPANY DENTAL PPO PLAN

SECURITY OF ELECTRONIC PROTECTED HEALTH INFORMATION
AMENDMENT

For: All Covered Participants

Under the federal security regulations enacted pursuant to the Health Insurance Portability
and Accountability Act of 1996 (HIPAA), your health plans are required to safeguard the
confidentiality and ensure the integrity and availability of your Electronic Protected Health
Information. Protected Health Information (PHI) is individually identifiable health
information related to your condition, services provided to you, or payments made for your
care, which is created or received by a health plan, a health care clearinghouse, or a health
care provider that electronically transmits such information. Electronic Protected Health
Information (ePHI) is PHI that is maintained or transmitted in electronic form. The Plan
and Texas Mutual Insurance Company (Employer) will reasonably and appropriately
safeguard ePHI created, received, maintained, or transmitted to or by Employer on behalf of
the Plan.

The Plan and Employer are separate and independent legal entities, which exchange
information to coordinate your Plan coverage. In order to receive ePHI from the Plan,
Employer agrees that it will:

■ Implement administrative, physical, and technical safeguards that reasonably and
appropriately protect the confidentiality, integrity, and availability of the ePHI that
Employer creates, receives, maintains, or transmits on behalf of the Plan;

■ Ensure that access to, and use and disclosure of ePHI by the employees or classes of
employees described in this Plan document is supported by reasonable and appropriate
security measures;

■ Ensure that any agent, including a subcontractor, to whom Employer provides this
information agrees to implement reasonable and appropriate security measures to
protect the information; and
■ Report to the Plan any security incident of which Employer becomes aware.

The classes of employees identified in the Employer’s HIPAA management procedure and
protocols may have access to, and use and disclose, PHI for plan administrative functions
that the Employer performs.
If you believe your rights under HIPAA have been violated, you have the right to file a
complaint with the Plan or with the Secretary of the U.S. Department of Health and Human
Services. Employer has provided a mechanism for resolving issues of noncompliance by
employees described above who have access to ePHI.

To file a complaint related to violations of HIPAA, please contact your supervisor or
contact the Privacy Officer directly. Also review the Employer’s privacy notice and
HIPAA management procedure for more information.

All other terms, provisions and conditions shown in this Summary Plan Description will
continue to apply.

66 SECTION 12 - ERISA