Lynn Shatz 12/3/2019 - Laserfiche WebLink

Liberty_ rolA intrmatiana9 underwriters. Healthcare Professional Liability LIBERTY INSURANCE UNDERWRITERS INC. (A Stock Insurance Company,hereinafter the"Company") ENDORSEMENT NO. I ] Effective Date: 07/01/2019 Policy Number: AHY-630201008 Issued To: Lynn D Shatz Return Premium ❑ Additional Premium 0 SCHEDULE Information Privacy Aggregate $25,000 Limit of Liability THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INFORMATION PRIVACY SUPPLEMENTARY PAYMENT ENDORSEMENT HIPAA FINES AND PENALTIES AND NOTIFICATION COSTS In consideration of the premium charged,it is hereby understood and agreed that this endorsement amends the following. I. The following is added to the SUPPLEMENTARY PAYMENTS section: HEALTH INFORMATION PRIVACY AND NOTIFICATION COSTS Subject to the Information Privacy Aggregate Limit of Liability shown in the Schedule above,the Company will: 1. pay HIPAA Fines and Penalties pursuant to the Health Insurance Portability and Accountability Act("HIPAA"), which the Insured becomes legally obligated to pay arising from a HIPAA Proceeding with respect to the management and transmission of Confidential Health Information; 2. reimburse the insured for notification costs related to the disclosure of Confidential Personal Information provided that the insured obtain the Company's prior approval before incurring such costs;and 3. pay Claims Expenses related to 1.and 2.above. II. With respect to the coverage provided by this endorsement,the following are added to the DEFINITIONS section of the policy: Confidential Health Information means information pertaining to a patient or a client that has been received or created by the Insured or provided by the Insured to another,subject to protection pursuant to HIPAA,including,but not limited to, an individual's health information,healthcare treatment information and the fact that the such individual has been treated by any provider. Confidential Personal Information means information not available to the general public from which an individual may be identified, including, without limitation, an individual's name, address, telephone number, social security number, account relationshi.,account number(s),account balance(s)and account history(ies). 1 2 HCPL-8101A(04/14)