Plan sponsor owns all plan data

provide to Employer, a copy of all Claim determination records, excluding any and all of the Business Confidential Information of Claim Administrator, other Blue Cross and/or Blue Shield companies, or Claim Administrator’s subsidiaries, affiliates, and vendors

Recorded reference: Page 7

Published rationale. Nowhere does the agreement say the Employer or the Plan owns claims, eligibility, accumulator or rebate data. Section 3.7 on page 7 gives the Employer only a right to request copies of claim determination records for three years after termination, with Business Confidential Information excluded, format to be agreed, preparation costs borne by the Employer and retention governed by the Claim Administrator's changeable policy. Section 3.3 on page 6 lets the Claim Administrator decide in its sole discretion whether to release data to the Employer's own consultants, who must sign the Claim Administrator's data exchange agreement and treat the data as the Claim Administrator's confidential information. Section 3.8 on page 7 lets the Claim Administrator and the Association use de identified data for industry improvement activities. Section 3.5 has the Employer agree not to contest the Claim Administrator's ownership of its Business Confidential Information. The model makes the sponsor sole owner with machine readable delivery on request; this is the reverse, so bad.

Claim Administrator may use or disclose a limited data set or de-identified data (“Data”) as permitted by the executed BAA, HIPAA and other applicable federal and state laws for the purpose of supporting industry improvement activities

Recorded reference: Page 7

Published rationale. On Page 7, Section 3.8 authorizes the Claim Administrator to use and disclose de-identified data and limited data sets for industry improvement activities and research. On Page 6 and 7, Section 3 treats plan records and claims systems as proprietary Business Confidential Information. The contract does not grant the Employer sole ownership of all claims, rebate, and eligibility data, nor does it mandate delivery of comprehensive data files in machine readable format on demand, directly contrary to the model term.

excluding any and all of the Business Confidential Information of Claim Administrator, other Blue Cross and/or Blue Shield companies, or Claim Administrator’s subsidiaries, affiliates, and vendors, in the possession of Claim Administrator.

Recorded reference: Page 7

Published rationale. Page 7 excludes broad business confidential information from claim determination records furnished on request after termination, imposes preparation costs and requires an agreed form. Page 15 includes pricing information, data and databases within the administrator's confidential information definition. Page 6 permits certain limited or de-identified data use for industry improvement, while prohibiting sale or use for financial profit in that stated category. These restrictions are not an outright sale right, but the city is never made sole owner of claim, eligibility, accumulator, rebate and derived data. Nor is unconditional machine-readable delivery promised. The administrator's explicit proprietary exclusion contradicts the model's comprehensive sponsor control and exit portability.

That the requested documents, records and other information (for purposes of this Section 3, “Confidential Information”) are proprietary and confidential in nature and that the release of the Confidential Information may reveal Claim Administrator’s Business Confidential Information.

Recorded reference: Page 6

Published rationale. The draft does not make the Employer the owner of plan data. Page 6, in the vendor data section, says the requested documents, records, and other information are proprietary and confidential and may reveal Claim Administrator's business confidential information. The vendor must not sell or lease that information and must return or destroy it at Claim Administrator's direction within sixty days after termination. Page 7, Section 3.7, provides claim determination records on request for three years after termination, excluding business confidential information of Claim Administrator, affiliates, and vendors. Page 15 defines that information to include cost and pricing data, databases, and derivatives. Section 3.8 lets Claim Administrator use de-identified data for industry improvement. Sale for vendor profit is barred, but the Employer is not given sole ownership, and reuse is allowed. The model contract makes the sponsor the sole owner and bars reuse, license, or sale. This draft treats the records as the vendor's confidential information. That is bad.

provide to Employer, a copy of all Claim determination records, excluding any and all of the Business Confidential Information of Claim Administrator

Recorded reference: Page 7

Published rationale. The model term makes the plan sponsor sole owner of claims, eligibility, accumulator, rebate and derived data, delivered in machine readable form on request, with no vendor reuse or resale. Nothing in this draft assigns data ownership to the Employer. Section 3.7 on page 7 lets the Employer request copies of claim determination records for three years after termination, at the Employer's cost, excluding all Business Confidential Information, and retention is subject to the Claim Administrator's own changeable records policy. Section 3.8 permits the Claim Administrator to use and disclose de-identified data for industry improvement activities. Section 3.3 treats data flowing to the Employer's own vendors as the Claim Administrator's confidential information, gated by its sole discretion and its own data exchange agreement. Data here belongs to the administrator in practice, with the plan buying back access. That contradicts the model term.