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Getting Set Up With OCI - FBFS Agent

  • OCI has been supporting agents with the products, tools, and services to help agents serve their clients and increase their income since 2002.

    Completion of this form will set you up with OCI as your general agency partner, as well as set you up on our platform.

    PLEASE NOTE: After you are set up with OCI, you will need to get contracted with the carrier(s) that you plan to sell. Completing this form does not get you contracted with a carrier.

  • You have full access to all of OCI's products and services. We ask you to complete this form only when you are ready to submit business and your client has agreed to move forward with the application. Thank you.
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    • Protecting your private information is important to OCI Insurance & Financial Services, Inc (“OCI”) and our employees. We want you to understand what information we collect and how we use it. In order to provide our customers with a broad range of products and services as effectively and conveniently as possible, we use technology to manage and maintain customer information. The following policy serves as a standard for all OCI employees for collection, use, retention, and security of nonpublic personal information.

      View OCI Privacy Policy


    • HIPAA Notification
      This notification is being sent by OCI Insurance and Financial
      Services INC. in order to comply with HIPAA regulations. This will
      allow us to continue to send you personal information we receive
      from or about your clients.
      Please accept the terms of this agreement at the bottom of the
      page.
      BUSINESS ASSOCIATE AGREEMENT
      THIS BUSINESS ASSOCIATE AGREEMENT (“Agreement”), entered into and effective this day in
      February, 2010, is by and between you, the broker, (“Business Associate”) and OCI Insurance and
      Financial Services INC. (“OCI”); and shall be collectively known herein as the “Parties”.
      WHEREAS, OCI wishes to commence a business relationship with “Business Associate” as defined in
      the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) including all pertinent
      regulations, issued by the U.S. Department of Health and Human Services as either have been
      amended by Subtitle D of the Health Information Technology for Economic and Clinical Health Act
      (“the HITECH Act”), as Title XIII of Division A and Title IV of Division B of the American Recovery and
      Reinvestment Act of 2009; and
      WHEREAS, the nature of the prospective contractual relationship between OCI and Business
      Associate may involve the exchange of Protected Health Information (“PHI”) as defined under HIPAA;
      and
      For good and lawful consideration OCI and Business Associate enter into this agreement for the
      purpose of ensuring compliance with the requirements of HIPAA, its implementing regulations, and the
      HITECH Act.
      In consideration of the premises and promises contained herein, it is mutually agreed by and between
      OCI and its Business Associates as follows:
      I. DEFINITIONS
      A. Individual. “Individual” shall have the same meaning as the term “individual” in 45 CFR
      164.501 and shall include a person who qualifies as a personal representative in accordance
      with 45 CFR 164.502(g).
      B. Breach. “Breach” shall have the same meaning as the term “breach” in 13400 of the HITECH
      Act and shall include the unauthorized acquisition, access, use or disclosure of PHI that
      compromises the security or privacy of such information.
      C. Designated Record Set. “Designated Record Set” shall have the same meaning as the term
      “designated record set” in 45 CFR 164.501.
      D. Privacy Rule. “Privacy Rule” shall mean the Standards for Privacy of Individually Identifiable
      Health Information in 45 CFR Part 160 and Part 164, Subparts A and B, as amended by the
      HITECH Act and as may otherwise be amended from time to time.
      E. Protected Health Information. “Protected Health Information” or “PHI” shall have the same
      meaning as the term “protected health information” in 45 CFR 164.501, limited to the
      information created or received by Business Associate from or on behalf of OCI.
      F. Required By Law. “Required By Law” shall have the same meaning as the term “required by

      law” in 45 CFR 164.501.
      G. Secretary. “Secretary” shall mean the “Secretary of the U. S. Department of Health and
      Human Services” or his designee.
      H. Unsecured Protected Health Information. “Unsecured Protected Health Information” or
      “Unsecured PHI” shall mean PHI that is not secured through the use of a technology or
      methodology specified by the Secretary in guidance or as otherwise defined in the 13402(h)
      of the HITECH Act.
      II. USE OR DISCLOSURE OF PHI BY BUSINESS ASSOCIATE
      A. Except as otherwise limited in this Agreement, Business Associates may use or disclose PHI
      to perform functions, activities, or services for, or on behalf of OCI, provided that each use or
      disclosure would not violate the Privacy Rule.
      B. Business Associate shall only use and disclose PHI if such use or disclosure complies with
      each applicable requirement of 45 CFR 164.504(e).
      C. Business Associate shall be directly responsible for full compliance with the relevant
      requirements of the Privacy Rule to the same extent as OCI.
      III. DUTIES OF BUSINESS ASSOCIATE RELATIVE TO PHI
      A. Business Associate shall not use or disclose PHI other than as permitted or required by this
      Agreement or as Required by Law.
      B. Business Associate shall implement administrative, physical and technical safeguards that
      reasonably and appropriately protect the confidentiality, integrity, and availability of the
      electronic PHI that it creates, receives, maintains or transmits on behalf of OCI.
      C. Business Associate shall immediately notify OCI of any use or disclosure of PHI in violation of
      this Agreement.
      D. Business Associates shall orally notify OCI of a Breach of Unsecured PHI within 24 hours of
      Business Associate’s (or Business Associate’s employee, officer, or agent) discovery of such
      Breach, followed by a report in writing, except where a law enforcement official determines
      that a notification would impede a criminal investigation or cause damage to national security.
      Business Associate’s written notification to OCI here under shall:
      1. Be made to OCI within 48 hours of the initial oral report,
      2. Include the individual whose Unsecured PHI has been, or is reasonably believed to
      have been, the subject of a Breach, and
      3. Be in substantially the same form as EXHIBIT A hereto.
      E. In the event of an unauthorized use or disclosure of PHI or a Breach of Unsecured PHI,
      Business Associate shall mitigate to the extent practicable any harmful effects of said
      disclosure that are known to it.
      F. Business Associate agrees to ensure that any agent, including a subcontractor, to whom it
      provides PHI, received from, or created or received by Business Associate on behalf of OCI,
      agrees to the same restrictions and conditions that apply through this Agreement to Business
      Associate with respect to such information.
      G. To the extent applicable, Business Associate shall provide access to PHI in a Designated
      Record Set at reasonable times, at the request of OCI or, as directed by OCI to an Individual
      in order to meet the requirements under 45 CFR 164.524.
      H. To the extent applicable, Business Associate shall make any amendment(s) to PHI in a
      Designated Record Set that OCI directs or agrees to pursuant to 45 CFR 164.526 at the
      request of OCI or an Individual.
      I. Business Associate shall, upon request with reasonable notice, provide OCI access to its
      premises for a review and demonstration of its internal practices and procedures for
      safeguarding PHI.

      J. Business Associate agrees to document such disclosures of PHI and information related to
      such disclosures as would be required for OCI to respond to a request by an individual for an
      accounting of disclosures of PHI in accordance with 45 CFR 164.528. Should an Individual
      make a request to OCI for an accounting of disclosures of his or her PHI pursuant to 45 CFR
      164.528, Business Associate agrees to promptly provide OCI with information in a format and
      manner sufficient to respond to the individual’s request.
      K. Business Associate shall upon request with reasonable notice, provide OCI with an
      accounting of uses and disclosures of PHI provided to it by OCI.
      L. Business Associate shall make its internal practices, books, records, and any other material
      request by the Secretary relating to the use, disclosure, and safeguarding of PHI received
      from OCI available to the Secretary for the purpose of determining compliance with the
      Privacy Rule. The aforementioned information shall be made available to the Secretary in the
      manner and place as designated by the Secretary or the Secretary’s duly appointed delegate.
      Under this Agreement, Business Associate shall comply and cooperate with any request for
      documents or other information from the Secretary directed to OCI that seeks documents or
      other information held by Business Associate.
      M. Business Associate may use Protected Health Information to report violations of law to
      appropriate Federal and State authorities, consistent with 42 CFR 164.502(j)(I).
      N. Except as otherwise limited in this Agreement, Business Associate may disclose PHI for the
      proper management and administration of Business Associate, provided that disclosures are
      Required By Law, or Business Associate obtains reasonable assurances from the person to
      whom the information is disclosed that it will remain confidential and used or further disclosed
      only as Required By Law or for the purpose for which it was disclosed to the person, and the
      person notifies Business Associate of any instances of which it is aware in which the
      confidentiality of the information has been breached.
      IV. TERM AND TERMINATION
      A. Term. The Term of this Agreement shall be effective as of the date first above written and
      shall terminate when all of the PHI provided by OCI to Business Associate, or created or
      received by Business Associate on behalf of OCI, is destroyed or returned to OCI, or, if it is
      infeasible to return or destroy PHI, protections are extended to such information, in
      accordance with the termination provisions in this Section IV.
      B. Termination for Cause. Upon OCI’s knowledge of a material breach by Business Associate,
      OCI shall:
      1. Provide an opportunity for Business Associate to cure the breach or end the violation
      and, if Business Associate does not cure the breach or end the violation within the
      time specified by OCI, terminate this Agreement:
      2. Immediately terminate this Agreement if Business Associate has breached a material
      term of this Agreement and cure is not possible; or
      3. If neither termination nor cure is feasible, report the violation to the Secretary.
      C. Effect of Termination.
      1. Except as provided in paragraph C(2) of this section, upon termination of this
      Agreement, for any reason, Business Associate shall return or destroy all PHI
      received from OCI, or created or received by Business Associate on behalf of OCI.
      This provision shall apply to PHI that is in the possession of subcontractors or agents
      of Business Associate. Business Associate shall not retain any copies of the PHI.
      2. In the event that Business Associate determines that returning or destroying the PHI
      is infeasible, Business Associate shall provide to OCI written notification of the
      conditions that make return or destruction infeasible. After written notification that

      return or destruction of PHI is infeasible, Business Associate shall extend the
      protections of this Agreement to such PHI and limit further uses and disclosures of
      such PHI to those purposes that make the return or destruction infeasible, for so long
      as Business Associate maintains such PHI.
      3. Should Business Associate make a disclosure of PHI in violation of this Agreement,
      OCI shall have the right to immediately terminate any contract other than this
      Agreement, then in force between the Parties.
      V. CONSIDERATION
      Business Associate recognizes that the promises it has made in this Agreement shall, henceforth, be
      detrimentally relied upon by OCI in choosing to continue or commence a business relationship with
      Business Associate.
      VI. REMEDIES IN EVENT OF BREACH
      Business Associate hereby recognizes that irreparable harm will result to OCI, and to the business of
      OCI, in the event of breach by Business Associate of any of the covenants and assurances contained
      in this Agreement. As such, in the event of breach of any of the covenants and assurances contained
      in Section II or III above, OCI shall be entitled to restrain Business Associate from any continued
      violation of Sections II or III. Furthermore, in the event of breach of Sections II or III by Business
      Associate, OCI is entitled to reimbursement and indemnification from Business Associate for OCI’s
      reasonable attorneys’ fees and expenses and costs that were reasonably incurred as a proximate
      result of Business Associates breach. The remedies contained in this Section VI shall be in addition to
      (and not supersede) any action for damages and/or any other remedy OCI may have for breach of any
      part of this Agreement.
      VII. MODIFICATION
      This Agreement may only be modified through a written document signed by the Parties and, thus, no
      oral modification hereof shall be permitted. The Parties agree to take such action as is necessary to
      amend this Agreement from time to time as is necessary for OCI to comply with the requirements of
      the Privacy Rule and HIPAA.
      VIII. INTERPRETATION OF THIS CONTRACT IN RELATION TO OTHER CONTRACTS BETWEEN
      THE PARTIES
      Should there be any conflict between the language of this contract and any other contract entered into
      between the Parties (either previous or subsequent to the date of this Agreement), the language and
      provisions of this Agreement shall control and prevail unless the Parties specifically refer in a
      subsequent written agreement to this Agreement by its title and date and specifically state that the
      provisions of the later written agreement shall control over this Agreement.
      IX. COMPLIANCE WITH STATE LAW
      The Business Associate acknowledges that by accepting the PHI from OCI, it becomes a holder of
      health records information and is subject to the provisions of Arizona law. If the HIPAA Privacy or
      Security Rules and the laws of Nebraska conflict regarding the degree of protection provided for PHI,
      Business Associate shall comply with the more restrictive protection requirement.
      X. MISCELLANEOUS
      A. Ambiguity. Any ambiguity in this Agreement shall be resolved to permit OCI to comply with
      the Privacy Rule.
      B. Regulatory Reference. A reference in this Agreement to a section in the Privacy Rule means
      the section as in effect or as amended.
      C. Notice to OCI. Any notice required under this Agreement to be given to OCI shall be made in
      writing to:

      4221 N 203rd Street
      Suite 200 Elkhorn, NE 68022
      Attention: Privacy Officer
      402-330-8700
      D. Notice to Business Associate. Any notice required under this Agreement to Business
      Associate shall be made in writing to Business Associate’s address on file with OCI at the
      time said Notice is required.
      IN WITNESS WHEREOF and acknowledging acceptance and agreement of the foregoing, the Parties
      affix their signatures hereto.

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    About Us

    OCI

    Headquartered in Elkhorn, Nebraska, OCI Insurance & Financial Services, Inc., is an insurance field marketing organization providing support to thousands of agents nationwide in the placement of these products and services.

    HIPAA Compliance Verification
    OCI Insurance & Financial Services, Insurance Agency, Elkhorn, NE

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    Contact Us

    402.330.8700
    Toll free: 866.320.8700
    Fax: 402.330.8706

    4221 N. 203rd St, Ste 200
    Elkhorn, NE 68022

    Hours:
    Monday – Thursday: 8:00 am – 5:00 pm
    Friday: 8:00 am – 4:30 pm

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