Addendum to Business Associate Agreement

This Addendum is incorporated into and made part of the Business Associate Agreement (“Agreement”) between the Regents of the University of California, a California constitutional corporation, on behalf of its University of California Health System and [INSERT NAME OF BUSINESS ASSOCIATE] (“Business Associate”) (hereinafter “the Parties.”) The Parties agree that, to the extent the Business Associate receives, maintains, uses, or discloses any records subject to 42 C.F.R. Part 2 (“Part 2”), the following terms apply:

Compliance with 42 C.F.R. Part 2
The Business Associate acknowledges that any records covered by Part 2 are subject to strict federal confidentiality protections. The Business Associate agrees that such records may be used or disclosed only in full compliance with Part 2, including all limitations on disclosures for law enforcement purposes and the requirements governing any court‑ordered disclosure.
Permitted Uses and Disclosures
The Business Associate shall use and disclose Part 2 records solely as permitted by Part 2 and consistent with any applicable patient consent. Any disclosure that is allowed under Part 2 must include the required prohibition on redisclosure notice.
Obligations Flowing to Subcontractors
To the extent the Business Associate engages any subcontractor that may access Part 2 records, the Business Associate shall ensure that the subcontractor is bound by written obligations that are no less protective than those set out in this Addendum.
Survival
These obligations regarding Part 2 records survive termination of the Agreement for as long as the Business Associate maintains such records.

IN WITNESS WHEREOF, the Parties have executed this Addendum to the Business Associate Agreement as of the date set forth below.

The Regens of the University of California
By: _______________________________
Name:_____________________________
Title:______________________________
Date: _____________________________

[BUSINESS ASSOCIATE]
By: ___________________________
Name:__________________________
Title:___________________________
Date:___________________________

For accommodations of persons with special needs at meetings, call 844-590-1757 (TTY 711).

UCLA Health Medicare Advantage Plan (HMO) has a contract with Medicare and enrollment in the plan depends on contract renewal. UCLA Health Medicare Advantage Plan includes Part D drug coverage. To enroll in UCLA Health Medicare Advantage Plan, you must have both Medicare Parts A and B and reside in the plan service area, Los Angeles County. In addition to your monthly plan premium, you must continue to pay your Medicare Part B premium.

Please contact Member Services at 1-833-627-8252 (833-MAP-UCLA) (TTY 711) for additional information. Hours are 8am - 8pm PT, Monday - Friday, April 1 through September 30, except on all federal holidays. Hours are 8am - 8pm PT, 7 days a week, October 1 through March 31, except Thanksgiving Day and Christmas Day.

Members enrolled in UCLA Health Medicare Advantage Plan (HMO) must use plan providers except in emergency or urgent care situations. If a member obtains care from an out-of-network provider without prior approval from UCLA Health Medicare Advantage Plan, neither Medicare nor UCLA Health Medicare Advantage Plan will be responsible for the costs. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Every year, Medicare evaluates plans based on a 5-star rating system. Star ratings may vary by contract or market. For plan year 2025, UCLA Health Medicare Advantage Plan’s H4647 (HMO) contract is too new to be measured for a Star rating.

(Smart Benefits Card) &more Benefits Prepaid Mastercard® is issued by Avidia Bank, pursuant to a license from Mastercard Inc. Use of this card is subject to the terms and conditions of the Cardholder Agreement.

Uber does not require the Uber app and the number of allowable rides varies by plan. Uber and Uber Health brand names, product names, and/or trademarks belong to their respective holders.

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Last Updated on 01/07/2026