Medicare Data Release Agreement
(Initial year: _______)
Carrier name ____________________________________ Contract #________
Enrollment Code(s)__________________________________________________
By the signature of the Contracting Official below, the Carrier contracting with the Office
of Personnel Management, hereby agrees
ü to limit access, use and disclosure, and
ü to physically safeguard the records of CSRS and FERS retirees, their spouses, and
survivor annuitants who are enrolled in the Plan named above and who are also
Medicare enrollees,
in accordance with the FEHB/MEDICARE Enrollment Data Exchange Agreement
between the Office of Personnel Management and the Social Security Administration, as
follows:
Data Exchange Agreement
Ø "OPM and SSA agree that the data obtained from SSA will be used only for
the administration of the Federal Employees Health Benefits Program (Chapter
89, title 5, United States Code) and in coordinating benefits through the
individual health benefits carriers who contract with OPM;
Ø to restrict access to the records created by the exchange to authorized personnel
whose duties and responsibilities require access;
Ø that the records involved in the exchange and the data contained therein will be
provided adequate security;
Ø that the files exchanged will not be duplicated or disseminated within or
outside OPM or SSA without written authority except as allowed by
regulations which permit disclosures among Federal or federally assisted
programs;
Ø files provided by OPM will remain the property of OPM, and files provided by
SSA will remain the property of SSA;
