This form should be used when you are requesting access for your facility to our online portal, MyPlanTools.
This form should not be used if your facility already has access and you wish to add a user.
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Note: This form is for health care providers only. Employers and agents should call Quartz Customer Service at 800.362.3310 to request access to MyPlanTools.
If the Provider listed in this application (“Provider”) is granted access to MyPlanTools the following conditions apply:
Access to MyPlanTools shall not be construed as conferring any license to MyPlanTools or any information contained in and / or displayed therein to Provider. Provider acknowledges and agrees that information contained in and / or displayed via MyPlanTools may be considered Protected Health Information (“PHI”), as defined by the Health Insurance Portability and Accountability Act of 1996 (and regulations thereunder as amended from time to time) (“HIPAA”). As such, Provider agrees to abide by the Privacy and Security Rules of HIPAA and any other applicable laws and regulations.
Provider agrees to limit access to MyPlanTools and information contained and / or displayed therein in accordance with HIPAA, which includes but is not limited to creating and assigning User IDs and passwords only for those end users who are authorized to use, access, or disclose PHI, and limiting use of PHI to the “minimum necessary” needed to complete work.
Provider agrees to timely terminate access to MyPlanTools when an end user resigns or changes job duties that no longer require the end user to access MyPlanTools. Timely termination is termination within two (2) business days after one of the aforementioned events occurs. If there is a breach or suspected breach of a User ID or password, Provider and / or the end user must notify their Provider Coordinator as soon as practicably possible but no later than two (2) business days after discovery. Provider is responsible for any and all breaches of security resulting from end user access to MyPlanTools.
We reserve the right to terminate Provider’s and / or any end user associated with Provider’s access to MyPlanTools at any time.
© 2018 Quartz Health Solutions, Inc. All rights reserved.
Quartz Health Solutions, Inc., Unity Health Plans Insurance Corporation, Gundersen Health Plan, Inc., Gundersen Health Plan Minnesota, Physicians Plus Insurance Corporation, Gundersen Health System, UnityPoint Health and UW Health are separate legal entities. Plans are underwritten by Unity Health Plans Insurance Corporation unless otherwise noted.