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Pages 4 through 110 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4
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//T|/...s%20with%20NO%2012600%20Response%20[YELLOW]/UFCW%20Oklahoma%20Local%201000/Waiver%2010.08.10.htm[07/21/2011 11:47:
rom: Brian D Peters [[email protected]]ent: Friday, October 08, 2010 10:27 AM
To: HHS HealthInsurance (HHS)ubject: Waiver
ollow Up Flag: Follow uplag Status: Yellow
Attachments: UFCW_OK_HW_FUND_Waiver_Request.pdf; UFCW_OK_Homeland_Contract.pdf;UFCW_OK_HW_FUND_SPD.pdfear Mr. James Mayhew,
he United Food and Commercial Workers Local 1000 Oklahoma Health & Welfare Fund is requesting a waiver from the restric
nnual limits set forth in the interim final regulations. We have attached for your review:
1. Waiver Request2. Contract between the Welfare Fund and the Employer3. Summary Plan Description of the Fund
you need any additional information, please feel free to contact me.
egards,
rian D Peters
und Administrator
rian D. Peters, C.P.A.ice President &hief Information Officer
EBA, Inc.www.nebainc.com010 N. W. 150th Avenueuite 100
embroke Pines, Florida 3302800.842.5899 Toll Free54.266.632254.266.2079 Fax
mportant Warning: This e-mail, and any attachments thereto, is intended only for use by the addressee(s) named herein and may containgally privileged and/or confidential information. If you are not the intended recipient of this e-mail (or the person responsible for delivering ocument to the intended recipient), you are hereby notified that any dissemination, distribution, printing or coping of this e-mail, and anytachment thereto, is strictly prohibited. If you have received this e-mail in error, please respond to the individual sending the message, andermanently delete the original and any copy of the e-mail and printout thereof.
UFCW OK L1000:000007
http://www.nebainc.com/http://www.nebainc.com/http://www.nebainc.com/8/22/2019 UFCW Oklahoma L1000 - Combined Redacted-Bates HW
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//T|/...ocal%201000%20Oklahoma%20Fund%20Waiver%20Application%20-%20Request%20for%20Additional%20Information.htm[07/21/2011 11:47
rom: Keels, Lisa (HHS/OCIIO)ent: Thursday, October 28, 2010 3:54 PM
To: [email protected]: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
ear Mr. Peters:
hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. In or
o complete your application, please provide the following information:
Please confirm that the effective date for the new will be January 1, 2011.
In your application, you state that approximately employees and dependents are covered by the Pl
Please indicate how many employees and depend e covered in each particular plan (i.e., please bre
out the numbers for Plan AA, Plan A, and Plan B).
For each plan (i.e., Plan AA, Plan A, and Plan B), please provide the current monthly premium rates and th
projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with t
restricted annual benefits. In other words, we would like a chart that reflects the following information fo
each plan:
2010 January Premium
(current level)
2011 January Premium
(renewal)
2011 January Premium
(if $750,000 annual
limit was applied)
EE
EE + Child (if applicable
or other appropriate
tier)
EE + Spouse (if
applicable or otherappropriate tier)
Family (if applicable or
other appropriate tier)
n order to complete your application, please provide this information by 5:00 pm, October 29, 2010. We look forwa
o receiving your completed application.
hank you,
isa Keels
sa M. Keels, J.D.
.S. Department of Health & Human Services
ffice of Consumer Information and Insurance Oversight
ffice of Oversight
UFCW OK L1000:000008
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//T|/...0Local%201000/RE%20UCFW%20Local%201000%20Oklahoma%20-%20Request%20for%20Addl%20Info%2010.29.10.htm[07/21/2011 11:47
rom: Keels, Lisa (HHS/OCIIO)ent: Friday, October 29, 2010 4:12 PM
To: Brian D Petersubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Informationhank you for the information, Mr. Peters. I will be in touch if I need additional information.
njoy your weekend.
hank you again,sa Keels
rom: Brian D Peters [mailto:[email protected]]ent: Friday, October 29, 2010 3:11 PMo: Keels, Lisa (HHS/OCIIO)ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
ear Ms. Keels,
lease see below for our response to your questions. Please let me know if you need any additional information.
Please confirm that the effective date for the new plans will be January 1, 2011.
The UCFW Local 1000 Oklahoma Fund is a calendar year plan. January 1, 2011 is the beginning of the next Plan
year.
In your application, you state that approximately employees and dependents are covered by the Plan.
Please indicate how many employees and dependents are covered in each particular plan (i.e., please break ou
the numbers for Plan AA, Plan A, and Plan B).
Listed below are the most current count of eligible employees and dependents broken out by Plan as of Novem
1, 2010. This list below does not include employees that are in a waiting period and were part of the original
estimate of
Plan AA
Plan A
Plan B
Total
For each plan (i.e., Plan AA, Plan A, and Plan B), please provide the current monthly premium rates and the
projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the
restricted annual benefits. In other words, we would like a chart that reflects the following information for ea
plan:
Please see attached document from the Fund Consultant.egards,
rian Peters
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, October 28, 2010 3:54 PMo: [email protected]: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
UFCW OK L1000:000009
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//T|/...0Local%201000/RE%20UCFW%20Local%201000%20Oklahoma%20-%20Request%20for%20Addl%20Info%2010.29.10.htm[07/21/2011 11:47
ear Mr. Peters:
hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. In order to
omplete your application, please provide the following information:
Please confirm that the effective date for the new plans will be January 1, 2011.
In your application, you state that approximately employees and dependents are covered by the Plan.
Please indicate how many employees and dependents are covered in each particular plan (i.e., please break outhe numbers for Plan AA, Plan A, and Plan B).
For each plan (i.e., Plan AA, Plan A, and Plan B), please provide the current monthly premium rates and the
projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the
restricted annual benefits. In other words, we would like a chart that reflects the following information for ea
plan:
2010 January Premium
(current level)
2011 January Premium
(renewal)
2011 January Premium
(if $750,000 annual
limit was applied)EE
EE + Child (if applicable
or other appropriate
tier)
EE + Spouse (if
applicable or other
appropriate tier)
Family (if applicable or
other appropriate tier)
n order to complete your application, please provide this information by 5:00 pm, October 29, 2010. We look forward to
eceiving your completed application.
hank you,
sa Keels
sa M. Keels, J.D.
.S. Department of Health & Human Servicesffice of Consumer Information and Insurance Oversight
ffice of Oversight
UFCW OK L1000:000010
mailto:[email protected]:[email protected]8/22/2019 UFCW Oklahoma L1000 - Combined Redacted-Bates HW
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//T|/...ma%20Local%201000/RE%20UCFW%20Local%201000%20Oklahoma%20-%20Addl%20Info%20Response%2010.29.10.htm[07/21/2011 11:47
rom: Brian D Peters [[email protected]]ent: Friday, October 29, 2010 3:11 PM
To: Keels, Lisa (HHS/OCIIO)ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
Attachments: HHS Response October 29 2010.pdfear Ms. Keels,
lease see below for our response to your questions. Please let me know if you need any additional information.
Please confirm that the effective date for the new plans will be January 1, 2011.
The UCFW Local 1000 Oklahoma Fund is a calendar year plan. January 1, 2011 is the beginning of the next Plan
year.
In your application, you state that approximately employees and dependents are covered by the Plan.
Please indicate how many employees and dependents are covered in each particular plan (i.e., please break ou
the numbers for Plan AA, Plan A, and Plan B).
Listed below are the most current count of eligible employees and dependents broken out by Plan as of Novem
1, 2010. This list below does not include employees that are in a waiting period and were part of the original
estimate of .
Plan AA
Plan A
Plan B
Total
For each plan (i.e., Plan AA, Plan A, and Plan B), please provide the current monthly premium rates and the
projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the
restricted annual benefits. In other words, we would like a chart that reflects the following information for ea
plan:Please see attached document from the Fund Consultant.
egards,
rian Peters
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, October 28, 2010 3:54 PMo: [email protected]: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
ear Mr. Peters:
hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. In order to
omplete your application, please provide the following information:
Please confirm that the effective date for the new plans will be January 1, 2011.
In your application, you state that approximately employees and dependents are covered by the Plan.
Please indicate how many employees and dependents are covered in each particular plan (i.e., please break ou
the numbers for Plan AA, Plan A, and Plan B).
UFCW OK L1000:000011
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//T|/...ma%20Local%201000/RE%20UCFW%20Local%201000%20Oklahoma%20-%20Addl%20Info%20Response%2010.29.10.htm[07/21/2011 11:47
For each plan (i.e., Plan AA, Plan A, and Plan B), please provide the current monthly premium rates and the
projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the
restricted annual benefits. In other words, we would like a chart that reflects the following information for ea
plan:
2010 January Premium
(current level)
2011 January Premium
(renewal)
2011 January Premium
(if $750,000 annual
limit was applied)
EE
EE + Child (if applicable
or other appropriate
tier)
EE + Spouse (if
applicable or other
appropriate tier)
Family (if applicable or
other appropriate tier)
n order to complete your application, please provide this information by 5:00 pm, October 29, 2010. We look forward to
eceiving your completed application.
hank you,
sa Keels
sa M. Keels, J.D.
.S. Department of Health & Human Services
ffice of Consumer Information and Insurance Oversight
ffice of Oversight
UFCW OK L1000:000012
mailto:[email protected]:[email protected]8/22/2019 UFCW Oklahoma L1000 - Combined Redacted-Bates HW
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//T|/...nse%20[YELLOW]/UFCW%20Oklahoma%20Local%201000/2nd%20Request%20for%20Additional%20Info%2011.5.10.htm[07/21/2011 11:47:
rom: Keels, Lisa (HHS/OCIIO)ent: Friday, November 05, 2010 10:29 AM
To: Brian D PetersCc: 'Jim Crump'; Habit, Sandra (HHS/OCIIO)
ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Applicationi Brian,
was a pleasure speaking with you this morning as well. Please send any additional documents for UFCW Local 1000 and
roger Dallas Health & Welfare Plan to the HHS general email, so we can ensure it goes through the entire process.
lso, thank you and Jim for confirming that you plan to remove the $ lifetime limit on
Thank you also for confirming that, if the annual limit requirements are waived for Plan AA, Plan A, and Plan B
nly annual limits you plan to have in the next Plan year are the overall annual limit and the annual limit on prescriptions.
lease confirm via email that this is the case.
hank you again, and have a wonderful weekend.
egards,sa
rom: Brian D Peters [mailto:[email protected]]ent: Friday, November 05, 2010 10:18 AMo: Keels, Lisa (HHS/OCIIO)c: 'Jim Crump'ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application
i Lisa,
was a pleasure speaking with you this morning. In the call I referenced a waiver that was filed on another fund we administe
he waiver was emailed on Tuesday 10/26/2010 for the United Food and Commercial Workers Local 1000 and Kroger Dallasealth & Welfare Plan. If I need to send any additional information should I send it to you or the generic HHS email? We were
reparing additional information for that Plan based on the additional information you requested for the Oklahoma Fund. Also, fo
our reference listed below is the contact information for the Fund Consultant.
lease let me know if you need any additional information.
hanks,
rian
und Consultant
ames H. Crump
rump Consulting, Inc.
913) 599-3822
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Friday, October 29, 2010 4:12 PMo: Brian D Petersubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
hank you for the information, Mr. Peters. I will be in touch if I need additional information.
UFCW OK L1000:000013
mailto:[email protected]:[email protected]8/22/2019 UFCW Oklahoma L1000 - Combined Redacted-Bates HW
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//T|/...nse%20[YELLOW]/UFCW%20Oklahoma%20Local%201000/2nd%20Request%20for%20Additional%20Info%2011.5.10.htm[07/21/2011 11:47:
njoy your weekend.
hank you again,
sa Keels
rian D. Peters, C.P.A.
ice President &
hief Information Officer
EBA, Inc.
010 N. W. 150th Avenue
uite 100
embroke Pines, Florida 33028
00.842.5899 Toll Free
54.266.6322
54.266.2079 Fax
mportant Warning: This e-mail, and any attachments thereto, is intended only for use by the addressee(s) named herein and may containgally privileged and/or confidential information. If you are not the intended recipient of this e-mail (or the person responsible for delivering
ocument to the intended recipient), you are hereby notified that any dissemination, distribution, printing or coping of this e-mail, and any
tachment thereto, is strictly prohibited. If you have received this e-mail in error, please respond to the individual sending the message, andermanently delete the original and any copy of the e-mail and printout thereof.
UFCW OK L1000:000014
8/22/2019 UFCW Oklahoma L1000 - Combined Redacted-Bates HW
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//T|/...LOW]/UFCW%20Oklahoma%20Local%201000/2nd%20Request%20for%20Additional%20Info%20Response%2011.5.10.htm[07/21/2011 11:47
rom: Keels, Lisa (HHS/OCIIO)ent: Friday, November 05, 2010 12:46 PM
To: Brian D PetersCc: Habit, Sandra (HHS/OCIIO)ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Applicationhanks for the clarification, Brian. And feel free to contact me with any questions as well.
sa
rom: Brian D Peters [mailto:[email protected]]ent: Friday, November 05, 2010 12:45 PMo: Keels, Lisa (HHS/OCIIO)ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application
i Lisa,
discussed your email below with the fund consultant and attorney and we have some with your clarification of your ema
The plan will remove the $
Currently the Plan still has annual limits on .
you need further clarification please contact me to discuss.
hanks,
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Friday, November 05, 2010 10:29 AMo: Brian D Petersc: 'Jim Crump'; Habit, Sandra (HHS/OCIIO)ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application
i Brian,
was a pleasure speaking with you this morning as well. Please send any additional documents for UFCW Local 1000 and
roger Dallas Health & Welfare Plan to the HHS general email, so we can ensure it goes through the entire process.
lso, thank you and Jim for confirming that you plan to remove the $
hank you also for confirming that, if the annual limit requirements are waived for Plan AA, Plan A, and Plan B, the only
nnual limits you plan to have in the next Plan year are the overall annual limit and the annual limit on prescriptions.
lease confirm via email that this is the case.
hank you again, and have a wonderful weekend.
egards,
sa
rom: Brian D Peters [mailto:[email protected]]
ent: Friday, November 05, 2010 10:18 AM
UFCW OK L1000:000015
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//T|/...LOW]/UFCW%20Oklahoma%20Local%201000/2nd%20Request%20for%20Additional%20Info%20Response%2011.5.10.htm[07/21/2011 11:47
o: Keels, Lisa (HHS/OCIIO)
c: 'Jim Crump'
ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application
i Lisa,
was a pleasure speaking with you this morning. In the call I referenced a waiver that was filed on another fund we
dminister. The waiver was emailed on Tuesday 10/26/2010 for the United Food and Commercial Workers Local 1000 and
roger Dallas Health & Welfare Plan. If I need to send any additional information should I send it to you or the generic HHS
mail? We were preparing additional information for that Plan based on the additional information you requested for theklahoma Fund. Also, for your reference listed below is the contact information for the Fund Consultant.
lease let me know if you need any additional information.
hanks,
rian
und Consultant
ames H. Crump
rump Consulting, Inc.
913) [email protected]
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]
ent: Friday, October 29, 2010 4:12 PM
o: Brian D Peters
ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
hank you for the information, Mr. Peters. I will be in touch if I need additional information.
njoy your weekend.
hank you again,
sa Keels
rian D. Peters, C.P.A.
ice President &
hief Information Officer
EBA, Inc.
010 N. W. 150th Avenue
uite 100
embroke Pines, Florida 33028
00.842.5899 Toll Free
54.266.6322
54.266.2079 Fax
mportant Warning: This e-mail, and any attachments thereto, is intended only for use by the addressee(s) named herein UFCW OK L1000:000016
mailto:[email protected]:[email protected]8/22/2019 UFCW Oklahoma L1000 - Combined Redacted-Bates HW
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//T|/...LOW]/UFCW%20Oklahoma%20Local%201000/2nd%20Request%20for%20Additional%20Info%20Response%2011.5.10.htm[07/21/2011 11:47
may contain legally privileged and/or confidential information. If you are not the intended recipient of this e-mail (or the
erson responsible for delivering this document to the intended recipient), you are hereby notified that any dissemination
istribution, printing or coping of this e-mail, and any attachment thereto, is strictly prohibited. If you have received this e
mail in error, please respond to the individual sending the message, and permanently delete the original and any copy of t
-mail and printout thereof.
UFCW OK L1000:000017
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//T|/...UFCW%20Oklahoma%20Local%201000/Request%20for%20Additional%20Information%20Correspondence%2011.10.10.htm[07/21/2011 11:47
rom: Keels, Lisa (HHS/OCIIO)ent: Wednesday, November 10, 2010 6:39 PM
To: Habit, Sandra (HHS/OCIIO)ubject: FW: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
rom: Keels, Lisa (HHS/OCIIO)ent: Wednesday, November 10, 2010 6:38 PM
o: 'Brian D Peters'ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
i Brian,
believe the response to the waiver application will be sent via email.
hanks,
sa
rom: Brian D Peters [mailto:[email protected]]
ent: Wednesday, November 10, 2010 4:10 PMo: Keels, Lisa (HHS/OCIIO)ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
i Lisa,
an you tell me if the response to the waiver application will be sent via mail or email?
hanks,
rian
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Friday, October 29, 2010 4:12 PMo: Brian D Petersubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
hank you for the information, Mr. Peters. I will be in touch if I need additional information.
njoy your weekend.
hank you again,
sa Keels
rom: Brian D Peters [mailto:[email protected]]
ent: Friday, October 29, 2010 3:11 PM
o: Keels, Lisa (HHS/OCIIO)
ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
ear Ms. Keels,
lease see below for our response to your questions. Please let me know if you need any additional information.
UFCW OK L1000:000018
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//T|/...UFCW%20Oklahoma%20Local%201000/Request%20for%20Additional%20Information%20Correspondence%2011.10.10.htm[07/21/2011 11:47
Please confirm that the effective date for the new plans will be January 1, 2011.
The UCFW Local 1000 Oklahoma Fund is a calendar year plan. January 1, 2011 is the beginning of the next Plan
year.
In your application, you state that approximately employees and dependents are covered by the Plan.
Please indicate how many employees and dependents are covered in each particular plan (i.e., please break ou
the numbers for Plan AA, Plan A, and Plan B).
Listed below are the most current count of eligible employees and dependents broken out by Plan as of Novem
1, 2010. This list below does not include employees that are in a waiting period and were part of the originalestimate of .
Plan AA
Plan A
Plan B
Total
For each plan (i.e., Plan AA, Plan A, and Plan B), please provide the current monthly premium rates and the
projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the
restricted annual benefits. In other words, we would like a chart that reflects the following information for eaplan:
Please see attached document from the Fund Consultant.
egards,
rian Peters
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]
ent: Thursday, October 28, 2010 3:54 PM
ubject: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
ear Mr. Peters:
hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. In order to
omplete your application, please provide the following information:
Please confirm that the effective date for the new plans will be January 1, 2011.
In your application, you state that approximately employees and dependents are covered by the Plan.
Please indicate how many employees and dependents are covered in each particular plan (i.e., please break outhe numbers for Plan AA, Plan A, and Plan B).
For each plan (i.e., Plan AA, Plan A, and Plan B), please provide the current monthly premium rates and the
projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the
restricted annual benefits. In other words, we would like a chart that reflects the following information for ea
plan:
2010 January Premium 2011 January Premium 2011 January Premium
UFCW OK L1000:000019
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//T|/...UFCW%20Oklahoma%20Local%201000/Request%20for%20Additional%20Information%20Correspondence%2011.10.10.htm[07/21/2011 11:47
(current level)
(renewal) (if $750,000 annual
limit was applied)
EE
EE + Child (if applicable
or other appropriate
tier)
EE + Spouse (if
applicable or other
appropriate tier)
Family (if applicable or
other appropriate tier)
n order to complete your application, please provide this information by 5:00 pm, October 29, 2010. We look forward to
eceiving your completed application.
hank you,
sa Keels
sa M. Keels, J.D.
.S. Department of Health & Human Services
ffice of Consumer Information and Insurance Oversight
ffice of Oversight
UFCW OK L1000:000020
mailto:[email protected]:[email protected]8/22/2019 UFCW Oklahoma L1000 - Combined Redacted-Bates HW
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//T|/...lahoma%20Local%201000/Request%20for%20Additional%20Information%20Correspondence%20Response%2011.10.10.htm[07/21/2011 11:47:
rom: Keels, Lisa (HHS/OCIIO)ent: Wednesday, November 10, 2010 6:46 PM
To: Habit, Sandra (HHS/OCIIO)ubject: FW: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
rom: Brian D Peters [mailto:[email protected]]ent: Wednesday, November 10, 2010 6:47 PM
o: Keels, Lisa (HHS/OCIIO)c: 'Jim Crump'; 'Phil Siino'ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
hanks,
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, November 10, 2010 6:38 PMo: Brian D Petersubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
i Brian,
believe the response to the waiver application will be sent via email.
hanks,
sa
rom: Brian D Peters [mailto:[email protected]]
ent: Wednesday, November 10, 2010 4:10 PM
o: Keels, Lisa (HHS/OCIIO)
ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
i Lisa,
an you tell me if the response to the waiver application will be sent via mail or email?
hanks,
rian
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]
ent: Friday, October 29, 2010 4:12 PM
o: Brian D Peters
ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
hank you for the information, Mr. Peters. I will be in touch if I need additional information.
njoy your weekend.
hank you again,
sa Keels
UFCW OK L1000:000021
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//T|/...lahoma%20Local%201000/Request%20for%20Additional%20Information%20Correspondence%20Response%2011.10.10.htm[07/21/2011 11:47:
rom: Brian D Peters [mailto:[email protected]]
ent: Friday, October 29, 2010 3:11 PM
o: Keels, Lisa (HHS/OCIIO)
ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
ear Ms. Keels,
lease see below for our response to your questions. Please let me know if you need any additional information.
Please confirm that the effective date for the new plans will be January 1, 2011.
The UCFW Local 1000 Oklahoma Fund is a calendar year plan. January 1, 2011 is the beginning of the next Plan
year.
In your application, you state that approximately employees and dependents are covered by the Plan.
Please indicate how many employees and dependents are covered in each particular plan (i.e., please break ou
the numbers for Plan AA, Plan A, and Plan B).
Listed below are the most current count of eligible employees and dependents broken out by Plan as of Novem
1, 2010. This list below does not include employees that are in a waiting period and were part of the original
estimate of
Plan AA
Plan A
Plan B
Total
For each plan (i.e., Plan AA, Plan A, and Plan B), please provide the current monthly premium rates and the
projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the
restricted annual benefits. In other words, we would like a chart that reflects the following information for ea
plan:
Please see attached document from the Fund Consultant.
egards,
rian Peters
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]
ent: Thursday, October 28, 2010 3:54 PM
ubject: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information
ear Mr. Peters:
hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. In order to
omplete your application, please provide the following information:
Please confirm that the effective date for the new plans will be January 1, 2011.
In your application, you state that approximately employees and dependents are covered by the Plan.
Please indicate how many employees and dependents are covered in each particular plan (i.e., please break ou
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the numbers for Plan AA, Plan A, and Plan B).
For each plan (i.e., Plan AA, Plan A, and Plan B), please provide the current monthly premium rates and the
projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the
restricted annual benefits. In other words, we would like a chart that reflects the following information for ea
plan:
2010 January Premium
(current level)
2011 January Premium
(renewal)
2011 January Premium
(if $750,000 annuallimit was applied)
EE
EE + Child (if applicable
or other appropriate
tier)
EE + Spouse (if
applicable or other
appropriate tier)
Family (if applicable or
other appropriate tier)
n order to complete your application, please provide this information by 5:00 pm, October 29, 2010. We look forward to
eceiving your completed application.
hank you,
sa Keels
sa M. Keels, J.D.
.S. Department of Health & Human Services
ffice of Consumer Information and Insurance Oversight
ffice of Oversight
UFCW OK L1000:000023
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rom: Keels, Lisa (HHS/OCIIO)ent: Monday, November 15, 2010 10:29 AM
To: Jim CrumpCc: Brian D Peters; Botwinick, Alexandra (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: RE: UFCW Local 1000 Oklahoma Health and Welfare Fundello Jim,
ust checked, and the approval letter was sent to Brian this morning at 9:03am. Please let us know if it was not received,
we will re-send it.
hank you,
sa
rom: Jim Crump [mailto:[email protected]]ent: Monday, November 15, 2010 10:17 AMo: Keels, Lisa (HHS/OCIIO)ubject: UFCW Local 1000 Oklahoma Health and Welfare Fund
ood morning Lisa,
am the Funds consultant/advisor and am involved in the waiver application process on behalf of the Funds Trustees. Ca
ou tell us when we can expect a response to the waiver request. The application was emailed to HHS 40 days ago.
hank you.
m Crump
rump Consulting, Inc.
13-599-3822
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rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, November 15, 2010 9:03 AM
To: '[email protected]'ubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711
mportance: High
Attachments: Updated Jan 1 Approval Letter .pdf
Mr. Peters,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act
ection forUnited Food and Commercial Workers Local 1000 Oklahoma Fund. HHS has reviewed your
pplication and made its determination. Please see the attached letter.
lease confirm receipt of this letter by replying to this e-mail address with a copy to [email protected]
lease let me know if I can be of further assistance.
incerely,
Alexandra Botwinick
ffice of Oversight
UFCW OK L1000:000025
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rom: Brian D Peters [[email protected]]ent: Sunday, November 21, 2010 4:49 PM
To: Botwinick, Alexandra (HHS/OCIIO)Cc: OCIIO Oversight
ubject: RE: Waiver of the Annual Limits Requirements of PHS Act Section 2711
ollow Up Flag: Follow uplag Status: Red
We are confirming the receipt of the email listed below.
hanks,
rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Monday, November 15, 2010 9:03 AMo: '[email protected]'ubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High
Mr. Peters,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act
ection forUnited Food and Commercial Workers Local 1000 Oklahoma Fund. HHS has reviewed your
pplication and made its determination. Please see the attached letter.
lease confirm receipt of this letter by replying to this e-mail address with a copy to [email protected]
lease let me know if I can be of further assistance.
incerely,
Alexandra Botwinick
ffice of Oversight
UFCW OK L1000:000026
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rom: Keels, Lisa (HHS/OCIIO)ent: Monday, November 15, 2010 10:57 AM
To: Habit, Sandra (HHS/OCIIO)ubject: FW: UFCW Local 1000 Oklahoma Health and Welfare Fund
rom: Jim Crump [mailto:[email protected]]ent: Monday, November 15, 2010 10:57 AM
o: Keels, Lisa (HHS/OCIIO)ubject: RE: UFCW Local 1000 Oklahoma Health and Welfare Fund
hank you Lisa. It was received.
egards,
m Crump
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Monday, November 15, 2010 9:29 AM
o: Jim Crumpc: Brian D Peters; Botwinick, Alexandra (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: RE: UFCW Local 1000 Oklahoma Health and Welfare Fund
ello Jim,
ust checked, and the approval letter was sent to Brian this morning at 9:03am. Please let us know if it was not received,
we will re-send it.
hank you,
sa
rom: Jim Crump [mailto:[email protected]]ent: Monday, November 15, 2010 10:17 AMo: Keels, Lisa (HHS/OCIIO)ubject: UFCW Local 1000 Oklahoma Health and Welfare Fund
ood morning Lisa,
am the Funds consultant/advisor and am involved in the waiver application process on behalf of the Funds Trustees. Ca
ou tell us when we can expect a response to the waiver request. The application was emailed to HHS 40 days ago.
hank you.
m Crump
rump Consulting, Inc.
13-599-3822
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rom: Jim Crump [[email protected]]ent: Monday, November 15, 2010 10:59 AM
To: Botwinick, Alexandra (HHS/OCIIO)ubject: RE: Waiver of the Annual Limits Requirements of PHS Act Section 2711hank you, Alexandra.
egards,
m Crump
rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Monday, November 15, 2010 9:33 AMo: '[email protected]'c: Keels, Lisa (HHS/OCIIO)ubject: FW: Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High
m,
lease see the e-mail below that was sent to Mr. Peters earlier this morning. Please let me know if you haveny questions.
incerely,
Alexandra Botwinick
ffice of Oversight
rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, November 15, 2010 9:03 AMo: '[email protected]'ubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High
Mr. Peters,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act
ection forUnited Food and Commercial Workers Local 1000 Oklahoma Fund. HHS has reviewed your
pplication and made its determination. Please see the attached letter.
lease confirm receipt of this letter by replying to this e-mail address with a copy to [email protected]
lease let me know if I can be of further assistance.
incerely,
UFCW OK L1000:000028
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Alexandra Botwinick
ffice of Oversight
mailto:[email protected]:[email protected]