Essex NYSARC - Redacted HWM

7/27/2019 Essex NYSARC - Redacted HWM

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//T|/...ng%20Team/Jean/Essex%20County%20Chapter%20NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Waiver.htm[12/21/2011 12:58:

rom: Kristie Watrous [[email protected]]ent: Wednesday, November 17, 2010 4:03 PM

To: HHS HealthInsurance (HHS)ubject: Waiver

ollow Up Flag: Follow uplag Status: Red

Attachments: Mntn Lake Srvc Standalone HRA 1-1-10_SIGNED.pdf; SMM - Standalone HRA.pdf;CAN5003_000.pdfAttached is Mountain Lake Services Waiver Application Letter with attachments. Please contact office with any questions. Thank you.

Kristie WatrousHuman Resources Specialist546-7721

ESSEX NYSARC:000001


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ESSEX NYSARC:000002


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Pages 3 through 18 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4

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//T|/...pter%20NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Request%20for%20additional%20info%2011.24.10.htm[12/21/2011 12:58

rom: Habit, Sandra (HHS/OCIIO)ent: Wednesday, November 24, 2010 11:21 AM

To: '[email protected]'ubject: Waiver Application - Mountain Lake Services

Mr. Nephew,

hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section

711. In order to complete your application, please provide the following information regarding Mountain

ake Services:

1. Indicate the annual limit of the HRA.

2. Is this a self or fully insured policy?

3. Is this a group or individual policy?

4. Can you provide COBRA equivalent rates for the following chart:

(The premium amounts is the total cost to the employer and the employee)

Premium(current level)

Premium(renewal)

Premium(if $750,000

annual limit wasapplied)

% increase if the$750,000 was

implemented

EE

EE + Child (ifapplicable or otherappropriate tier)

EE + Spouse (ifapplicable or otherappropriate tier)

Family (ifapplicable or otherappropriate tier)

If you have any questions, please feel free to contact me. Have a good holiday!

Thank you,

Sandy

andra Habit

uality Analyst

ffice of Consumer Information and Insurance Oversight

01-492-4175

[email protected]

NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly

sclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu

r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full eESSEX NYSARC:000004
mailto:[email protected]:[email protected]


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//T|/...pter%20NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Request%20for%20additional%20info%2011.24.10.htm[12/21/2011 12:58

f the law.

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//T|/...hapter%20NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Request%20for%20info%20response%2012.1.10.htm[12/21/2011 12:58:

rom: Marty Nephew [[email protected]]ent: Wednesday, December 01, 2010 2:11 PM

To: Habit, Sandra (HHS/OCIIO)Cc: Patricia Allen

ubject: RE: Waiver Application - Mountain Lake ServicesMs. Habit,

lease see responses below and let me know should you have any questions.

hank you,

Martin J. Nephewxecutive Director

Mountain Lake Services0 St. Patrick's Place

ort Henry, NY 12974

hone: (518)546-3381 x51ax: (518)546-7138

rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, November 24, 2010 11:21 AMo: Marty Nephewubject: Waiver Application - Mountain Lake Services

Mr. Nephew,

hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section711. In order to complete your application, please provide the following information regarding Mountain

ake Services:

1. Indicate the annual limit of the HRA. B n SPD for 2011 Annual Contributi punused funds rolled from prior years. mum projected account rollover is $ emaximum projected benefit would be $ .

2. Is this a self or fully insured policy? Se 3. Is this a group or individual policy? Gr 4. Can you provide COBRA equivalent rates for the following chart:



Premium(renewal)

Premium(if $750,000annual limit was

% increase if the$750,000 wasimplemented

EE

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Family (ifapplicable or other

appropriate tier)


Thank you,

Sandy

andra Habit

uality Analyst

ffice of Consumer Information and Insurance Oversight01-492-4175

[email protected]

NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly

sclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu

r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full e

f the law.

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rom: Marty Nephew [[email protected]]ent: Friday, December 03, 2010 7:17 AM

To: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application - Mountain Lake Servicesandy,

This plan does comply with grandfathered regulations.

hanks,


Mountain Lake Services0 St. Patrick's Place

ort Henry, NY 12974

hone: (518)546-3381 x51ax: (518)546-7138

rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, December 01, 2010 2:17 PMo: Marty Nephewc: Patricia Allenubject: RE: Waiver Application - Mountain Lake Services

Mr. Nephew,

hank you for your response. I have one last question for you and then I should be finished reviewing your application. Is this

an complying with grandfathered regulations or in effect prior to March 23, 2010?

andy

rom: Marty Nephew [mailto:[email protected]]ent: Wednesday, December 01, 2010 2:11 PMo: Habit, Sandra (HHS/OCIIO)c: Patricia Allenubject: RE: Waiver Application - Mountain Lake Services

Ms. Habit,

lease see responses below and let me know should you have any questions.

hank you,


ESSEX NYSARC:000008


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Mountain Lake Services

0 St. Patrick's Placeort Henry, NY 12974

hone: (518)546-3381 x51ax: (518)546-7138

rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, November 24, 2010 11:21 AM

o: Marty Nephewubject: Waiver Application - Mountain Lake Services

Mr. Nephew,

hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section

711. In order to complete your application, please provide the following information regarding Mountain

ake Services:

1. Indicate the annual limit of the HRA. B n SPD for 2011 Annual Contributi punused funds rolled from prior years. mum projected account rollover is $ emaximum projected benefit would be $ .

2. Is this a self or fully insured policy? Se 3. Is this a group or individual policy? Gr 4. Can you provide COBRA equivalent rates for the following chart:



Premium(renewal)

Premium(if $750,000annual limit was

% increase if the$750,000 wasimplemented

EE



Family (ifapplicable or otherappropriate tier)


Thank you,

Sandy

ESSEX NYSARC:000009


10/12


andra Habit

uality Analyst

ffice of Consumer Information and Insurance Oversight

01-492-4175

[email protected]

NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publiclysclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu

r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full e

f the law.

ESSEX NYSARC:000010


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//T|/...NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Mountain%20Lake%20Services%20approval%2012_14_10.htm[12/21/2011 12:58

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Tuesday, December 14, 2010 12:14 PM

To: '[email protected]'ubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711

mportance: High

ollow Up Flag: Follow up

lag Status: Red

Attachments: Updated Jan 1 Approval Letter .pdf

ood Afternoon,

hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act

ection 2711 forMountain Lake Services. HHS has reviewed your application and made its determinationlease see the attached letter.

lease confirm receipt of this letter by replying to this e-mail.

lease let me know if I can be of further assistance.

incerely,

Alexandra Botwinick

ffice of Oversight

HHS/[email protected]

ESSEX NYSARC:000011


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rom: Marty Nephew [[email protected]]ent: Tuesday, December 14, 2010 1:13 PM

To: Botwinick, Alexandra (HHS/OCIIO)ubject: RE: Waiver of the Annual Limits Requirements of PHS Act Section 2711eceived on 12/12/2010.

hank you,


Mountain Lake Services

0 St. Patrick's Placeort Henry, NY 12974

hone: (518)546-3381 x51

ax: (518)546-7138

rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, December 14, 2010 12:14 PMo: Marty Nephewubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High

ood Afternoon,

hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act

ection 2711 forMountain Lake Services.

HHS has reviewed your application and made its determinationlease see the attached letter.

lease confirm receipt of this letter by replying to this e-mail.

lease let me know if I can be of further assistance.

incerely,

Alexandra Botwinick

ffice of Oversight

HHS/[email protected]

ESSEX NYSARC:000012

Essex NYSARC - Redacted HWM

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