UFCW Local 400 - Redacted HWM

7/27/2019 UFCW Local 400 - Redacted HWM

1/50

///co-adshare/...OI%20Processing%20Team/Mike/United%20Food%20and%20Commercial%20Workers%20Local%20400/waiver.htm[11/15/2011 3:33

rom: Danielle T. Norris [[email protected]]

ent: Wednesday, December 29, 2010 5:46 PM

o: HHS HealthInsurance (HHS); OCIIO Oversight

c: Sharon M. Goodman; William H. Tobin; [email protected]

ubject: waiver

ttachments: 1-334178-Local_400_PPACA_Waiver_Application.pdf; 1-333599-

Local_400_Waiver_Chart_Explanatory_Memorandum.doc; 1-334289-

Local_400_Waiver_Application_Chart.xls

Mr. Mayhew:

ttached please find an Application for Waiver of the PPACA Lifetime Limits Prohibition, filed on behalf of the United Food and

ommercial Workers Local 400 and Employers Health and Welfare Fund ("Fund"). In addition to the Application, please note t

ollowing:

The completed HHS spreadsheet and an explanatory memorandum are attached hereto.

. The Fund was in existence prior to March 23, 2010. It is our understanding that all the Fund's Plans meet the requirements

"grandfathered plan," as that term is used in applicable regulations. The Plans are prepared to comply with the PPACA

equirements applicable to grandfathered plans, effective February 1, 2011.

I. The Fund is a Taft-Hartley employee welfare benefit plan. The effective dates and expiration dates of the principal collectiv

argaining agreement covering % of all participants in the Fund are as follows: 10/14/2007-10/15/2011.

lease feel free to contact me with any questions.

est regards,

anielle Norris

anielle T. Norris

Attorney At Law

levin & Hart, P.C.625 Massachusetts Ave., N.W., Suite 450

Washington, D.C. 20036

02-797-8700 Tel

02-234-8231 Fax

[email protected]

UFCW L400:000001
mailto:[email protected]:[email protected]


2/50

December 16,2010

SENT BY E-MAILDepartment of Health and Human ServicesOffice of Consumer Informationand Office of OversightATTN: James Mayhew, Room 737-F-04200 Independence Avenue, SWWashington DC 20201

(e-mail: healthinsurance~hhs.gov)

Re: Waiver - Restricted Annual Limits forFund Year Beginning February 1,2011Dear Mr. Mayhew:

The Board of Trustees of the United Food and Commercial Workers Local 400and Employers Health and Welfare Fund (the "Trustees") is the plan sponsor and planadministrator of the United Food and Commercial Workers Local 400 and EmployersHealth and Welfare Fund (the "Fund"). The Fund is a multiemployer plan with a PlanYear beginning February 1, 2011. The Fund provides health and welfare benefits toemployees and their dependents who are covered by collective bargaining agreementsnegotiated by employers contributing to the Fund and United Food and CommercialWorkers Union Local 400 (the "Bargaining Parties"). The Plan is administered by aBoard of Trustees, which consists of both Union and Employer representatives selectedby the Union and the Employers which have entered into collective bargainingagreements relating to the Plan. All health benefits under the Fund are self-funded andpaid only from these assets. The Fund offers health and welfare benefits to part-time andfull-time employees, retirees and their dependents.

Employer and employee contribution rates are set by collective bargainingagreements negotiated by the Bargaining Parties. Thus, the Trustees administer the Fundand set benefits based on the limited pool of assets available to them. The Trustees haveno legal abilty to require any increase in the contributions to the Fund in excess of therates provided for under the collective bargaining agreements.

The Trustees are required to administer the Fund consistent with their fiduciaryduties under the Employee Retirement Income Security Act of 1974 ("ERISA") and theFund's governing documents. With the help and direction of the Bargaining Parties, theFund's Trustees have created and administered the Fund's Plan of benefits, in the manner

UFCW L400:000002


3/50

Department of Health and Human ServicesOffice of Consumer Information and Office of OversightATTN: James MayhewDecember 16,2010Page 2

that they believe best serves the Fund's participants and dependents and best uses theresources available to fund such benefits. The annual and lifetime limits on certainbenefits exist to enable the Fund to provide a full range of benefits and options within theconfines of the Fund's assets, while limiting the out-of-pocket costs payable byparticipants and dependents. ERISA requires that the Trustees take those actions that arenecessary and appropriate pursuant to their fiduciary duties to safeguard the Fund'ssolvency. As stated above, additional increases in employer and/or employeecontributions wil not occur until the current collective bargaining agreements expire.This of course limits the Trustees' abilty to fund the costs of the mandated enhancedbenefits required under the Patient Protection and Affordable Care Act ("PPACA").Further, faced with such dramatic increases in costs, employers also may attempt tonegotiate out of the Plan or try to eliminate some coverage altogether. The effect of notreceiving a waiver from the restricted annual limits is the prospect that participants underexpiring contracts wil lose some access to coverage or wil have to shoulder a largerburden in paying for such coverage. This is particularly troublesome given that coverageis provided to a significant percentage of part-time employees who would otherwise haveno access to affordable quality health care. Indeed, because of the strains the restrictedannual limits place on the collective bargaining process, there is an increased possibiltythat participants wil lose coverage altogether.

The classes of benefits and specific maximums for which waivers are being soughtare set forth in Exhibits A-D attached hereto, to the extent that such maximums are onessential benefits under the PPACA. For clarification purposes, these are designationsgiven by the Fund to the different programs of benefits provided to different classes ofemployees and retirees: Plan 1 Plan 500 Plan V Plan S

UFCW L400:000003


4/50

Department of Health and Human ServicesOffice of Consumer Information and Office of OversightATTN: James MayhewDecember 16, 2010Page 3

1. Annual Limits.The Fund provides benefits for a number of classes of individuals covered by the

Fund as set forth in the attached exhibits. Since the Employer contribution rates andparticipant cost-sharing amounts relating to the benefits described in Exhibits A to Darefixed under the collective bargaining agreements, the Fund has no abilty to increase itssource of funding from employers.The Trustees have reviewed the cost of increasing the annual benefit limits to complywith the requirements of PP ACA. The Trustees have concluded that increasing theannual benefit maximum to $750,000 per year for the Plan Year beginning February 1,2011 for all benefit programs wil increase Fund costs significantly, as calculated by theFund's consultant. This rise in costs would unexpectedly deplete Fund assets andreserves. To offset this increase in costs, benefit changes, such as the type and magnitudedescribed in the attached exhibits likely would be required. Accordingly, compliancewith PP ACA's annual benefit limit requirements can be expected to result in a significantdecrease in access to benefits for those currently covered by the classes of benefits setforth in the attached exhibits and/or a significant increase in premiums paid by thosecovered by such classes of benefits upon expiration of the current collective bargainingagreements, if not sooner. This waiver application is submitted in order to avoid theseresults.

2. Lifetime Limits.

While the interim final rules issued by the Departments of the Treasury, Labor,and Health and Human Services, 75 Fed. Reg. 37187 (June 22, 2010), ("Regulations")discuss waivers of the annual limit requirements under Section 1001 of the PP ACA, italso would be consistent with the purpose of the waiver provision to grant a waiver of therequirement that the Fund eliminate its lifetime limits. The Preamble to the Regulationsindicates that the purpose of the waiver program is to mitigate any unintendedconsequences of the PPACA's application to plans with low benefit limits. See 75 Fed.Reg. 37187, 37207. The Plans, particularly the retiree programs, have several benefitslimits that are low enough to be in the nature of annual limits (for example, all of theprograms have a $ lifetime hospice care limit.) If the Fund is required to removesuch lifetime limits, such a change likely wil have the direct and unintended

UFCW L400:000004


5/50


consequence of significantly decreasing participants' access to benefits or significantlyincreasing the cost of those benefits. Absent waiver, the Board of Trustees likely wil beforced to either significantly reduce or eliminate categories of benefits or increaseparticipant cost-sharing for the affected benefits, effective February 1, 2011. Thus, theFund's lifetime limits are precisely the types of limits for which Congress intended tooffer relief via the waiver program.

To the extent that the Department of Health and Human Services would denythe Fund's request for a waiver for its lifetime limits but would grant a waiver forsuch limits if they are converted to annual limits as permitted under PP ACA, wehereby request such a waiver on the grounds that the Board of Trustees wil adopt aresolution to convert its lifetime limits to annual limits, effective February 1,2011.

Attestation: The undersigned, on behalf of the Board of Trustees, hereby certifiesthe following:1. That the Fund was in force prior to September 23, 2010; and2. That the application of restricted annual limits to the classes set forth in the

attached exhibits is expected to result in a significant decrease in access to benefits forthose currently covered by such classes or a significant increase in premiums paid bythose covered by such classes.Thank you for your consideration. Please contact the Fund's legal co-counsel,Wiliam Tobin at Reinhart Boerner Van Deuren s.c. (414-298-1000) or Sharon Goodmanat Slevin and Hart (202-797-8700) with any questions or requests for additionalinformation.

Sincerely,BOARD OF TRUSTEES OF THE UNITED FOOD ANDCOMMERCIAL WORKERS LOCAL 400 AND EMPLOYERSHEALTH AND WELFARE PLAN~y: '-Steve~ L erTitle: Employer Trustee

UFCW L400:000005


6/50


By:~?ff~Thomas P. McNuttTitle: Union TrusteeR\5263716_3Attachments

UFCW L400:000006


7/50

EXHIBIT APlan 1

1. Terms. Plan 1 generally covers full-time and part-time employees whohave earned years of seniority.2. Number of Individuals Covered. Plan 1 currently covers approximatelyemployees.3. Current Anual and Lifetime Limits and Rates. Plan 1 provides for limitson benefits as set forth in the Plan document. Select pertinent benefit provisions follow:

CONVALESCENT CARE CHIROPRACTIC SERVICES PER YEAR

DIABETES EDUCATION DENTAL VISION CARE PHYSICAL EXAMINATION

LIFETIME LrMITSLIFETIME BENEFIT MAXIM INPATIENT & OUTPATIENT (ALCOHOL SUBSTANCE ABUSE)

PODIATRIST SURGERIE HOSPICE CARE $5 UFCW L400:000007


8/50

.. .. BIFE'lII\LIMITSGROWTH HORMONES HEARING AIDS ORTHODONTIC & PERIODONTIC

4.Premium. Description of Significant Decrease in Access to Benefits or Increase in

(a) Anual Limits. If the Fund is required to remove the annual limitsabove, the Trustees likely would be required to consider significant benefit changes inorder to offset these increased costs. For example, the Fund's consultant estimates thatthe following changes could be needed to offset the cost of increasing this program'sannual maximums to $750,000 for the Plan Year beginning February 1,2011, if thewaiver is not granted (incorporating an increase from an annual maximum of $ to$750,000 if the Trustees were to convert the current lifetime maximum to an anualmaximum in the event HHS does not grant a waiver with regard to the lifetimemaximums as requested below):

Increase annual deductible to $ (from $ .Increase annual out-of-pocket maximum to $ (from $ .

(b) Lifetime Limits. Similarly, if the Fund is required to remove thelifetime limits above, the Trustees likely would be required to consider significant benefitchanges in order to offset these increased costs. For example, the following changescould be needed to offset the cost of eliminating this program's lifetime maximums forthe Plan Year beginning February 1,2011 if the waiver is not granted:

Increase annual deductible to $ (from $ ).Increase annual out-of-pocket maximum to $ (from $ ).

( c) Combined Impact of Limits. If the Fund is required to remove theannual and lifetime limits above, the Fund's consultant estimates that the followingchanges could be needed to offset both costs for the Plan Year beginning February 1,2011, if the waiver is not granted (incorporating the conversion of the above lifetimemaximums to annual maximums):


5263716 A-UFCW L400:000008


9/50

The Trustees believe the magnitude of the changes discussed above constitutes asignificant decrease in access to benefits for those currently covered by the Plan 1.Additionally, the Trustees expect the bargaining parties would consider negotiatingincreases in the premiums paid by employees covered by Plan 1 at the time of theexpiration of the current collective bargaining agreements due to the increased costsattributed to higher annual benefit limits being extended to Plan 1 participants.

Accordingly, the Trustees request a waiver from the increase in the annual andlifetime essential benefit limits under PP ACA. Specifically, the Trustees request thatPlan 1 be allowed to maintain all limits set forth in #3 above for the Plan Year beginningFebruary 1, 2011. In the event that the requested waiver with regard to lifetime limits isdenied, the Trustees request that Plan 1 be allowed to maintain the annual limits set forthin #3 above, including an annual maximum of $ for the Plan Year beginningFebruary 1, 2011.

5263716 A-UFCW L400:000009


10/50

EXHIBIT BPlan 500

1.seniority . Terms. Plan 500 covers employees who have less then years of2. Number of Individuals Covered. Plan 500 currently covers approximately

employees.3. Current Annual and Lifetime Limits and Rates. Plan 500 provides forlimits on benefits as set forth in the Plan document. Select pertinent benefit provisionsfollow:

CHIROPRACTIC SERVICES PER YEAR

. DIABETES EDUCATION

... ..i LIFETIM LIMITS. .... ....LIFETIME BENEFIT MAXIMUM INPATIENT & OUTPATIENT (ALCOHOL & SUBSTANCE ABUSE)

PODIA TRIST SURGERIES HOSPICE CARE

5263716 B-UFCW L400:000010


11/50

GROWTH HORMONES

4.Premium. Description of Significant Decrease in Access to Benefits or Increase in(a) Anual Limits. If the Fund is required to remove the annual limitsabove, the Trustees likely would be required to consider significant benefit changes in

order to offset these increased costs. For example, the Fund's consultant estimates thatthe following changes could be needed to offset the cost of increasing this program'sannual maximums to $750,000 for the Plan Year beginning February 1, 2011, if thewaiver is not granted (incorporating an increase from an annual maximum of$ to$750,000 if the Trustees were to convert the current lifetime maximum to an annualmaximum in the event HHS does not grant a waiver with regard to the lifetimemaximums as requested below):


(b) Lifetime Limits. Similarly, if the Fund is required to remove thelifetime limits above, the Trustees likely would be required to consider significant benefitchanges in order to offset these increased costs. For example, the following change couldbe needed just to offset the cost of eliminating this program's lifetime maximums for thePlan Year beginning February 1, 2011 if the waiver is not granted:

Increase annual deductible to $ (from $ .Increase annual out-of-pocket maximum to $ (from $ ).(c) Combined Impact of Limits. If the Fund is required to remove the annualand lifetime limits above, the Fund's consultant estimates that the following changescould be needed to offset both costs for the Plan Year beginning February 1, 2011, if thewaiver is not granted (incorporating the conversion of the above lifetime maximums toannual maximums):Increase annual deductible to $ (from $ .Increase annual out-of-pocket maximum to $ (from $ ).

The Trustees believe the magnitude of the changes discussed above constitutes asignificant decrease in access to benefits for those currently covered by Plan 500.Additionally, the Trustees expect the bargaining parties would consider negotiating

5263716 B-UFCW L400:000011


12/50

increases in the premiums paid by employees covered by Plan 500 at the time of theexpiration of the current collective bargaining agreements due to the increased costsattributed to higher annual benefit limits being extended to Plan 500 participants.Accordingly, the Trustees request a waiver from the increase in the annual and

lifetime essential benefit limits under PP ACA. Specifically, the Trustees request thatPlan 500 be allowed to maintain all limits set forth in #3 above for the Plan Yearbeginning February 1, 2011. In the event that the requested waiver with regard tolifetime limits is denied, the Trustees request that Plan 500 be allowed to maintain theannual limits set forth in #3 above, including an annual maximum of $ for thePlan Year beginning February 1,2011.

5263716 B-UFCW L400:000012


13/50

EXHIBIT CPlan V

1. Terms. Plan V generally covers retirees prior to age 65.2. Number of Individuals Covered. Plan V currently covers approximatelyemployees.

3. Current Anual and Lifetime Limits and Rates. Plan V provides for limitson benefits as set forth in the Plan document. Select pertinent benefit provisions follow:

LIFETIME BENEFIT MAXIMUM INPATIENT & OUTPATIENT (ALCOHOL &SUBSTANCE ABUSE)

PODIATRIST SURGERIES HOSPICE CARE GROWTH HORMONES


(a) Anual Limits. If the Fund is required to remove the annuallimits above, the Trustees likely would be required to consider significant benefit changes

5263716 C-UFCW L400:000013


14/50

in order to offset these increased costs. For example, the Fund's consultant estimates thatthe following changes could be needed to offset the cost of increasing this program'sannual maximums to $750,000 for the Plan Year beginning February 1, 2011, if thewaiver is not granted (incorporating an increase from an annual maximum of $ to$750,000 if the Trustees were to convert the current lifetime maximum to an annualmaximum in the event HHS does not grant a waiver with regard to the lifetimemaximums as requested below):Increase annual deductible to $ (from $ ).Increase annual out-of-pocket maximum to $ (from $ ).

(b) Lifetime Limits. Similarly, if the Fund is required to remove thelifetime limits above, the Trustees likely would be required to consider significant benefitchanges in order to offset these increased costs. For example, the following changescould be needed to offset the cost of eliminating this program's lifetime maximums forthe Plan Year beginning February 1,2011 if the waiver is not granted:

Increase annual deductible to $ (from $ ).Increase annual out-of-pocket maximum to $ (from $ .

( c) Combined Impact of Limits. If the Fund is required to remove theannual and lifetime limits above, the Fund's consultant estimates that the followingchanges could be needed to offset both costs for the Plan Year beginning February 1,2011, if the waiver is not granted (incorporating the conversion of the above lifetime

maximums to annual maximums):Increase annual deductible to $ (from $ ).Increase annual out-of-pocket maximum to $ (from $ .

The Trustees believe the magnitude of the changes discussed above constitutes asignificant decrease in access to benefits for those currently covered by Plan V.Additionally, the Trustees expect to consider increases in the premiums paid by retireescovered by Plan V due to the increased costs attributed to higher annual benefit limitsbeing extended to Plan V participants.Accordingly, the Trustees request a waiver from the increase in the annual andlifetime essential benefit limits under PP ACA. Specifically, the Trustees request that

Plan V be allowed to maintain all limits set forth in #3 above for the Plan Year beginningFebruary 1, 2011. In the event that the requested waiver with regard to lifetime limits isdenied, the Trustees request that Plan V be allowed to maintain the annual limits set forthin #3 above, including an annual maximum of $ for the Plan Year beginningFebruary 1,2011.5263716 C-

UFCW L400:000014


15/50

EXHIBIT DPlan S

1. Terms. Plan S generally covers retirees over age 65.2. Number of Individuals Covered. Plan S currently covers approximately employees.

3. Current Annual and Lifetime Limits and Rates. Plan S provides for limitson benefits as set forth in the Plan document. Select pertinent benefit provisions follow:

DIABETES EDUCA nON

LIFETIME LIMITS .... ... ...LIFETIME BENEFIT MAXIMUM INPATIENT & OUTPATIENT (ALCOHOL & SUBSTANCE ABUSE)PODIA TRIST SURGERIES PER LIFETIME HOSPICE CARE PER LIFETIME


(a) Annual Limits. If the Fund is required to remove the annual limitsabove, the Trustees likely would be required to consider significant benefit changes inorder to offset these increased costs. For example, the Fund's consultant estimates that

5263716 D-UFCW L400:000015


16/50

the following changes could be needed to offset the cost of increasing this program'sanual maximums to $750,000 for the Plan Year beginning February 1, 2011, if thewaiver is not granted (incorporating an increase from an annual maximum of$ to$750,000 if the Trustees were to convert the current lifetime maximum to an annualmaximum in the event HHS does not grant a waiver with regard to the lifetimemaximums as requested below):


(b) Lifetime Limits. Similarly, if the Fund is required to remove thelifetime limits above, the Trustees likely would be required to consider significant benefitchanges in order to offset these increased costs. For example, the following changescould be needed to offset the cost of eliminating this program's lifetime maximums forthe Plan Year beginning February 1, 2011 if the waiver is not granted:Increase annual deductible to $ (from $ .Increase annual out-of-pocket maximum to $ (from $ ).

(c) Combined Impact of Limits. If the Fund is required to remove theannual and lifetime limits above, the Fund's consultant estimates that the followingchanges could be needed to offset both costs for the Plan Year beginning February 1,2011, if the waiver is not granted (incorporating the conversion of the above lifetimemaximums to annual maximums):


The Trustees believe the magnitude of the changes discussed above constitutes asignificant decrease in access to benefits for those currently covered by Plan S.Additionally, the Trustees expect to consider increases in the premiums paid by retireescovered by Plan S due to the increased costs attributed to higher annual benefit limitsbeing extended to Plan S participants.Accordingly, the Trustees request a waiver from the increase in the annual andlifetime essential benefit limits under PP ACA. Specifically, the Trustees request that

Plan S be allowed to maintain all limits set forth in #3 above for the Plan Year beginningFebruary 1, 2011. In the event that the requested waiver with regard to lifetime limits isdenied, the Trustees request that Plan S be allowed to maintain the annual limits set forthin #3 above, including an annual maximum of $ for the Plan Year beginningFebruary 1,2011.

5263716 D-UFCW L400:000016


17/50

United Food and Commercial Workers Local 400and Employers Health and Welfare Fund

Waiver of Annual Limits RequirementsAttachment to Application

General

The attached spreadsheet has been prepared in a good faith effort to comply withthe published requirements for applying for a waiver from PPACA's annual limits. Thespreadsheet has been completed in as broad and comprehensive a manner as possible, butits fields should not be interpreted as confirmation that a given benefit is an essentialbenefit or a benefit for which a waiver is required. Despite the answers given on thespreadsheet, the titles to a number of columns do not fit with the nature of the Fund as amultiemployer plan, as more fully explained below and in the letter enclosed with thesematerials. That letter provides a more detailed explanation regarding the application, andwe refer HHS to that letter for important information regarding the application which

cannot be adequately expressed in the spreadsheet.

Column AK - AU

Each of the benefit packages referenced in the United Food and CommercialWorkers Local 400 and Employers Health and Welfare Funds waiver application is partof a self insured, multiemployer Taft-Hartley health and welfare fund. Employercontribution rates and Employee contribution rates applicable to certain active employeesare established in Collective Bargaining Agreements (CBA) between the Fundscontributing employers and the Local Union. As such, employer and employeecontributions and coverage tiers vary depending upon the CBA terms. The Trustees who

serve as the Fund's administrator and the bargaining parties are bound by the negotiatedrates in the CBAs, until the expiration dates of the CBAs. The Trustees also cannotspeculate as to whether and how any increased contributions needed to offset the cost ofcomplying with the $750,000 annual limits would be assigned between participants oremployers. The principal CBA covering % of all Plan participants will not expire untilOctober 15, 2011. Therefore, the Fund c ot at this point determine how it would coverthe additional costs of complying with the annual limits prohibition if the waiver is notgranted.

Plan 1 and Plan 500 (Active Employees)

For the purposes of completing this spreadsheet, the Plan's benefit consultant hasincluded a composite premium equivalent rate in columns AL - AN (Current MonthlyPremium Rates or Premium Equivalent Rate) and Columns AO -AQ (Renewal MonthlyPremium Rate or Premium Equivalent Rate if Waiver Granted) to show average rates foreach plan of benefits and the percentage increases in costs if the waiver is not granted.

Since it is currently impossible for the Fund to anticipate how any necessary rateincreases would be assigned (between employee and employer contributions) if the

UFCW L400:000017


18/50

waiver is not granted and the Trustees are bound by the negotiated employer contributionrates in the CBAs, the full projected increases are reflected only in the employeecontribution rate in column AS.

With regard to Plan 1 and Plan 500, the structure of the chart and the percentage

reflected in Column AU (Projected Rate Increase that would result from compliance with$750,000 Annual Limit Restriction) does not adequately reflect the potential increaseattributed to employee contributions if the waiver is not granted. In the event the waiveris not granted for Plans 1 and Plan 500, employee contributions could increase by thefollowing projected percentages under this approach:

UFCW Local 400 &Employers Plan

Individual/ EmployeeTier

Projected PercentageRate Increase that wouldresult from compliancewith $750,000 Annual

Plan 1 EmployeePlan 1 Employee + Children

Plan 1 Employee + Spouse

Plan 1 Employee + Family

Plan 500 Employee

Plan 500 Employee + Family

Plans V and Plan S (Retirees)

With regard to Plan S and Plan V, the security features within the chart made itimpossible for the Fund to illustrate the Premium Equivalent for these Plans accurately.

Employers do not make a monthly contribution on behalf of each retiree. Instead, theemployer contribution for active employees reflects a share of the costs to cover claimsand administration for the retirees of the active employers covered by Plan S and Plan V.Retirees of inactive employers pay the full cost of coverage. However, as explainedabove, the Trustees cannot increase the active employee contribution to offset the cost ofcomplying with the $750,000 annual limits. Therefore, if the cost of coverage increases,the retirees co-payment also likely will increase, even if there is no change in the cost-sharing percentage.

For purposes of completing the chart, only the rates for the employee contributionportions of the premium rates are populated in Columns AL, AO, and AR (Employee

Contribution). Because there is no direct monthly employer contribution, the employercontribution rate in Columns AM, AP and AS and Totals in Columns AN, AQ, and ATwere left blank. In addition, the Projected Rate Increase that would result fromcompliance with $750,000 Annual Limit Restriction in Column AU reflects only theincrease to the applicable rate for employee contributions.

UFCW L400:000018


19/50

Column AV - Decrease in Access to Benefits that would Result from compliancewith $750,000 Annual Limit Restriction

As a multiemployer Taft-Hartley Plan with contribution rates set in collectivebargaining agreements, the Board of Trustees is limited in its ability to fund the costs of

the annual limits required under PPACA. As the Trustees believe that a waiver of thePPACA annual limits is warranted, no decisions have been made at this time regardingthe actual benefit decreases that would be needed to offset a $750,000 annual limit.However, if the waiver is not granted, the Trustees would likely have to considerincreases to deductibles and/or increases to the contribution amounts required to be paidby participants. These increases could be unaffordable for a large number of participantswho would forego medical care because of the large contributions and deductibles.Please see the accompanying letter and exhibits regarding the level ofbenefit changeswhich the Fund's benefit consultant has calculated could be necessary to offset theexpected increased costs of complying with the $750,000 annual limit.

333599v1

UFCW L400:000019


20/50

Ann ual

Limit Waiver

Request

App licant

Name

Policy Name

(use a new

row for each

policy

application)

App licant

(Plan/ Policy

Situs) City

App licant

(Plan/

Policy

Situs)

State

Plan/ Policy

Effective Date

(mm/dd/yyyy)

Contact

Names

Street

Addresses Cit ies State Zip Code

Phone

Numbers

(including

area code)

Email

Addresses

C

(e.

Be

Rx o

1625

Massachuset

UFCW Local400 and

Employers

H&W Plan Plan 1 Charleston WV 01/01/2011

Sharon M.

Goodman/Wi

lliam Tobin

ts Ave NW,

Suite

450/1000North Water

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

202

202-797-

8700/414-

298-8279

sgoodman@

slevinhart.com/wtobin@re

inhartlaw.co

m

UFCW Local

400 and

Employers


Sharon M.

Goodman/Wi

lliam Tobin

1625

Massachuset

ts Ave NW,

Suite

450/1000

North Water

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

203

202-797-

8700/414-

298-8279

sgoodman@

slevinhart.co

m/wtobin@re

inhartlaw.co

m


21/50

UFCW Local

400 andEmployers


Sharon M.Goodman/Wi

lliam Tobin

1625

Massachuset

ts Ave NW,

Suite

450/1000

North WaterStreet, Suite

1700

Washington/

Milwaukee DC

20036/53

204

202-797-8700/414-

298-8279

sgoodman@

slevinhart.co

m/[email protected]

m

UFCW Local

400 and Sharon M.

1625

Massachuset

ts Ave NW,

Suite

450/1000

North Water 202-797-

sgoodman@

slevinhart.co

m/wtobin@re

Empoyers


Goo man/Wi

lliam Tobin

Street, Suite

1700

Was ington/

Milwaukee DC

20036/53

205

8700/414-

298-8279

in artaw.co

m

UFCW Local

400 and

Employers


Sharon M.

Goodman/Wi

lliam Tobin

1625

Massachuset

ts Ave NW,

Suite

450/1000

North Water

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

205

202-797-

8700/414-

298-8279

sgoodman@

slevinhart.co

m/wtobin@re

inhartlaw.co

m

UFCW Local400 and

Employers


Sharon M.

Goodman/Wi

lliam Tobin

1625

Massachuset

ts Ave NW,

Suite

450/1000North Water

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

205

202-797-

8700/414-

298-8279

sgoodman@


inhartlaw.co

m


22/50


23/50

Ambul ator y Emerg ency Hosp italizatio n Laboratory Pediat ri c

Maternity/

Newborn

Mental Health/

Substance

Abuse

Rehabilitative/

Devices

Preventive/

Wellness

Current Essential Benefits Ann ual Limits (Annual Li mit for Each Essential Benefit)


24/50


25/50


26/50

ndividual/ Employee

Tier*

Employee

/Retiree

contribution

(if applicable)

Employer

contribution

(if applicable) Total

Employee/Ret

iree

contribution

(if applicable)

Employer

contribution


Employee/Ret

iree

contribution

(if applicable)

Employer

contribution


Current Monthly Premium Rates or

Premium Equivalent Rates (in dollars)*:

Renewal Monthly Premium Rates or

Premium Equivalent Rates if Waiver Granted

(in dollars)*

Projected Rate Increase that woul d result

from compliance with $750,000 Annual Limit

Restriction (in d ollars) (Average Premium

by Individual)*

Employee

Employee +Children


27/50

Employee +Spouse

Employee +Family

Employee

Employee +Family


28/50

Employee

Employee +Family

Employee

Employee +Family

* When completing the columns requesting premium rate information, please express the premium rates as a composite rate (ifpremiums are a range based on years of service or age) and by tier (Employee, Employee +Spouse, Employee +Child, Family,etc.) as applicable. If you are an issuer, please provide the premium amount in the column titled, "Total" (Column AN, AQ and AT).


29/50

///co-adshare/...Mike/United%20Food%20and%20Commercial%20Workers%20Local%20400/Request%20for%20info%201.28.11.htm[11/15/2011 3:33

rom: Scelzo, Kathleen (HHS/OCIIO)ent: Friday, January 28, 2011 1:27 PM

To: Habit, Sandra (HHS/OCIIO)ubject: FW: Waiver UFCW LOcal 400 Employers Health and Welfare Fund

Attachments: 1-339302-4506_01_110120_Local_400_Waiver_Application_(revised).xls

athleen M. Scelzo, RN, MSN

ules Compliance Divisionffice of Insurance Oversight

ffice of Consumer Information and Insurance Oversight (OCIIO)

epartment of Health and Human Services

501 Wisconsin Avenue

ethesda, MD

01-492-4121

rom: Danielle T. Norris [mailto:[email protected]]ent: Monday, January 24, 2011 1:37 PMo: Scelzo, Kathleen (HHS/OCIIO)ubject: Waiver

ear Ms. Scelzo,

s you requested in our telephone discussion on January 20th regarding the waiver application for the UFCW Local 400 and

mployers Health and Welfare Fund, attached is a revised spreadsheet that reflects the increases if the waivers are not granted

nd only the employee contributions bear those higher costs.

you need any additional information, please feel free to call me at 202-797-8700.

est regards,

anielle

anielle T. Norris

Attorney At Law

levin & Hart, P.C.

625 Massachusetts Ave., N.W., Suite 450


02-797-8700 Tel

02-234-8231 Fax

[email protected]

UFCW L400:000029


30/50

///co-adshare/...20Food%20and%20Commercial%20Workers%20Local%20400/Request%20for%20additional%20info%201.31.11.htm[11/15/2011 3:33

rom: Scelzo, Kathleen (HHS/OCIIO)ent: Friday, January 28, 2011 11:29 AM

To: 'Danielle T. Norris'Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver UFCW Local 400

mportance: Highanielle,

an you give me a call please? I need to clarify two more points:

Lifetime limits

Plan S and V employer contribution


ules Compliance Division

ffice of Insurance Oversight




ethesda, MD

01-492-4121

rom: Danielle T. Norris [mailto:[email protected]]ent: Monday, January 24, 2011 1:37 PMo: Scelzo, Kathleen (HHS/OCIIO)ubject: Waiver

ear Ms. Scelzo,

s you requested in our telephone discussion on January 20th regarding the waiver application for the UFCW Local 400 and

mployers Health and Welfare Fund, attached is a revised spreadsheet that reflects the increases if the waivers are not granted

nd only the employee contributions bear those higher costs.


est regards,

anielle

anielle T. Norris

Attorney At Law

levin & Hart, P.C.

625 Massachusetts Ave., N.W., Suite 450


02-797-8700 Tel

02-234-8231 Fax

[email protected]

UFCW L400:000030


31/50

///co-adshare/...20Team/Mike/United%20Food%20and%20Commercial%20Workers%20Local%20400/Correspondence%202.2.11.htm[11/15/2011 3:33

rom: Danielle T. Norris [[email protected]]ent: Wednesday, February 02, 2011 6:16 PM

To: Scelzo, Kathleen (HHS/OCIIO)Cc: Sharon M. Goodman; William H. Tobinubject: Re: Waiver UFCW Local 400

mportance: High

Attachments: 1-333599-Local_400_Waiver_Chart_Explanatory_Memorandum.doc; 1-343248-506_01_110202_Local_400_Waiver_application_chart.xlsear Ms. Scelzo,

n our telephone discussion on January 28th regarding the revised waiver application for the UFCW Local 400 and Employersealth and Welfare Fund, you indicated that the waiver application spreadsheet must include specific dollar figures in the sectiertaining to the employer contribution for Plan S and Plan V rather than reference the attachment. As we discussed, the Funpplication (a copy of which is attached) explains the premium equivalents and employer contributions for these Plans accurateowever, since you indicated that a numerical entry is required, as you requested, we have revised the chart to show a $0mployer contribution for Plan S and Plan V each month to reflect that the employer does not pay a separate employerontribution for each retiree each month.

est regards,

anielleanielle T. Norris

Attorney At Law

levin & Hart, P.C.

625 Massachusetts Ave., N.W., Suite 450Washington, D.C. 20036

02-797-8700 Tel02-234-8231 [email protected]

rom: Scelzo, Kathleen (HHS/OCIIO) [mailto:[email protected]]ent: Friday, January 28, 2011 11:29 AMo: Danielle T. Norrisc: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver UFCW Local 400mportance: High

anielle,an you give me a call please? I need to clarify two more points:

Lifetime limits

Plan S and V employer contribution

athleen M. Scelzo, RN, MSNules Compliance Divisionffice of Insurance Oversightffice of Consumer Information and Insurance Oversight (OCIIO)epartment of Health and Human Services501 Wisconsin Avenueethesda, MD01-492-4121

rom: Danielle T. Norris [mailto:[email protected]]ent: Monday, January 24, 2011 1:37 PM

UFCW L400:000031


32/50

///co-adshare/...20Team/Mike/United%20Food%20and%20Commercial%20Workers%20Local%20400/Correspondence%202.2.11.htm[11/15/2011 3:33

o: Scelzo, Kathleen (HHS/OCIIO)ubject: Waiver

ear Ms. Scelzo,

s you requested in our telephone discussion on January 20th regarding the waiver application for the UFCW Local 400 andmployers Health and Welfare Fund, attached is a revised spreadsheet that reflects the increases if the waivers are not grantednd only the employee contributions bear those higher costs.


est regards,anielle

anielle T. Norris

Attorney At Law

levin & Hart, P.C.

625 Massachusetts Ave., N.W., Suite 450Washington, D.C. 20036

02-797-8700 Tel02-234-8231 [email protected]

UFCW L400:000032


33/50

Annual

Limit Waiver

Request

App lic ant

Name

Policy Name

(use a new

row for each

policy

application)

Applicant

(Plan/ Policy

Situs) City

App lic ant

(Plan/

Policy

Situs)

State

Plan/ Policy

Effective Date

(mm/dd/yyyy)

Contact

Names

Street


Phone

Numbers

(including

area code)

Email

Addresses

C

(e.

Be

Rx o

1625

Massachuset

UFCW Local400 and

Employers


Sharon M.

Goodman/Wi

lliam Tobin

ts Ave NW,

Suite

450/1000North Water

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

202

202-797-

8700/414-

298-8279

sgoodman@


inhartlaw.co

m

UFCW Local

400 and

Employers


Sharon M.

Goodman/Wi

lliam Tobin

1625

Massachuset

ts Ave NW,

Suite

450/1000

North Water

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

203

202-797-

8700/414-

298-8279

sgoodman@

slevinhart.co

m/wtobin@re

inhartlaw.co

m


34/50

Ambulatory Emergency Hosp italizat ion Laboratory Pediatric

Maternity/

Newborn

Mental Health/

Substance

Abuse

Rehabilitative/

Devices

Preventive/

Wellness

Current Essential Benefits Annual Li mits (Annual Limi t for Each Essential Benefit)


35/50

ndividual/ Employee

Tier*

Employee

/Retiree

contribution

(if applicable)

Employer

contribution


Employee/Ret

iree

contribution

(if applicable)

Employer

contribution


Employee/Ret

iree

contribution

(if applicable)

Employer

contribution



Premium Equivalent Rates (in dol lars)*:



(in dollars)*

Projected Rate Increase that would result

from compliance wit h $750,000 Annual Limi t

Restrict ion (in dollars) (Average Premium

by Individual)*

Employee

Employee +Children


36/50

Annual

Limit Waiver

Request

App lic ant

Name

Policy Name

(use a new

row for each

policy

application)

Applicant

(Plan/ Policy

Situs) City

App lic ant

(Plan/

Policy

Situs)

State

Plan/ Policy

Effective Date

(mm/dd/yyyy)

Contact

Names

Street


Phone

Numbers

(including

area code)

Email

Addresses

C

(e.

Be

Rx o

1625

Massachuset

UFCW Local400 and

Employers


Sharon M.

Goodman/Wi

lliam Tobin

ts Ave NW,

Suite

450/1000North Water

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

204

202-797-

8700/414-

298-8279

sgoodman@


inhartlaw.co

m

UFCW Local

400 and

Employers


Sharon M.

Goodman/Wi

lliam Tobin

1625

Massachuset

ts Ave NW,

Suite

450/1000

North Water

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

205

202-797-

8700/414-

298-8279

sgoodman@

slevinhart.co

m/wtobin@re

inhartlaw.co

m


37/50


Maternity/

Newborn

Mental Health/

Substance

Abuse

Rehabilitative/

Devices

Preventive/

Wellness



38/50

ndividual/ Employee

Tier*

Employee

/Retiree

contribution

(if applicable)

Employer

contribution


Employee/Ret

iree

contribution

(if applicable)

Employer

contribution


Employee/Ret

iree

contribution

(if applicable)

Employer

contribution






(in dollars)*




by Individual)*

Employee +Spouse

Employee +Family attached

memo

attached

memo

attached

memo

attached

memo

attached

memo

attached

memo

attached

memo

attached

memo

attached

memo


39/50

Annual

Limit Waiver

Request

App lic ant

Name

Policy Name

(use a new

row for each

policy

application)

Applicant

(Plan/ Policy

Situs) City

App lic ant

(Plan/

Policy

Situs)

State

Plan/ Policy

Effective Date

(mm/dd/yyyy)

Contact

Names

Street


Phone

Numbers

(including

area code)

Email

Addresses

C

(e.

Be

Rx o

UFCW Local

400 and Sharon M.

1625

Massachuset

ts Ave NW,

Suite

450/1000


sgoodman@

slevinhart.co

m/wtobin@re

Employers


Goodman/Wi

lliam Tobin

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

205

8700/414-

298-8279

inhartlaw.co

m

UFCW Local

400 and

Employers


Sharon M.

Goodman/Wi

lliam Tobin

1625

Massachuset

ts Ave NW,

Suite

450/1000

North Water

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

205

202-797-

8700/414-

298-8279

sgoodman@

slevinhart.co

m/wtobin@re

inhartlaw.co

m

UFCW Local

400 and

Employers

H&W Plan Plan V Charleston WV 01/01/2011

Sharon M.

Goodman/Wi

lliam Tobin

1625

Massachuset

ts Ave NW,

Suite450/1000

North Water

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

205

202-797-

8700/414-

298-8279

[email protected]

m/wtobin@re

inhartlaw.co

m


40/50


Maternity/

Newborn

Mental Health/

Substance

Abuse

Rehabilitative/

Devices

Preventive/

Wellness



41/50

ndividual/ Employee

Tier*

Employee

/Retiree

contribution

(if applicable)

Employer

contribution


Employee/Ret

iree

contribution

(if applicable)

Employer

contribution


Employee/Ret

iree

contribution

(if applicable)

Employer

contribution






(in dollars)*




by Individual)*

Employee

Employee +Family

Employee


42/50

Annual

Limit Waiver

Request

App lic ant

Name

Policy Name

(use a new

row for each

policy

application)

Applicant

(Plan/ Policy

Situs) City

App lic ant

(Plan/

Policy

Situs)

State

Plan/ Policy

Effective Date

(mm/dd/yyyy)

Contact

Names

Street


Phone

Numbers

(including

area code)

Email

Addresses

C

(e.

Be

Rx o

UFCW Local

400 and Sharon M.

1625

Massachuset

ts Ave NW,

Suite

450/1000


sgoodman@

slevinhart.co

m/wtobin@re

Employers

H&W Plan Plan V Charleston WV 01/01/2011

Goodman/Wi

lliam Tobin

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

205

8700/414-

298-8279

inhartlaw.co

m

UFCW Local

400 and

Employers

H&W Plan Plan S Charleston WV 01/01/2011

Sharon M.

Goodman/Wi

lliam Tobin

1625

Massachuset

ts Ave NW,

Suite

450/1000

North Water

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

205

202-797-

8700/414-

298-8279

sgoodman@

slevinhart.co

m/wtobin@re

inhartlaw.co

m

UFCW Local

400 and

Employers

H&W Plan Plan S Charleston WV 01/01/2011

Sharon M.

Goodman/Wi

lliam Tobin

1625

Massachuset

ts Ave NW,

Suite450/1000

North Water

Street, Suite

1700

Washington/

Milwaukee DC

20036/53

205

202-797-

8700/414-

298-8279

[email protected]

m/wtobin@re

inhartlaw.co

m


43/50


Maternity/

Newborn

Mental Health/

Substance

Abuse

Rehabilitative/

Devices

Preventive/

Wellness



44/50

ndividual/ Employee

Tier*

Employee

/Retiree

contribution

(if applicable)

Employer

contribution


Employee/Ret

iree

contribution

(if applicable)

Employer

contribution


Employee/Ret

iree

contribution

(if applicable)

Employer

contribution






(in dollars)*




by Individual)*

Employee +Family

Employee

Employee +Family

* When completing the columns requesting premium rate information, please express the premium rates as a composite rate (ifpremiums are a range based on years of service or age) and by tier (Employee, Employee +Spouse, Employee +Child, Family,


45/50

///co-adshare/...ssing%20Team/Mike/United%20Food%20and%20Commercial%20Workers%20Local%20400/Approval%202.3.11.htm[11/15/2011 3:33

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Thursday, February 03, 2011 2:49 PM

To: '[email protected]'; '[email protected]'Cc: Habit, Sandra (HHS/OCIIO)ubject: UFCW Local 400 and Employers H&W Plan Waiver of the Annual Limits Requirements 2-3-2011

mportance: High

Attachments: Updated Jan 1 Approval Letter .pdfood Morning,

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

ection 2711 forUFCW Local 400 and Employers H&W Plan. HHS has reviewed your application and made

etermination. Please see the attached letter.

he attached letter refers to the following plans:

Plan 1

Plan 500

Plan S

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

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

Alexandra Botwinick

ffice of Oversight

HHS/[email protected]

UFCW L400:000045


46/50

UFCW L400:000046


47/50

UFCW L400:000047


48/50

///co-adshare/...mercial%20Workers%20Local%20400/UFCW%20Local%20400%20Limited%20Waiver%20Approval%202.15.11.htm[11/15/2011 3:33

rom: Scelzo, Kathleen (HHS/OCIIO)ent: Tuesday, February 15, 2011 11:11 AM

To: '[email protected]'Cc: '[email protected]'ubject: UFCW Local 400 Limited Waiver Approval

Attachments: Jan 1 Approval.pdf

ood Morning,

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

ection 2711 for UFCW Local 400

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

he attached letter refers to the following plans:

lan V

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

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


ules Compliance Division

ffice of Insurance Oversight




ethesda, MD

01-492-4121

UFCW L400:000048


49/50

UFCW L400:000049


50/50

UFCW Local 400 - Redacted HWM

Documents

Transcript of UFCW Local 400 - Redacted HWM