UFCW Local One - Redacted HWM
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///co-adshare/...-%20Torres/DFOI%20Processing%20Team/Mike/UFCW%20Local%20One%20Health%20Care%20Fund/Waiver.txt[11/15/2011 11:37:
rom: Andrea D Goldberger [[email protected]]ent: Tuesday, November 30, 2010 5:04 PMo: OCIIO Oversight; HHS HealthInsurance (HHS)
Cc: 'Sarah E. Sanchez'; 'Barry S. Slevin'; 'Sharon M. Goodman';Gingell, John'ubject: Waiver
Attachments: Waiver Application.pdf
Good Afternoon,
Attached please find an Application for Waiver of PPACA Lifetime Limits Prohibition filed on behalf of the UFCWocal One Health Care Fund.
hank you,
Andrea D. GoldbergerUFCW Local One Benefit Funds911 Airport Road
Oriskany, NY 13424
15-797-9600, ext 2253ax: 315-797-9664
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///co-adshare/...I%20Processing%20Team/Mike/UFCW%20Local%20One%20Health%20Care%20Fund/Waiver%20and%20SPD.txt[11/15/2011 11:37:
rom: Andrea D Goldberger [[email protected]]ent: Wednesday, December 01, 2010 12:58 PMo: OCIIO Oversight; HHS HealthInsurance (HHS)
Cc: 'Sarah E. Sanchez'; 'Barry S. Slevin'; 'Sharon M. Goodman'; 'Gingell, John'ubject: Waiver and SPD
Attachments: Waiver Application.pdf; hc spd - 2009 8x11_FINAL.pdf; WRAPPLAN009.pdf; PLAN Q PPO 2009.pdf; PLAN R PPO-2009.pdf; PLAN S PPO - 1-1-010.pdf; PLAN T PPO.pdf; PLAN U PPO 8-1-2010.pdf
Good Afternoon,
Attached please find an Application for Waiver of PPACA Lifetime Limitsrohibition filed on behalf of the UFCW Local One Health Care Fund, as well ascopy of the Fund's SPD and Plan Summaries. The Application was emailedesterday, November 30th; however, the SPD and Summaries were inadvertentlyeft off the email.
hank you,
Andrea D. Goldberger
UFCW Local One Benefit Funds911 Airport Road
Oriskany, NY 1342415-797-9600, ext 2253ax: 315-797-9664
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Mr. JamesMayhewPage
agreement xpiresand s renegotiatedandeven henmay decidenot to increasecontributions.)Thus, he Fund's only option for addressinghe increased ostsinvolved in eliminating the lifetime limits describedabove likely is tosignificantly educe hese enefits r otherbenefits fferedby theFund.If theDepartment f HealthandHumanServiceswill notgrant heFunda waiverof the ifetime imits described erein,but wouldgranta waiver or such imits ifthey arefirst convertedo annual imits, the Boardof Trusteeswill amend hePlan o convert hereferencedifetime imits to annualimits, effectiveJanuary1,2011,andhereby eeks waiverof suchannualimits.
6. The requiredattestation f the informationabove,signedby the ChairmanandCo-Chairman f the Fund's Board of Trustees,s enclosed s AttachmentA tothis etter.We respectfully equestexpeditedhandlingof this matter. If you have anyquestions r needadditionalnformation, lease ontactheundersigned.
Sincerely,l \ . -ftft/^r- D Arurv\
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ArrncnmENTAUFCW Locu, Oun Hn.lr,rn Canr FuNoPPACALrnnrlnnnLTNNNSrVNN APPLICATIONAttnsr,luoN oFPr,.q,NtvrrNIstn lroR
On behalf of the Boardof Trustees f the UFCW Local One HealthCareFund(ooFund"),the undersigned,Chairmanand Co-Chairmanof the UFCW Local One Health Care Fund, doherebyattest o the following:
(1) heFundwas n forceprior o September3,2010;and(2) basedupon the information contained n the Fund's letter to which this Attestation isattachedas Exhibit A ("Letter"), the elimination of the lifetime limits referenced n theLetter, and the application of restricted annual limits to the benefits referenced n theLetter, would result in a significant decrease n access o benefits for those currentlycoveredby the Plan and/or a significant increase n the amountsneeded o cover the costof the Plan.
One Health Care Plan
315260v1
I One Health Care Plan
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///co-adshare/...ing%20Team/Mike/UFCW%20Local%20One%20Health%20Care%20Fund/Request%20for%20info%2012.17.10.htm[11/15/2011 11:37
rom: Keels, Lisa (HHS/OCIIO)ent: Friday, December 17, 2010 2:53 PM
To: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Attachments: Waiver Application Form.xlsxDear Andrea:
hank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements he Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide theollowing information:
I. Please complete the entire annual limits spreadsheet, which is attached to this email. Please return thecompleted spreadsheet to this email address as an attachment. We will only be able to process spreadshthat are fully complete (i.e., every cell should contain the information requested). If a cell on thespreadsheet does not pertain to your plan, please write None, and/or provide an explanation regardingwhy you are unable to complete that particular cell in a separate document.
II. In addition, please provide the following information:
As we discussed, please confirm that, pending a waiver, you plan to convert the $ lifetime limit onretirees and their spouses to an annual limit, and that you are applying for a waiver on the $ annual limon retirees and their spouses.
As we discussed, you have benefit limits on hearing aids. Hearing aids may be considered an essential heal
benefit under Section 1302(b)(1)(G) of the Affordable Care Act. However, because regulations have not beissued regarding this matter, we rely on the Interim Final Regulations, which state that, [f]or plan years . .beginning before the issuance of regulations defining essential health benefits, for purposes of enforcemen
the Departments will take into account good faith efforts to comply with a reasonable interpretation of the t
essential health benefits. (Federal Register, Vol. 75, No. 123, page 37191 (Monday, June 28, 2010)). Do
believe in good faith that hearing aids are not considered essential health benefits? If so, please confirm tyou are not applying for a waiver on the hearing aid limits.
Also as we discussed, please confirm that you are not applying for a waiver on adult orthodontic, optical, an
dental benefits, and that you are only applying for a waiver on pediatric oral and vision benefits, to the extenyou have them.
Please confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance
grandfathering provisions, pursuant to 45 CFR 147.140?
Please confirm that the Collective Bargaining Agreement was ratified prior to October 3, 2008.
Please provide the date for which the Collective Bargaining Agreement will expire.
n order to complete your application, please provide this information by 5:00pm, December 20, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you,isa
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///co-adshare/...ing%20Team/Mike/UFCW%20Local%20One%20Health%20Care%20Fund/Request%20for%20info%2012.20.10.htm[11/15/2011 11:37
rom: Andrews, Jane (HHS/OCIIO)ent: Monday, December 20, 2010 10:20 AM
To: Andrews, Jane (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: Your application for a waiver of annual limiits
Attachments: Waiver Application Form.xlshank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act
PHS Act) Section 2711. In order to expedite your application, please provide the following information:
I. Please complete the entire annual limits spreadsheet, [attached to the email] [and available at:http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html]. Please return the completed spreadshto this email address as an attachment. We will only be able to process spreadsheets that are fully comp(i.e., every cell should contain the information requested). If a cell on the spreadsheet does not pertain tyour plan, please write None, and/or provide an explanation regarding why you are unable to completethat particular cell in a separate document.
II. In addition, if you did not include the following information in your application and is applicable, pleaseprovide the following information:
Confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance with
grandfathering provisions, pursuant to 45 CFR 147.140.
Confirm whether the plan was created pursuant to the Taft-Hartley Act. If it is, please provide the date the
collective bargaining agreement will expire.
Confirm that your plan is either self-insured or fully insured.
If you did not complete and submit a signed attestation in accordance with the September 3, 2010 guidance,
please submit that with the spreadsheet as a separate attachment.
n order to complete your application, please provide this information by 5:00 pm, December 22, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you and feel free to contact me with questions.
ane W. Andrews
CIIO
501 Wisconsin Aveethesda, MD 20814
01-492-4122 (desk)
02-536-6779 (Blackberry)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
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rom: Keels, Lisa (HHS/OCIIO)ent: Monday, December 20, 2010 10:59 AM
To: Sarah E. SanchezCc: [email protected]; Price, Francoise; Gingell, John; Sharon M. Goodman; Habit, SandraHHS/OCIIO)ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Dear Ms. Sanchez,
hank you for your email and for letting me know about the Funds schedule. HHS will process your application auickly as possible after it is completed. However, please note that, as stated in our September 3, 2010 Guidance,HHS will issue a decision within 30 days of receiving a complete application.
lease feel free to contact me with any questions.
hank you again,isa
isa M. Keels, J.D.U.S. Department of Health & Human ServicesOffice of Consumer Information and Insurance Oversight
Office of [email protected]
rom: Sarah E. Sanchez [mailto:[email protected]]ent: Monday, December 20, 2010 10:44 AMo: Keels, Lisa (HHS/OCIIO)c: [email protected]; Price, Francoise; Gingell, John; Sharon M. Goodmanubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Ms. Keels-
his firm represents the UFCW Local One Health Care Fund. This is in response to your below email to the Fund Director, An
oldberger. The Fund is in the process of putting together the data necessary to respond to your request for additional
formation. However, it is unlikely that the Fund will be able to respond by 5pm today. The Fund will make every attempt to
rovide you with the requested information by Thursday of this week. Please let me know if that presents any problem. Thank
arah Sanchez
arah E. Sanchez
rincipal
levin & Hart, P.C.
625 Massachusetts Ave., N.W., Suite 450
Washington, D.C. 20036
02-797-8700 Tel02-234-8231 Fax
RS CIRCULAR 230 NOTICE: To comply with requirements imposed by the IRS, this is to inform you that any tax advice contained in this
ommunication (including any attachments) was not intended or written to be used, and cannot be used, for the purpose of (i) avoiding tax-re
enalties under the Internal Revenue Code or (ii) promoting, marketing or recommending to another party any matter addressed herein.
he information contained in this message is intended only for the use of the designated recipients named above. This message may be an
ttorney-client communication, and as such, is privileged and confidential If the reader of this message is not the intended recipient or an ag
esponsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error, and that any revie
issemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify
UFCW L ONE:000012
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As we discussed, please confirm that, pending a waiver, you plan to convert the $ lifetime limit on retirnd their spouses to an annual limit, and that you are applying for a waiver on the $ annual limit on retirees aheir spouses.
As we discussed, you have benefit limits on hearing aids. Hearing aids may be considered an essential healtenefit under Section 1302(b)(1)(G) of the Affordable Care Act. However, because regulations have not been issu
egarding this matter, we rely on the Interim Final Regulations, which state that, "[f]or plan years . . . beginning befhe issuance of regulations defining 'essential health benefits,' for purposes of enforcement, the Departments will tanto account good faith efforts to comply with a reasonable interpretation of the term 'essential health benefits.'"Federal Register, Vol. 75, No. 123, page 37191 (Monday, June 28, 2010)). Do you believe in good faith that heariids are not considered "essential health benefits?" If so, please confirm that you are not applying for a waiver on earing aid limits.
Also as we discussed, please confirm that you are not applying for a waiver on adult orthodontic, optical, andental benefits, and that you are only applying for a waiver on pediatric oral and vision benefits, to the extent you h
hem.
Please confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance wrandfathering provisions, pursuant to 45 CFR 147.140?
Please confirm that the Collective Bargaining Agreement was ratified prior to October 3, 2008.
Please provide the date for which the Collective Bargaining Agreement will expire.
n order to complete your application, please provide this information by 5:00pm, December 20, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you,isa
isa M. Keels, J.D.U.S. Department of Health & Human ServicesOffice of Consumer Information and Insurance OversightOffice of Oversight
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ANNUAL LIMIT WAIVER APPLICATIO
Annual L imit
Waiver
Request
Appl icant
Name
Policy Name
(use a new
row for each
policy
application)
Appl icant
(Plan/ Policy
Situs) City
Appl icant
(Plan/
Policy
Situs)
State
Plan/ Policy
Effective Date
(mm/dd/yyyy)
Contact
Name
Street
Address City State Zip Code
Phone
Number
(including
area code)
Ema
Addr
UFCW LocalOne HealthCare Fund Plan M Oriskany NY 01/01/2011
AndreaGoldberger
5911 AirportRd Oriskany NY 13424
1-315-797-9600, ext
2253
andberg
n
UFCW LocalOne HealthCare Fund Retiree Oriskany NY 01/01/2011
AndreaGoldberger
5911 AirportRd Oriskany NY 13424
1-315-797-9600, ext
2253
andberg
n
PRA Disclosure Statement
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ANNUAL LIMIT WAIVER APPLICATIO
Emergency Hospitalization Laboratory Pediatric
Maternity/
Newborn
Mental Health/
Substance
Abuse
Rehabilitative/
Devices
Preventive/
Wellness Pres
Current Essential Benefits Annual Limits (Annual Limit for Each Essential Benefit)
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ANNUAL LIMIT WAIVER APPLICATIO
Coinsuran
ce (if
applicable)
Individual/ Employee
Tier*
Employee
contribution
(if applicable)
Employer
contribution
(if applicable) Total
Employee
contribution
(if applicable)
Employer
contribution
(if applicable) Total
Employee
contribution
(if applicable)
Em
cont
(if ap
$0.00 $0.00
$0.00 $0.00
Projected Rate Incr
from compliance with
Restriction (in dollar
Indi
Current Monthly Premium Rates or Premium
Equivalent Rates (in dollars)*:
x
insurance
Renewal Monthly Premium Rates or
Premium Equivalent Rates if Waiver Granted
(in dollars)*
Employee
Individual
* When completing the columns requesting premium rate information, please express the premium rates as a compremiums are a range based on years of service or age) and by tier (Employee, Employee +Spouse, Employee +as a licable. If ou are an issuer, lease rovide the remium amount in the column titled, "Total" (Column AN,
* When completing the columns requesting premium rate information, please express the premium rates as a compremiums are a range based on years of service or age) and by tier (Employee, Employee +Spouse, Employee +as applicable. If you are an issuer, please provide the premium amount in the column titled, "Total" (Column AN,
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///co-adshare/...ing%20Team/Mike/UFCW%20Local%20One%20Health%20Care%20Fund/Request%20for%20info%2021.23.10.htm[11/15/2011 11:37
rom: Keels, Lisa (HHS/OCIIO)ent: Thursday, December 23, 2010 3:24 PM
To: [email protected]: Habit, Sandra (HHS/OCIIO); 'Sarah E. Sanchez'; 'Sullivan, Susan'; 'Price, Francoise'; 'Gingell, John'; 'Sharon MGoodman'ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Informationhank you, Andrea. I do have a couple of questions about the spreadsheet, and I just left you a voicemail message regardi
his:
1. I was wondering whether you are only applying for a waiver for the Funds Retiree coverage and Plan M. I know
those are the only two applications listed on the spreadsheet, but your original application provides SPDs for othe
plans. Some of these plans have lifetime limits of $ . Please confirm that you are either removing theselifetime limits or converting them to annual limits (which do not require a waiver this year because the limit would
above $750,000).
2. Also, for Plan M, the annual limit is listed as $ on the spreadsheet. I assume that there is no overall annual land that the $ is the limit on preventive care, as is stated in your original application. Please confirm whethethis is the case, and I will change the spreadsheet to reflect this.
3. Is Plan M the Mini-Wrap Plan included in your original application? I notice that that plan has a $ limit onpreventive care, so Im assuming they are the same. However, please confirm.
s I mentioned in my voicemail, I am out of the office now through next week. However, I will be checking my email
ntermittently, and I will respond to you as quickly as possible.
hank you again, and happy holidays.
sa
rom: Andrea D Goldberger [mailto:[email protected]]ent: Thursday, December 23, 2010 2:13 PMo: Keels, Lisa (HHS/OCIIO)c: Habit, Sandra (HHS/OCIIO); 'Sarah E. Sanchez'; 'Sullivan, Susan'; 'Price, Francoise'; 'Gingell, John'; 'Sharon M. Goodman'ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Dear Ms. Keels,
This is in response to your below request for additional information concerning the annualmits waiver application of the UFCW Local One Health Care Fund ("Fund").
. The completed spreadsheet includes information pertaining to the Funds Retiree coverand Plan M, a supplemental benefit Plan that does not include hospitalization or major medoverage.
I. The Fund will eliminate its current lifetime limit on retiree benefits, effective January 1,011. The Fund is applying to HHS for an annual limits waiver relating to retiree benefitsnder the Plan, so that the Fund may retain the current $ limit on retiree benefits, onow, on an annual basis.
n its waiver application, the Fund indicated that it intended to apply for a waiver relating tmits on the essential benefits available under the Plan. Per your request, this is to adviseou that the Fund has a good faith belief that the hearing aid benefit, the adult dental and
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ision benefits, and the orthodontic benefit are not essential benefits, as that term is used ihe PPACA, and therefore the Fund is not applying for an annual limits waiver relating to suenefits.
The Fund was in existence prior to March 23, 2010. It is the Fund's understanding that PlaQ, R and M meet the requirements of a "grandfathered plan," as that term is used in
pplicable regulations. These Plans are prepared to comply with the PPACA requirementspplicable to grandfathered plans, effective January 1, 2011. Further, it is the Fund'snderstanding that Plans S, T and U will not be grandfathered, effective January 1, 2011.
These Plans are prepared to comply with the PPACA requirements applicable to non-randfathered plans, effective January 1, 2011.
Currently, there are 67 collective bargaining agreements between the U.F.C.W. District Unioocal One and the Fund's various participating employers that call for contributions to theund. The effective and expiration dates of the current collective bargaining agreementsovering % of the Fund's participants are as follows:
4/6/2008-4/2/20114/27/2008-4/23/2011
/3/2008-7/30/2011
Should you have any questions, please contact the Fund office.
Thank you and Happy Holidays,
ndrea D. Goldberger
FCW Local One Benefit Funds
911 Airport Road
riskany, NY 13424
15-797-9600, ext 2253
ax: 315-797-9664
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Friday, December 17, 2010 2:53 PMo: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Dear Andrea:
hank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements he Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide the
ollowing information:
I. Please complete the entire annual limits spreadsheet, which is attached to this email. Please return thecompleted spreadsheet to this email address as an attachment. We will only be able to process spreadshthat are fully complete (i.e., every cell should contain the information requested). If a cell on thespreadsheet does not pertain to your plan, please write None, and/or provide an explanation regardingwhy you are unable to complete that particular cell in a separate document.
II. In addition, please provide the following information:
As we discussed, please confirm that, pending a waiver, you plan to convert the $ lifetime limit onUFCW L ONE:000020
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retirees and their spouses to an annual limit, and that you are applying for a waiver on the $ annual limon retirees and their spouses.
As we discussed, you have benefit limits on hearing aids. Hearing aids may be considered an essential heal
benefit under Section 1302(b)(1)(G) of the Affordable Care Act. However, because regulations have not beissued regarding this matter, we rely on the Interim Final Regulations, which state that, [f]or plan years . .beginning before the issuance of regulations defining essential health benefits, for purposes of enforcementhe Departments will take into account good faith efforts to comply with a reasonable interpretation of the tessential health benefits. (Federal Register, Vol. 75, No. 123, page 37191 (Monday, June 28, 2010)). Do
believe in good faith that hearing aids are not considered essential health benefits? If so, please confirm tyou are not applying for a waiver on the hearing aid limits.
Also as we discussed, please confirm that you are not applying for a waiver on adult orthodontic, optical, an
dental benefits, and that you are only applying for a waiver on pediatric oral and vision benefits, to the extenyou have them.
Please confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance
grandfathering provisions, pursuant to 45 CFR 147.140?
Please confirm that the Collective Bargaining Agreement was ratified prior to October 3, 2008.
Please provide the date for which the Collective Bargaining Agreement will expire.
n order to complete your application, please provide this information by 5:00pm, December 20, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you,isa
sa M. Keels, J.D.
.S. Department of Health & Human Services
ffice of Consumer Information and Insurance Oversight
ffice of Oversight
01-492-4168
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rom: Keels, Lisa (HHS/OCIIO)ent: Thursday, December 23, 2010 12:58 PM
To: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Informationi Andrea,
hanks for your email. To answer your question, we are requesting the effective dates of each agreement, as well as the
ates each CBA expires. However, since you have 67 CBAs, at the moment, you can just provide the date the first CBAxpires.
We might ask for more information, but that is fine for now. Please let me know if this makes sense.
appy Holidays to you, too!
sa
rom: Andrea D Goldberger [mailto:[email protected]]
ent: Thursday, December 23, 2010 12:04 PMo: Keels, Lisa (HHS/OCIIO)ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Dear Lisa,
am forwarding our response to your request for information today and have a questionegarding the information you need pertaining to collective bargaining agreements. The unas 67 collective bargaining agreements that contain provisions for health care benefitshrough the UFCW Local One Health Care Fund. Are you requesting the effective dates of egreement or the earliest and more recent or something altogether different?
hank you and Happy Holidays!!
Andrea Goldberger
ndrea D. Goldberger
FCW Local One Benefit Funds
911 Airport Road
riskany, NY 13424
15-797-9600, ext 2253
ax: 315-797-9664
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Friday, December 17, 2010 2:53 PMo: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Dear Andrea:
hank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements he Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide theollowing information:
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I. Please complete the entire annual limits spreadsheet, which is attached to this email. Please return thecompleted spreadsheet to this email address as an attachment. We will only be able to process spreadshthat are fully complete (i.e., every cell should contain the information requested). If a cell on thespreadsheet does not pertain to your plan, please write None, and/or provide an explanation regardingwhy you are unable to complete that particular cell in a separate document.
II. In addition, please provide the following information:
As we discussed, please confirm that, pending a waiver, you plan to convert the $ lifetime limit onretirees and their spouses to an annual limit, and that you are applying for a waiver on the $ annual limon retirees and their spouses.
As we discussed, you have benefit limits on hearing aids. Hearing aids may be considered an essential heal
benefit under Section 1302(b)(1)(G) of the Affordable Care Act. However, because regulations have not beissued regarding this matter, we rely on the Interim Final Regulations, which state that, [f]or plan years . .beginning before the issuance of regulations defining essential health benefits, for purposes of enforcementhe Departments will take into account good faith efforts to comply with a reasonable interpretation of the tessential health benefits. (Federal Register, Vol. 75, No. 123, page 37191 (Monday, June 28, 2010)). Dobelieve in good faith that hearing aids are not considered essential health benefits? If so, please confirm t
you are not applying for a waiver on the hearing aid limits.
Also as we discussed, please confirm that you are not applying for a waiver on adult orthodontic, optical, an
dental benefits, and that you are only applying for a waiver on pediatric oral and vision benefits, to the extenyou have them.
Please confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance
grandfathering provisions, pursuant to 45 CFR 147.140?
Please confirm that the Collective Bargaining Agreement was ratified prior to October 3, 2008.
Please provide the date for which the Collective Bargaining Agreement will expire.
n order to complete your application, please provide this information by 5:00pm, December 20, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you,isa
sa M. Keels, J.D.
.S. Department of Health & Human Services
ffice of Consumer Information and Insurance Oversight
ffice of Oversight
01-492-4168
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rom: Andrea D Goldberger [[email protected]]ent: Thursday, December 23, 2010 2:13 PM
To: Keels, Lisa (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO); 'Sarah E. Sanchez'; 'Sullivan, Susan'; 'Price, Francoise'; 'Gingell, John'; 'Sharon MGoodman'ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Attachments: 5170 Waiver Application Spreadsheet from HHS w_Andrea_s Entries (UFCW 1) (1).XLSX
Dear Ms. Keels,This is in response to your below request for additional information concerning the annual
mits waiver application of the UFCW Local One Health Care Fund ("Fund").
. The completed spreadsheet includes information pertaining to the Funds Retiree coverand Plan M, a supplemental benefit Plan that does not include hospitalization or major medoverage.
I. The Fund will eliminate its current lifetime limit on retiree benefits, effective January 1,011. The Fund is applying to HHS for an annual limits waiver relating to retiree benefitsnder the Plan, so that the Fund may retain the current $ limit on retiree benefits, onow, on an annual basis.n its waiver application, the Fund indicated that it intended to apply for a waiver relating tmits on the essential benefits available under the Plan. Per your request, this is to adviseou that the Fund has a good faith belief that the hearing aid benefit, the adult dental andision benefits, and the orthodontic benefit are not essential benefits, as that term is used ihe PPACA, and therefore the Fund is not applying for an annual limits waiver relating to suenefits.
The Fund was in existence prior to March 23, 2010. It is the Fund's understanding that PlaQ, R and M meet the requirements of a "grandfathered plan," as that term is used in
pplicable regulations. These Plans are prepared to comply with the PPACA requirements
pplicable to grandfathered plans, effective January 1, 2011. Further, it is the Fund'snderstanding that Plans S, T and U will not be grandfathered, effective January 1, 2011.These Plans are prepared to comply with the PPACA requirements applicable to non-
randfathered plans, effective January 1, 2011.
Currently, there are 67 collective bargaining agreements between the U.F.C.W. District Unioocal One and the Fund's various participating employers that call for contributions to theund. The effective and expiration dates of the current collective bargaining agreementsovering % of the Fund's participants are as follows:
4/6/2008-4/2/20114/27/2008-4/23/2011
/3/2008-7/30/2011Should you have any questions, please contact the Fund office.
Thank you and Happy Holidays,
ndrea D. Goldberger
FCW Local One Benefit Funds
911 Airport Road
riskany, NY 13424
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15-797-9600, ext 2253
ax: 315-797-9664
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Friday, December 17, 2010 2:53 PMo: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Dear Andrea:
hank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements he Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide theollowing information:
I. Please complete the entire annual limits spreadsheet, which is attached to this email. Please return thecompleted spreadsheet to this email address as an attachment. We will only be able to process spreadshthat are fully complete (i.e., every cell should contain the information requested). If a cell on thespreadsheet does not pertain to your plan, please write None, and/or provide an explanation regardingwhy you are unable to complete that particular cell in a separate document.
II. In addition, please provide the following information:
As we discussed, please confirm that, pending a waiver, you plan to convert the $ lifetime limit on retiand their spouses to an annual limit, and that you are applying for a waiver on the $ annual limit onretirees and their spouses.
As we discussed, you have benefit limits on hearing aids. Hearing aids may be considered an essential heal
benefit under Section 1302(b)(1)(G) of the Affordable Care Act. However, because regulations have not beissued regarding this matter, we rely on the Interim Final Regulations, which state that, [f]or plan years . .beginning before the issuance of regulations defining essential health benefits, for purposes of enforcemen
the Departments will take into account good faith efforts to comply with a reasonable interpretation of the tessential health benefits. (Federal Register, Vol. 75, No. 123, page 37191 (Monday, June 28, 2010)). Dobelieve in good faith that hearing aids are not considered essential health benefits? If so, please confirm tyou are not applying for a waiver on the hearing aid limits.
Also as we discussed, please confirm that you are not applying for a waiver on adult orthodontic, optical, an
dental benefits, and that you are only applying for a waiver on pediatric oral and vision benefits, to the extenyou have them.
Please confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance w
grandfathering provisions, pursuant to 45 CFR 147.140?
Please confirm that the Collective Bargaining Agreement was ratified prior to October 3, 2008.
Please provide the date for which the Collective Bargaining Agreement will expire.
n order to complete your application, please provide this information by 5:00pm, December 20, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
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hank you,isa
sa M. Keels, J.D.
.S. Department of Health & Human Services
ffice of Consumer Information and Insurance Oversight
ffice of Oversight
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rom: Keels, Lisa (HHS/OCIIO)ent: Monday, December 27, 2010 7:57 AM
To: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Informationi Andrea,
hope you are still enjoying the holiday season! Thanks so much for your clarifications below.
egarding the lifetime limits, I double checked, and the regulations state that lifetime limits need to be removed for all pla
eginning on or after September 23, 2010. ("the provisions of PHS Act section 2711, insofar as it relates to lifetime limits,...ap
o grandfathered health plans for plan years beginning on or after September 23, 2010." See 45 CFR 147.140(d)). In light of t
egulation, can you please confirm that you are either removing the lifetime limits or converting them to annual limits for all plan
both grandfathered and non-grandfathered)?
hank you again for your other responses and clarifications. Once you confirm that you are removing or converting the lifetime
mits, we will move forward with the application for Plan M (the mini-wrap plan) and the Funds Retiree coverage.
ave a great day,
sa
rom: Andrea D Goldberger [mailto:[email protected]]ent: Thursday, December 23, 2010 3:37 PMo: Keels, Lisa (HHS/OCIIO)ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Hi Lisa sorry I missed your call! Regarding your questions, please see my comments belownitially, we included all plans with our application because the Plans have annual limits onrthodontia, dental, vision and hearing aids. Since at this time we do not believe that theseall under the definition of essential benefits, we did not include these Plans on thepreadsheet.
Our office is closed on Monday, however I will be working remotely and can be reached bymail or by cell at 518-857-9822.
Thank you, and Enjoy the Holiday!!
Andrea
ndrea D. Goldberger
FCW Local One Benefit Funds
911 Airport Road
riskany, NY 13424
15-797-9600, ext 2253ax: 315-797-9664
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, December 23, 2010 3:24 PMo: [email protected]: Habit, Sandra (HHS/OCIIO); 'Sarah E. Sanchez'; 'Sullivan, Susan'; 'Price, Francoise'; 'Gingell, John'; 'Sharon M. Goodman'ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
hank you, Andrea. I do have a couple of questions about the spreadsheet, and I just left you a voicemail message regardi
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his:
1. I was wondering whether you are only applying for a waiver for the Funds Retiree coverage and Plan M. I know
those are the only two applications listed on the spreadsheet, but your original application provides SPDs for othe
plans. Some of these plans have lifetime limits of $ Please confirm that you are either removing theselifetime limits or converting them to annual limits (which do not require a waiver this year because the limit would
above $750,000). The lifetime limits will be eliminated for all non-grandfathered plans effective 1/1/2011. The
lifetime limits for grandfathered plans will remain for Plan year 2011 as I believe that this is allowed.
2. Also, for Plan M, the annual limit is listed as $ on the spreadsheet. I assume that there is no overall annual land that the $ is the limit on preventive care, as is stated in your original application. Please confirm whethethis is the case, and I will change the spreadsheet to reflect this. Yes, you are correct. The $ is actually an annualimit on the amount paid for an annual physical. This Plan is a supplemental plan that has no hospitalization or ma
medical coverage, but encourages an annual physical.
3. Is Plan M the Mini-Wrap Plan included in your original application? I notice that that plan has a $ limit onpreventive care, so Im assuming they are the same. However, please confirm. Yes sorry! Mini-wrap and Plan M
one and the same!
s I mentioned in my voicemail, I am out of the office now through next week. However, I will be checking my email
ntermittently, and I will respond to you as quickly as possible.
hank you again, and happy holidays.
sa
rom: Andrea D Goldberger [mailto:[email protected]]ent: Thursday, December 23, 2010 2:13 PMo: Keels, Lisa (HHS/OCIIO)
c: Habit, Sandra (HHS/OCIIO); 'Sarah E. Sanchez'; 'Sullivan, Susan'; 'Price, Francoise'; 'Gingell, John'; 'Sharon M. Goodman'ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Dear Ms. Keels,
This is in response to your below request for additional information concerning the annualmits waiver application of the UFCW Local One Health Care Fund ("Fund").
. The completed spreadsheet includes information pertaining to the Funds Retiree coverand Plan M, a supplemental benefit Plan that does not include hospitalization or major medoverage.
I. The Fund will eliminate its current lifetime limit on retiree benefits, effective January 1,011. The Fund is applying to HHS for an annual limits waiver relating to retiree benefitsnder the Plan, so that the Fund may retain the current $ limit on retiree benefits, onow, on an annual basis.
n its waiver application, the Fund indicated that it intended to apply for a waiver relating tmits on the essential benefits available under the Plan. Per your request, this is to adviseou that the Fund has a good faith belief that the hearing aid benefit, the adult dental andision benefits, and the orthodontic benefit are not essential benefits, as that term is used ihe PPACA, and therefore the Fund is not applying for an annual limits waiver relating to suenefits.
UFCW L ONE:000028
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The Fund was in existence prior to March 23, 2010. It is the Fund's understanding that PlaQ, R and M meet the requirements of a "grandfathered plan," as that term is used in
pplicable regulations. These Plans are prepared to comply with the PPACA requirementspplicable to grandfathered plans, effective January 1, 2011. Further, it is the Fund'snderstanding that Plans S, T and U will not be grandfathered, effective January 1, 2011.
These Plans are prepared to comply with the PPACA requirements applicable to non-randfathered plans, effective January 1, 2011.
Currently, there are 67 collective bargaining agreements between the U.F.C.W. District Unioocal One and the Fund's various participating employers that call for contributions to theund. Th ffective and expiration dates of the current collective bargaining agreementsovering % of the Fund's participants are as follows:
4/6/2008-4/2/20114/27/2008-4/23/2011
/3/2008-7/30/2011
Should you have any questions, please contact the Fund office.
Thank you and Happy Holidays,
ndrea D. Goldberger
FCW Local One Benefit Funds
911 Airport Road
riskany, NY 13424
15-797-9600, ext 2253
ax: 315-797-9664
rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]
ent: Friday, December 17, 2010 2:53 PMo: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Dear Andrea:
hank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements he Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide theollowing information:
I. Please complete the entire annual limits spreadsheet, which is attached to this email. Please return the
completed spreadsheet to this email address as an attachment. We will only be able to process spreadshthat are fully complete (i.e., every cell should contain the information requested). If a cell on thespreadsheet does not pertain to your plan, please write None, and/or provide an explanation regardingwhy you are unable to complete that particular cell in a separate document.
II. In addition, please provide the following information:
As we discussed, please confirm that, pending a waiver, you plan to convert the $ lifetime limit onretirees and their spouses to an annual limit, and that you are applying for a waiver on the $ annual limon retirees and their spouses.
UFCW L ONE:000029
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As we discussed, you have benefit limits on hearing aids. Hearing aids may be considered an essential heal
benefit under Section 1302(b)(1)(G) of the Affordable Care Act. However, because regulations have not beissued regarding this matter, we rely on the Interim Final Regulations, which state that, [f]or plan years . .beginning before the issuance of regulations defining essential health benefits, for purposes of enforcementhe Departments will take into account good faith efforts to comply with a reasonable interpretation of the tessential health benefits. (Federal Register, Vol. 75, No. 123, page 37191 (Monday, June 28, 2010)). Dobelieve in good faith that hearing aids are not considered essential health benefits? If so, please confirm tyou are not applying for a waiver on the hearing aid limits.
Also as we discussed, please confirm that you are not applying for a waiver on adult orthodontic, optical, an
dental benefits, and that you are only applying for a waiver on pediatric oral and vision benefits, to the extenyou have them.
Please confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance
grandfathering provisions, pursuant to 45 CFR 147.140?
Please confirm that the Collective Bargaining Agreement was ratified prior to October 3, 2008.
Please provide the date for which the Collective Bargaining Agreement will expire.
n order to complete your application, please provide this information by 5:00pm, December 20, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you,isa
sa M. Keels, J.D.
.S. Department of Health & Human Servicesffice of Consumer Information and Insurance Oversight
ffice of Oversight
01-492-4168
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rom: Keels, Lisa (HHS/OCIIO)ent: Tuesday, December 28, 2010 7:45 PMo: Habit, Sandra (HHS/OCIIO)ubject: FW: UFCW Local One Health Care Fund Waiver Application -
Request for Additional Information
_______________________________________
rom: Keels, Lisa (HHS/OCIIO)ent: Tuesday, December 28, 2010 7:44 PMo: [email protected]: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
hanks, Andrea. Happy New Year to you, too!
isa_______________________________________rom: [email protected] [[email protected]]ent: Tuesday, December 28, 2010 7:35 PMo: Keels, Lisa (HHS/OCIIO)
ubject: Re: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Hi Lisa,
We are eliminating the lifetime limits. Thank you for checking in - I will be in my office all day tomorrow if you no speak with me.
Happy New Year!
Andrea
ent from my Verizon Wireless Phone
---- Reply message -----rom: "Keels, Lisa (HHS/OCIIO)"
Date: Tue, Dec 28, 2010 6:54 pmubject: UFCW Local One Health Care Fund Waiver Application - Request for Additional Informationo: "[email protected]"
Cc: "Habit, Sandra (HHS/OCIIO)"
Hi again, Andrea,
hope you're doing well. I just wanted to check in about my email below. As I mentioned, as soon as you confirmhat you are either removing the lifetime limits or converting them to annual limits, we can process your applicationlease let me know if you have any questions. I am working tomorrow (Wednesday) morning.
hank you again,isa_______________________________________rom: Keels, Lisa (HHS/OCIIO)ent: Monday, December 27, 2010 7:56 AMo: [email protected]
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Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Hi Andrea,
hope you are still enjoying the holiday season! Thanks so much for your clarifications below.
Regarding the lifetime limits, I double checked, and the regulations state that lifetime limits need to be removed forlans beginning on or after September 23, 2010. ("the provisions of PHS Act section 2711, insofar as it relates to
fetime limits,...apply to grandfathered health plans for plan years beginning on or after September 23, 2010." See CFR 147.140(d)).. In light of the regulation, can you please confirm that you are either removing the lifetime limitonverting them to annual limits for all plans (both grandfathered and non-grandfathered)?
hank you again for your other responses and clarifications. Once you confirm that you are removing or convertinhe lifetime limits, we will move forward with the application for Plan M (the mini-wrap plan) and the Funds Retioverage.
Have a great day,isa
rom: Andrea D Goldberger [mailto:[email protected]]ent: Thursday, December 23, 2010 3:37 PMo: Keels, Lisa (HHS/OCIIO)ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Hi Lisa sorry I missed your call! Regarding your questions, please see my comments below. Initially, we includell plans with our application because the Plans have annual limits on orthodontia, dental, vision and hearing aids.ince at this time we do not believe that these fall under the definition of essential benefits, we did not include theslans on the spreadsheet.
Our office is closed on Monday, however I will be working remotely and can be reached by email or by cell at 51857-9822.
hank you, and Enjoy the Holiday!!
Andrea
Andrea D. GoldbergerUFCW Local One Benefit Funds911 Airport Road
Oriskany, NY 1342415-797-9600, ext 2253ax: 315-797-9664
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rom: Keels, Lisa (HHS/OCIIO)ent: Tuesday, December 28, 2010 6:55 PMo: [email protected]
Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: UFCW Local One Health Care Fund Waiver Application -
Request for Additional Information
Hi again, Andrea,
hope you're doing well. I just wanted to check in about my email below. As I mentioned, as soon as you confirmhat you are either removing the lifetime limits or converting them to annual limits, we can process your applicationlease let me know if you have any questions. I am working tomorrow (Wednesday) morning.
hank you again,isa_______________________________________rom: Keels, Lisa (HHS/OCIIO)ent: Monday, December 27, 2010 7:56 AMo: [email protected]
Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Hi Andrea,
hope you are still enjoying the holiday season! Thanks so much for your clarifications below.
Regarding the lifetime limits, I double checked, and the regulations state that lifetime limits need to be removed forlans beginning on or after September 23, 2010. ("the provisions of PHS Act section 2711, insofar as it relates tofetime limits,...apply to grandfathered health plans for plan years beginning on or after September 23, 2010." See
CFR 147.140(d)). In light of the regulation, can you please confirm that you are either removing the lifetime limitsonverting them to annual limits for all plans (both grandfathered and non-grandfathered)?
hank you again for your other responses and clarifications. Once you confirm that you are removing or convertinhe lifetime limits, we will move forward with the application for Plan M (the mini-wrap plan) and the Funds Retioverage.
Have a great day,isa
rom: Andrea D Goldberger [mailto:[email protected]]ent: Thursday, December 23, 2010 3:37 PMo: Keels, Lisa (HHS/OCIIO)
ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Hi Lisa sorry I missed your call! Regarding your questions, please see my comments below. Initially, we includell plans with our application because the Plans have annual limits on orthodontia, dental, vision and hearing aids.ince at this time we do not believe that these fall under the definition of essential benefits, we did not include theslans on the spreadsheet.
Our office is closed on Monday, however I will be working remotely and can be reached by email or by cell at 51857-9822.
hank you, and Enjoy the Holiday!!
UFCW L ONE:000033
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Andrea
Andrea D. GoldbergerUFCW Local One Benefit Funds911 Airport Road
Oriskany, NY 1342415-797-9600, ext 2253ax: 315-797-9664
_______________________________rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, December 23, 2010 3:24 PMo: [email protected]
Cc: Habit, Sandra (HHS/OCIIO); 'Sarah E. Sanchez'; 'Sullivan, Susan'; 'Price, Francoise'; 'Gingell, John'; 'Sharon MGoodman'
ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
hank you, Andrea. I do have a couple of questions about the spreadsheet, and I just left you a voicemail messageegarding this:
. I was wondering whether you are only applying for a waiver for the Funds Retiree coverage and Plan M. Inow that those are the only two applications listed on the spreadsheet, but your original application provides SPDsther plans. Some of these plans have lifetime limits of $ Please confirm that you are either removing thfetime limits or converting them to annual limits (which do not require a waiver this year because the limit wouldbove $750,000). The lifetime limits will be eliminated for all non-grandfathered plans effective 1/1/2011. Thefetime limits for grandfathered plans will remain for Plan year 2011 as I believe that this is allowed.
. Also, for Plan M, the annual limit is listed as $ on the spreadsheet. I assume that there is no overall annmit, and that the $ is the limit on preventive care, as is stated in your original application. Please confirm
whether this is the case, and I will change the spreadsheet to reflect this. Yes, you are correct. The $ is actually nnual limit on the amount paid for an annual physical. This Plan is a supplemental plan that has no hospitalization
major medical coverage, but encourages an annual physical.
. Is Plan M the Mini-Wrap Plan included in your original application? I notice that that plan has a $ limn preventive care, so Im assuming they are the same. However, please confirm. Yes sorry! Mini-wrap and Pla
M are one and the same!
As I mentioned in my voicemail, I am out of the office now through next week. However, I will be checking mymail intermittently, and I will respond to you as quickly as possible.
hank you again, and happy holidays.
isa
rom: Andrea D Goldberger [mailto:[email protected]]ent: Thursday, December 23, 2010 2:13 PMo: Keels, Lisa (HHS/OCIIO)
Cc: Habit, Sandra (HHS/OCIIO); 'Sarah E. Sanchez'; 'Sullivan, Susan'; 'Price, Francoise'; 'Gingell, John'; 'Sharon MUFCW L ONE:000034
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Goodman'ubject: RE: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Dear Ms. Keels,
his is in response to your below request for additional information concerning the annual limits waiver application
he UFCW Local One Health Care Fund ("Fund").
The completed spreadsheet includes information pertaining to the Funds Retiree coverage and Plan M, aupplemental benefit Plan that does not include hospitalization or major medical coverage.
I. The Fund will eliminate its current lifetime limit on retiree benefits, effective January 1, 2011. The Fund ispplying to HHS for an annual limits waiver relating to retiree benefits under the Plan, so that the Fund may retain
urrent $ limit on retiree benefits, only now, on an annual basis.
n its waiver application, the Fund indicated that it intended to apply for a waiver relating to limits on the essentialenefits available under the Plan. Per your request, this is to advise you that the Fund has a good faith belief that thearing aid benefit, the adult dental and vision benefits, and the orthodontic benefit are not essential benefits, as thaerm is used in the PPACA, and therefore the Fund is not applying for an annual limits waiver relating to such bene
he Fund was in existence prior to March 23, 2010. It is the Fund's understanding that Plans Q, R and M meet theequirements of a "grandfathered plan," as that term is used in applicable regulations. These Plans are prepared toomply with the PPACA requirements applicable to grandfathered plans, effective January 1, 2011. Further, it is thund's understanding that Plans S, T and U will not be grandfathered, effective January 1, 2011. These Plans arerepared to comply with the PPACA requirements applicable to non-grandfathered plans, effective January 1, 2011
Currently, there are 67 collective bargaining agreements between the U.F.C.W. District Union Local One and theund's various participating employers that call for contributions to the Fund. The effective and expiration dates ofurrent collective bargaining agreements covering % of the Fund's participants are as follows:
/6/2008-4/2/2011
/27/2008-4/23/2011
/3/2008-7/30/2011
hould you have any questions, please contact the Fund office.UFCW L ONE:000035
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hank you and Happy Holidays,
Andrea D. GoldbergerUFCW Local One Benefit Funds911 Airport Road
Oriskany, NY 1342415-797-9600, ext 2253ax: 315-797-9664
_______________________________rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Friday, December 17, 2010 2:53 PMo: [email protected]
Cc: Habit, Sandra (HHS/OCIIO)ubject: UFCW Local One Health Care Fund Waiver Application - Request for Additional Information
Dear Andrea:
hank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements he Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide theollowing information:
Please complete the entire annual limits spreadsheet, which is attached to this email. Please return theompleted spreadsheet to this email address as an attachment. We will only be able to process spreadsheets that arully complete (i.e., every cell should contain the information requested). If a cell on the spreadsheet does not perto your plan, please write None, and/or provide an explanation regarding why you are unable to complete thatarticular cell in a separate document.
I. In addition, please provide the following information:
As we discussed, please confirm that, pending a waiver, you plan to convert the $ lifetime limit on retirnd their spouses to an annual limit, and that you are applying for a waiver on the $ annual limit on retirees aheir spouses.
As we discussed, you have benefit limits on hearing aids. Hearing aids may be considered an essential healthenefit under Section 1302(b)(1)(G) of the Affordable Care Act. However, because regulations have not been issuegarding this matter, we rely on the Interim Final Regulations, which state that, [f]or plan years . . . beginning befhe issuance of regulations defining essential health benefits, for purposes of enforcement, the Departments will tanto account good faith efforts to comply with a reasonable interpretation of the term essential health benefits.Federal Register, Vol. 75, No. 123, page 37191 (Monday, June 28, 2010)). Do you believe in good faith that heariids are not considered essential health benefits? If so, please confirm that you are not applying for a waiver on earing aid limits.
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Also as we discussed, please confirm that you are not applying for a waiver on adult orthodontic, optical, andental benefits, and that you are only applying for a waiver on pediatric oral and vision benefits, to the extent you hhem.
Please confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance wrandfathering provisions, pursuant to 45 CFR 147.140?
Please confirm that the Collective Bargaining Agreement was ratified prior to October 3, 2008.
Please provide the date for which the Collective Bargaining Agreement will expire.
n order to complete your application, please provide this information by 5:00pm, December 20, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Hum
ervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you,isa
isa M. Keels, J.D.U.S. Department of Health & Human Services Office of Consumer Information and Insurance Oversight Office ofOversight [email protected]
01-492-4168
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rom: Habit, Sandra (HHS/OCIIO)ent: Thursday, December 30, 2010 4:16 PM
To: '[email protected]'ubject: UFCW Local One Health Care Fund Approval Letter for a Waiver of the Annual Limits Requirements 120-2010
mportance: High
Attachments: Updated Jan 1 Approval Letter .pdfood Afternoon,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act
ection 2711 for UFCW Local One Health Care Fund. HHS has reviewed your application and made its
etermination. Please see the attached letter. The following plans have been approved:
Plan M
Retiree
lease confirm receipt of this letter by replying to this e-mail.
lease let me know if I can be of further assistance.
incerely
andy Habit
epartment of Health and Human Services
ffice of Consumer Information and Insurance Oversight
01-492-4175
UFCW L ONE:000038
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rom: [email protected]: Thursday, December 30, 2010 5:45 PMo: Habit, Sandra (HHS/OCIIO)
Subject: Re: UFCW Local One Health Care Fund Approval Letter for a Waiver of the Annual LimitsRequirements 12-30-2010Dear Sandy,
We are writing to acknowledge receipt of your email approving the waiver application for Plan M and theRetiree benefit provided by the UFCW Local One Health Care Fund.
hank you for your department's assistance and quick response.
appy New Year,ndrea Goldberger
ent from my Verizon Wireless Phone
---- Reply message -----rom: "Habit, Sandra (HHS/OCIIO)"
Date: Thu, Dec 30, 2010 4:15 pmubject: UFCW Local One Health Care Fund Approval Letter for a Waiver of the Annual Limits Requireme
2-30-2010o: "'[email protected]'"
Good Afternoon,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Actection 2711 for UFCW Local One Health Care Fund.. HHS has reviewed your application and made itsetermination. Please see the attached letter. The following plans have been approved:lan M
Retiree
lease confirm receipt of this letter by replying to this e-mail.
lease let me know if I can be of further assistance.
incerely
andy HabitDepartment of Health and Human ServicesOffice of Consumer Information and Insurance Oversight
NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has een publicly disclosed and may be privileged and confidential. It is for internal government use only an
must not be disseminated, distributed, or copied to persons not authorized to receive the information.Unauthorized disclosures may result in prosecution to the full extent of the law.
UFCW L ONE:000042
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rom: Keels, Lisa (HHS/OCIIO)ent: Monday, January 24, 2011 4:08 PM
To: Andrews, Jane (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: FW: Your application for a waiver of annual limiitsi Jane,
lease see below. Andrea confirmed that she received an approval letter from Sandy on 12/30. Im not sure about the G
rive, but they were officially approved.
hanks,
sa
rom: Andrews, Jane (HHS/OCIIO)ent: Tuesday, January 04, 2011 3:51 PMo: '[email protected]'c: Keels, Lisa (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: RE: Your application for a waiver of annual limiits
am glad you are all set. Thank you and happy new year to you.
ane W. Andrews
CIIO
501 Wisconsin Ave
ethesda, MD 20814
01-492-4122 (desk)
02-536-6779 (Blackberry)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Andrea D Goldberger [mailto:[email protected]]ent: Tuesday, January 04, 2011 3:24 PMo: Andrews, Jane (HHS/OCIIO)ubject: RE: Your application for a waiver of annual limiits
Dear Jane,
We received the same email from Lisa Keels and responded. When we received this initialmail from you, we thought it was a duplicate in error and did not respond I apologize foot contacting you sooner.
We did receive a letter of approval from Sandra Habit on 12/30/10. Please let me know if ywould like me to forward a copy of the email to you.
hank you and Happy New Year,Andrea
ndrea D. GoldbergerUFCW Local One Benefit Funds
911 Airport RoadOriskany, NY 13424
UFCW L ONE:000044
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15-797-9600, ext 2253ax: 315-797-9664
rom: Andrews, Jane (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, January 04, 2011 3:28 PMo: '[email protected]'c: Andrews, Jane (HHS/OCIIO)ubject: RE: Your application for a waiver of annual limiits
lease confirm that you received this e-mail from me. Thank you.
ane W. Andrews
CIIO
501 Wisconsin Ave
ethesda, MD 20814
01-492-4122 (desk)
02-536-6779 (Blackberry)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governm
use only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatioUnauthorized disclosure may result in prosecution to the full extent of the law.
rom: Andrews, Jane (HHS/OCIIO)ent: Monday, December 20, 2010 11:22 AMo: '[email protected]'ubject: Your application for a waiver of annual limiits
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. In order to expedite your application, please provide the following information:
I. Please complete the entire annual limits spreadsheet, [attached to the email] [and available at:
http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html]. Please return the completed spreadshto this email address as an attachment. We will only be able to process spreadsheets that are fully comp(i.e., every cell should contain the information requested). If a cell on the spreadsheet does not pertain tyour plan, please write None, and/or provide an explanation regarding why you are unable to completethat particular cell in a separate document.
II. In addition, if you did not include the following information in your application and is applicable, pleasprovide the following information:
Confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance with
grandfathering provisions, pursuant to 45 CFR 147.140.
Confirm whether the plan was created pursuant to the Taft-Hartley Act. If it is, please provide the date the
collective bargaining agreement will expire.
Confirm that your plan is either self-insured or fully insured.
If you did not complete and submit a signed attestation in accordance with the September 3, 2010 guidance
please submit that with the spreadsheet as a separate attachment.
n order to complete your application, please provide this information by 5:00 pm, December 22, 2010. Once thisUFCW L ONE:000045
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nformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you and feel free to contact me with questions.
ane W. Andrews
CIIO
501 Wisconsin Aveethesda, MD 20814
01-492-4122 (desk)
02-536-6779 (Blackberry)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
UFCW L ONE:000046
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rom: Andrews, Jane (HHS/OCIIO)ent: Tuesday, January 04, 2011 3:51 PM
To: '[email protected]'Cc: Keels, Lisa (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)
ubject: RE: Your application for a waiver of annual limiitsam glad you are all set. Thank you and happy new year to you.
ane W. Andrews
CIIO
501 Wisconsin Aveethesda, MD 20814
01-492-4122 (desk)
02-536-6779 (Blackberry)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Andrea D Goldberger [mailto:[email protected]]
ent: Tuesday, January 04, 2011 3:24 PMo: Andrews, Jane (HHS/OCIIO)ubject: RE: Your application for a waiver of annual limiits
Dear Jane,
We received the same email from Lisa Keels and responded. When we received this initialmail from you, we thought it was a duplicate in error and did not respond I apologize foot contacting you sooner.
We did receive a letter of approval from Sandra Habit on 12/30/10. Please let me know if ywould like me to forward a copy of the email to you.
hank you and Happy New Year,Andrea
ndrea D. GoldbergerUFCW Local One Benefit Funds
911 Airport RoadOriskany, NY 13424
15-797-9600, ext 2253ax: 315-797-9664
rom: Andrews, Jane (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, January 04, 2011 3:28 PMo: '[email protected]'c: Andrews, Jane (HHS/OCIIO)ubject: RE: Your application for a waiver of annual limiits
lease confirm that you received this e-mail from me. Thank you.
ane W. Andrews
CIIO
501 Wisconsin Ave
ethesda, MD 20814
UFCW L ONE:000047
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01-492-4122 (desk)
02-536-6779 (Blackberry)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Andrews, Jane (HHS/OCIIO)ent: Monday, December 20, 2010 11:22 AMo: '[email protected]'ubject: Your application for a waiver of annual limiits
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. In order to expedite your application, please provide the following information:
I. Please complete the entire annual limits spreadsheet, [attached to the email] [and available at:http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html]. Please return the completed spreadshto this email address as an attachment. We will only be able to process spreadsheets that are fully comp(i.e., every cell should contain the information requested). If a cell on the spreadsheet does not pertain t
your plan, please write None, and/or provide an explanation regarding why you are unable to completethat particular cell in a separate document.
II. In addition, if you did not include the following information in your application and is applicable, pleaseprovide the following information:
Confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance with
grandfathering provisions, pursuant to 45 CFR 147.140.
Confirm whether the plan was created pursuant to the Taft-Hartley Act. If it is, please provide the date the
collective bargaining agreement will expire.
Confirm that your plan is either self-insured or fully insured.
If you did not complete and submit a signed attestation in accordance with the September 3, 2010 guidance,
please submit that with the spreadsheet as a separate attachment.
n order to complete your application, please provide this information by 5:00 pm, December 22, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you and feel free to contact me with questions.
ane W. Andrews
CIIO
501 Wisconsin Ave
ethesda, MD 20814
01-492-4122 (desk)
02-536-6779 (Blackberry)
UFCW L ONE:000048
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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
UFCW L ONE:000049
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rom: Andrews, Jane (HHS/OCIIO)ent: Monday, January 24, 2011 3:58 PM
To: Keels, Lisa (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: What Happened with UFCW Local district One?think they were one we were duplicating efforts one. I have not been actively pursuing that ones completion, however, when
ok at the folder for UFCW local district one, I dont see that they have been completed or approved. Can you please give a s
pdate? Thanks!
ane W. AndrewsCIIO
501 Wisconsin Ave
ethesda, MD 20814
01-492-4122 (desk)
02-536-6779 (Blackberry)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
UFCW L ONE:000050
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rom: Andrews, Jane (HHS/OCIIO)ent: Tuesday, January 25, 2011 8:20 AM
To: Habit, Sandra (HHS/OCIIO)ubject: RE: Your application for a waiver of annual limiitshank you!
ane W. Andrews
CIIO
501 Wisconsin Ave
ethesda, MD 2081401-492-4122 (desk)
02-536-6779 (Blackberry)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Habit, Sandra (HHS/OCIIO)ent: Monday, January 24, 2011 5:13 PM
o: Andrews, Jane (HHS/OCIIO); Keels, Lisa (HHS/OCIIO)c: Pham, Erica (HHS/OCIIO); Botwinick, Alexandra (HHS/OCIIO)ubject: RE: Your application for a waiver of annual limiits
moved UFCW District Local One into UFCW Local One Health Care Fund.
andy
rom: Andrews, Jane (HHS/OCIIO)ent: Monday, January 24, 2011 4:57 PMo: Habit, Sandra (HHS/OCIIO); Keels, Lisa (HHS/OCIIO)c: Pham, Erica (HHS/OCIIO); Botwinick, Alexandra (HHS/OCIIO)
ubject: RE: Your application for a waiver of annual limiits
andy - Would you be able to look at the original application and make a determination about its correct name (maybe Alex or
rica know its corrected name for the public list) and then consolidate the folders so we dont have dupes? Thanks.
ane W. Andrews
CIIO
501 Wisconsin Ave
ethesda, MD 20814
01-492-4122 (desk)
02-536-6779 (Blackberry)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Habit, Sandra (HHS/OCIIO)ent: Monday, January 24, 2011 4:41 PMo: Andrews, Jane (HHS/OCIIO); Keels, Lisa (HHS/OCIIO)ubject: RE: Your application for a waiver of annual limiits
he approval is in UFCW Local One Health Care Fund not UFCW District Union Local One. They appear to be duplicate files
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oth folders contain correspondence to Andrea and the applications are identical.
andy
rom: Andrews, Jane (HHS/OCIIO)ent: Monday, January 24, 2011 4:13 PMo: Keels, Lisa (HHS/OCIIO)c: Habit, Sandra (HHS/OCIIO)ubject: RE: Your application for a waiver of annual limiits
andy can you please check to see why their approval did not get on G Drive? Thanks a lot!
ane W. Andrews
CIIO
501 Wisconsin Ave
ethesda, MD 20814
01-492-4122 (desk)
02-536-6779 (Blackberry)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatioUnauthorized disclosure may result in prosecution to the full extent of the law.
rom: Keels, Lisa (HHS/OCIIO)ent: Monday, January 24, 2011 4:08 PMo: Andrews, Jane (HHS/OCIIO)c: Habit, Sandra (HHS/OCIIO)ubject: FW: Your applic