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November 16, 2010
Department of Health and Human ServicesOffice of Consumer Information and Insurance Oversight, Office of OversightAttention J ames Mayhew, Room 737-F-04200 Independence Ave. SWWashington, DC 20201
Dear Mr. Mayhew:
Andersen Corporation is interested in applying for a waiver from the restricted annual
limits set forth in the interim final regulations under the Patient Protection and AffordableCare Act for three of our medical plans. The waiver would apply for the plan yearbeginning on J anuary 1, 2011 and ending on December 31, 2011.
The information on the plans is listed below:
Feature Andersen Corporation Plan Provision
Terms of the Plans forWhich the Waiver isBeing Sought
See the attached SPDs for the Silver Line New J erseyUnion Drivers and Grandfathered Production Plan(Plan U), Silver Line New Jersey Union ProductionMedical Plan (Plan T1/T2) and the Silver Line Illinois
Union Production Medical Plan (Plan P2). Page 5 ofeach SPD has an overview of the coverage providedby each plan. These plans are offered to unionemployees at our Silver Line Window business. Theyhave employees primarily in New J ersey and Illinois.
Number of IndividualsCovered by ThesePlans
As of November 16 there are employees enrolledin the Silver Line New J ersey Union Drivers andGrandfathered Production Plan (Plan U);employees enrolled in the Silver Line New J erseyUnion Production Medical Plan (Plan T1/T2); andemployees enrolled in the Silver Line Illinois Union
Production Medical Plan (Plan P2).Annual Limits andRates Associated withThese Plans
The annual limits of $ per member and$ per member are specified in the attachedSPDs and the excerpts from the union contracts. The2010 2011 weekly employee rates are attached asExhibit A and are taken from the union contracts.
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11/3/2011
2
Feature Andersen Corporation Plan Provision
Reason thatCompliance with theInterim Final
Regulations wouldIncrease Premiums
According to our actuary, if Silver Line increased theannual limit in all three plans to $750,000, the 2011cost of the plans (total premium) would increase by
approximately This is a significant impact tothe business. S is faced with attempting torenegotiate the plan design and/or employeecontributions with the union to better reflect the cost ofthe plan that was in place prior to health care reformbeing passed. The plan design must be significantlyreduced to pay for the removal of the annual limits. Ifwe are not successful in renegotiating the plan design,Silver Line may have to eliminate jobs to account forthe increase in costs to the business. A spreadsheetdepicting the increase to the business is attached as
Exhibit B.Attestation I attest that these plans were in force prior toSeptember 23, 2010 and that applying an annual limitof $750,000 to these plans would result in a significantincrease in premiums paid by Andersen Corporationfor health care coverage for our employees.
If you have any questions about this letter, please contact me directly at 651-264-2836.
Sincerely,
Kathy ProndzinskiDirector, Corporate Benefits DesignAndersen Corporation100 Fourth Avenue NorthBayport, MN 55003
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1
Lancey, Brandon (CMS/OSORA)
From: Prondzinski, Kathy [[email protected]]Sent: Wednesday, December 01, 2010 6:11 PMTo: OCIIO OversightSubject: FW: Waiver - 2nd request
At tachments: PPACA limited benefits waiver letter - 11-16-2010 FINAL.doc; Exhibit A and Exhibit B - 2011Actuarial Support of cost increase of hc reform.xls; 2010 Silver Line Plan U SPD_FINAL_ 614 10.pdf; 2010 Silver Line Plan T1 SPD_FINAL_ 6 14 10.pdf; 2010 Silver Line Plan P2SPD_FINAL_12 9 09.pdf; Silver Line NJ Union Contract.tif; Silver Line IL ProductionContract.tif
Importance: High
To whom it may concern:
Although I know that HHS has 30 days in which to determine if we will be granted a waiver, our union has refused tocontinue to bargain until we hear back from HHS on whether or not a waiver has been granted. I therefore am respectfullyasking if there is an answer to our request for a waiver yet. The sooner we hear back, the sooner we can proceed witheither informing our associates that the annual limits will remain in place, and that their plan will remain unchanged, or, inthe case that the waiver is not granted, continuing to bargain with the union and try to offset the additional cost of raising
the limits by changing plan design and/or increasing contributions.
Your attention to this matter is greatly appreciated.
Kathy Prondzinski
Kathy ProndzinskiDirector, Corporate Benefits DesignAndersen Corporation100 Fourth Avenue NorthBayport, MN 55003
Tel: 651-264-2836 Fax: [email protected] of the environment before you print!
From: Prondzinski, KathySent: Tuesday, November 16, 2010 2:03 PMTo:[email protected]:
Subject: WaiverImportance: HighAttached please find:
Andersen Corporations application for waiver from the restricted annual limits set forth in the interim finalregulations under the Patient Protection and Affordable Care Act (PPACA) Exhibits A and B (actuarial support of the cost impact of health care reform and employee contributions for 2010
and 2011) Summary Plan Descriptions (SPDs) for the three plans for which we are requesting a waiver Excerpts from the Silver Line New J ersey Union Contract and The Silver Line Illinois Production Union Contract,
outlining the employee contribution agreements with the company
Should you need any further information, please feel free to contact me, using the information below.
Thank you,
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2
Kathy Prondzinski
Kathy ProndzinskiDirector, Corporate Benefits DesignAndersen Corporation100 Fourth Avenue NorthBayport, MN 55003
Tel: 651-264-2836 Fax: 651-275-6585
Think of the environment before you print!
Right-click heretpictures.To helpprivacy,Outlookautomatic downlopicturefromtheTheenvironmenbusinesspartner.Corporation hasan ENERGY STAPartner oftheYe
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11/15/2010
Contract Expires
Dependent Eligibility
Deductible
Out-of-Pocket Max
Calendar Year Max
Lifetime Maximum
Coinsurance
Preventive Care
Office Visit
Inpatient Facility
IP/OP Surgery
ER
NJ Grandfathered Production & Drivers Plan
All dependents to age 26
Illinois Pro
March 1, 2013
All dependents to age 26
NJ Production Plan
2010 SL IL Union
Production
Union Plan P2
2011 SL NJ Union
GP & Drivers (U)
Union Plan A
2010 SL NJ Union
Production (T1/T2)
Union Plan B
March 1, 2013
In-Network In-Network
March 1, 2013
In-Network In-Network
February 1, 2011
No out of network coverage
$750,000
$750,000
Prescription Drug
2011 SL NJ Union
Production (T1/T2)
Union Plan B
Required HC Reform Changes
2010 SL NJ Union
GP & Drivers (U)
Union Plan A
In-Network
Required HC Reform Changes
March 1, 2013
Benefit Percentage Impact fr om 2010 Design
Actuarial Rates EE EE EE
Employee Contributions CountRate EE Mthly EE% Rate EE Mthly EE% Co CountRate EE Mthly EE%Employee Only (T2) Employee Only Employee +Spouse Employee +Children Family Total Cost Change Total Cost
% Change Total Cost
Co Cost
Projected Change Co Cost
% Change Co Cost
EE Cost
Projected Change EE Cost
% Change EE Cost
2010 Un ion Plan (U) A 2011 Union Plan (U) A
2010 Union Plan (T1/T2) B
2010 IL Prod Plan P2
2011 Union Plan (T1/T2) B
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Silver Line Union Employee Weekly Contributions
Silver Line NJ Union Medical Plan Weekly Employee Contributions
Contract Language
Count 2010 2011 2012 Count 2010 2011 2012
Employee Only Employee OnlyEmployee +Spouse Employee +SpouseEmployee+Child(ren) Employee +Childr(reFamily Family
Total Contributions $Annual Increase * Silver Line IL Union Production Medical Plan Weekly Employee Contributions
* Silver Line Illinois Union Contract Lang ontract expires Feb. 1,Employee Only Employee +Spouse Employee+Child(ren) Family
Total Contributions Annual Increase
Increases in premium cost shall be shared with the company payin
and the employee paying of the increase provided that the
Employee's share be capped a per week p ontract year.If the same language remains for 2011, it is a increase with the c
* NOTE: this contract expires Feb. 1, 2011. These employee contributions ar
illustrative ONLY based on current the contract language and are subject to
change after negotiations begin Dec. 2010
EXHIBIT A
Union Plan A (Grandfathered Production & Drivers - U) Union Plan B (Product ion - T1/T2)
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rom: Prondzinski, Kathy [[email protected]]ent: Monday, December 20, 2010 4:28 PMo: Habit, Sandra (HHS/OCIIO)
Cc: Parrucci, Tammyubject: RE: Waiver Application - Andersen Corporation
Attachments: waiver_application_forms_.zipttached please find:
I. The completed annual limits spreadsheets.II. The following information is also being provided as requested:
I am confirming that the plan was created pursuant to the Taft-Hartley Act. The expiration of the last collective
bargaining agreement is December 31, 2012.
I confirm that the plan was in existence before March 23, 2010. We will be complying with the requirements of th
Grandfathering Regulation, 45 CFR 147.140.
his should constitute a complete application. As stated in our earlier emails, time is of the essence, due to the suspension of our
ollectively bargained negotiations. A timely response is most appreciated.
Kathy Prondzinski
irector, Corporate Benefits Design
ndersen Corporation
00 Fourth Avenue Northayport, MN 55003
el: 651-264-2836 Fax: 651-275-6585
Think of the environment before you print!
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, December 16, 2010 2:05 PMo: Prondzinski, Kathyubject: Waiver Application - Andersen Corporation
Ms. Prondzinski,hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (P
Act) Section 2711. In order to expedite your application, please provide the following information:. Please complete the entire annual limits spreadsheet, available at:ttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheet to this emaddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouldontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None, anrovide an explanation regarding why you are unable to complete that particular cell in a separate document.
I. In addition, please provide the following information:
Confirm whether the plan was created pursuant to the Taft-Hartley Act. And if so, please state the expiration of t
ast collective bargaining agreement.
Please confirm that your plan was in existence before March 23, 2010, and if so, whether it will be complying wit
requirements of the Grandfathering Regulation, 45 CFR 147.140?Once this information is received and the application is complete, it will be processed by the Department of Health an
Human Services (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision wi0 days of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decis
hank you,ANDERSEN:000234
mailto:[email protected]://www.hhs.gov/ociio/regulations/annual_limit_waivers.htmlhttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.htmlhttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.htmlmailto:[email protected]8/22/2019 Andersen Corporation - Redacted HWM
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andy
andy Habit
epartment of Health and Human Services
ffice of Consumer Information and Insurance Oversight
01-492-4175
NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly
sclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed,
opied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full extent o
w.
_________________________________________________________________________________________________________
o Whom It May Concern:
n November 16, 2010, Andersen Corporation submitted to HHS an application for a waiver from the restricted annual limits set fo
the interim final regulations under the Patient Protection and Affordable Care Act for three of its medical plans. The waiver wouldpply for the plan year beginning on January 1, 2011 and ending on December 31, 2011.
We understand that HHS intends to rule on complete waiver applications within 30 days of receipt. Therefore, we anticipate receivi
esponse by the close of business today, Thursday, December 16 th.
s stated in our earlier email (below), time is of the essence due to the suspension of critically important collective bargaining
egotiations with our union. A further bargaining session is scheduled Monday, December 20 th in anticipation of receiving a respon
our waiver application by December 16 th. If we do not receive a timely response from HHS, the bargaining process will be delay
rther to the prejudice of the Company, the Union and the employees.
our attention and cooperation are greatly appreciated.
athy
Kathy Prondzinski
irector, Corporate Benefits Design
ndersen Corporation
00 Fourth Avenue North
ayport, MN 55003
el: 651-264-2836 Fax: 651-275-6585
rom: Prondzinski, Kathyent: Wednesday, December 01, 2010 5:11 PMo: [email protected]: FW: Waiver - 2nd requestmportance: High
o whom it may concern:
lthough I know that HHS has 30 days in which to determine if we will be granted a waiver, our union has refused to continue to
argain until we hear back from HHS on whether or not a waiver has been granted. I therefore am respectfully asking if there is an
nswer to our request for a waiver yet. The sooner we hear back, the sooner we can proceed with either informing our associates
e annual limits will remain in place, and that their plan will remain unchanged, or, in the case that the waiver is not granted,
ontinuing to bargain with the union and try to offset the additional cost of raising the limits by changing plan design and/or increas
ontributions.
ANDERSEN:000235
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our attention to this matter is greatly appreciated.
athy Prondzinski
Kathy Prondzinski
irector, Corporate Benefits Design
ndersen Corporation
00 Fourth Avenue North
ayport, MN 55003
el: 651-264-2836 Fax: [email protected]
Think of the environment before you print!
rom: Prondzinski, Kathyent: Tuesday, November 16, 2010 2:03 PMo: [email protected]:ubject: Waivermportance: High
ttached please find: Andersen Corporations application for waiver from the restricted annual limits set forth in the interim final regulations und
the Patient Protection and Affordable Care Act (PPACA)
Exhibits A and B (actuarial support of the cost impact of health care reform and employee contributions for 2010 and 2011
Summary Plan Descriptions (SPDs) for the three plans for which we are requesting a waiver
Excerpts from the Silver Line New Jersey Union Contract and The Silver Line Illinois Production Union Contract, outlining
employee contribution agreements with the company
hould you need any further information, please feel free to contact me, using the information below.
hank you,
athy Prondzinski
Kathy Prondzinski
irector, Corporate Benefits Design
ndersen Corporation
00 Fourth Avenue North
ayport, MN 55003
el: 651-264-2836 Fax: 651-275-6585
Think of the environment before you print!
ANDERSEN:000236
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rom: Habit, Sandra (HHS/OCIIO)ent: Thursday, December 16, 2010 3:05 PM
To: '[email protected]'ubject: Waiver Application - Andersen Corporation
Ms. Prondzinski,hank 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:. Please complete the entire annual limits spreadsheet, available at:
ttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheet to this eddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None,nd/or provide an explanation regarding why you are unable to complete that particular cell in a separate documentI. In addition, please provide the following information:
Confirm whether the plan was created pursuant to the Taft-Hartley Act. And if so, please state the expiration o
he last collective bargaining agreement.
Please confirm that your plan was in existence before March 23, 2010, and if so, whether it will be complying w
the requirements of the Grandfathering Regulation, 45 CFR 147.140?Once this information is received and the application is complete, it will be processed by the Department of Healthnd Human Services (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a deci
within 30 days of receiving a complete application. You will receive an e-mail from HHS notifying you of the waecision.
hank you,andy
andy Habit
epartment of Health and Human Services
ffice of Consumer Information and Insurance Oversight
01-492-4175
NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly
sclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu
r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full e
f the law.
ANDERSEN:000237
http://www.hhs.gov/ociio/regulations/annual_limit_waivers.htmlmailto:[email protected]:[email protected]://www.hhs.gov/ociio/regulations/annual_limit_waivers.html8/22/2019 Andersen Corporation - Redacted HWM
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ANNUAL LIMIT WAIVER APPLICATION
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
Name
Street
Address City State Zip Code
Phone
Number
(including
area code)
Address
C
(e.
Be
Rx o
Silver Line
Building
Products,
LLC.
Silver Line
Illinois Union
Production
Medical P lan Minneapolis MN 01/01/2011
Kathy
Prondzinski
100 Fourth
Ave N Bayport MN 55003
651-264-
2836
kathy.prondzi
nski@anders
encorp.com Lim
Silver Line
Building
Products,
Silver Line
Illinois Union
Production Kathy 100 Fourth 651-264-
kathy.prondzi
nski@anders
LLC. Medical Plan Minneapolis MN 01/01/2011 Prondzinski Ave N Bayport MN 55003 2836 encorp.com Lim
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless itdisplays a valid OMB control number. The information collection is 0938-1105. The time required to complete this information collection is estimated to average ( 8 hours) or ( 240 minutes) per response, includinsearch existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
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ANNUAL LIMIT WAIVER APPLICATION
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 An nual Limits (Annu al Limit fo r Each Essential Benefit)
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ANNUAL LIMIT WAIVER APPLICATION
ndividual/ Employee
Tier*
Employee
contribution
(if applicable)
Employer
contribution
(if applicable) Total
Employee
contribution
(if applicable)
Employer
contribution
(if applicable) Total
Employee
contribution
(if applicable)
Employer
contribution
(if applicable) Total
Employee
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 +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).
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ANNUAL LIMIT WAIVER APPLICATION
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
Name
Street
Address City State Zip Code
Phone
Number
(including
area code)
Address
C
(e.
Be
Rx o
Silver Line
Building
Products,
LLC.
Silver Line
New J ersey
Union
Grandfathere
d Production
and Driver
Medical P lan Minneapolis MN 01/01/2011
Kathy
Prondzinski
100 Fourth
Ave N Bayport MN 55003
651-264-
2836
kathy.prondzi
nski@anders
encorp.com Lim
Silver Line
Building
Products,
LLC.
Silver Line
New J ersey
Union
Grandfathere
d Production
and Driver
Medical P lan Minneapolis MN 01/01/2011
Kathy
Prondzinski
100 Fourth
Ave N Bayport MN 55003
651-264-
2836
kathy.prondzi
nski@anders
encorp.com Lim
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless itdisplays a valid OMB control number. The
information collection is 0938-1105. The time required to complete this information collection is estimated to average ( 8 hours) or ( 240 minutes) per response, includinsearch existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
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ANNUAL LIMIT WAIVER APPLICATION
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 An nual Limits (Annu al Limit fo r Each Essential Benefit)
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ANNUAL LIMIT WAIVER APPLICATION
ndividual/ Employee
Tier*
Employee
contribution
(if applicable)
Employer
contribution
(if applicable) Total
Employee
contribution
(if applicable)
Employer
contribution
(if applicable) Total
Employee
contribution
(if applicable)
Employer
contribution
(if applicable) Total
Employee
Projected Rate Increase that would result
from c ompliance with $750,000 Annual Limit
Restriction (in dollars) (Average Premium
by Individual)*
Current Monthly Premium Rates or
Premium Equivalent Rates (in dollars)*:
Renewal Monthly Premium Rates or
Premium Equivalent Rates if Waiver Granted
(in dollars)*
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).
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ANNUAL LIMIT WAIVER APPLICATION
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
Name
Street
Address City State Zip Code
Phone
Number
(including
area code)
Address
C
(e.
Be
Rx o
Silver Line
Building
Products,
LLC.
Silver Line
New J ersey
Union
Production
Medical P lan Minneapolis MN 01/01/2011
Kathy
Prondzinski
100 Fourth
Ave N Bayport MN 55003
651-264-
2836
kathy.prondzi
nski@anders
encorp.com Lim
Silver Line
Silver Line
New J ersey
BuildingProducts,
LLC.
UnionProduction
Medical P lan Minneapolis MN 01/01/2011
Kathy
Prondzinski
100 Fourth
Ave N Bayport MN 55003
651-264-
2836
kathy.prondzinski@anders
encorp.com Lim
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless itdisplays a valid OMB control number. The information collection is 0938-1105. The time required to complete this information collection is estimated to average ( 8 hours) or ( 240 minutes) per response, includinsearch existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
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ANNUAL LIMIT WAIVER APPLICATION
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 An nual Limits (Annu al Limit fo r Each Essential Benefit)
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ANNUAL LIMIT WAIVER APPLICATION
ndividual/ Employee
Tier*
Employee
contribution
(if applicable)
Employer
contribution
(if applicable) Total
Employee
contribution
(if applicable)
Employer
contribution
(if applicable) Total
Employee
contribution
(if applicable)
Employer
contribution
(if applicable) Total
Employee
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 +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).
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///co-adshare/...pproval%20Letter%20for%20a%20Waiver%20of%20the%20Annual%20Limits%20Requirements%2012-30-2010.htm[11/03/2011 4:09:
rom: Habit, Sandra (HHS/OCIIO)ent: Thursday, December 30, 2010 3:16 PM
To: '[email protected]'ubject: Andersen Corporation Approval Letter for a Waiver of the Annual Limits Requirements 12-30-2010
Attachments: Updated Jan 1 Approval Letter .pdf
ood Afternoon,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Actection 2711 for Andersen Corporation. HHS has reviewed your application and made its determination.
lease see the attached letter. The following plans have been approved:
Silver Line
New Jersey
Union
Grandfathered
Production
and Driver
Medical Plan
Silver Line
New JerseyUnion
Grandfathered
Production
and Driver
Medical Plan
Silver Line
New Jersey
Union
Production
Medical Plan
Silver Line
New JerseyUnion
Production
Medical Plan
Silver Line
Illinois Union
Production
Medical Plan
Silver Line
Illinois Union
Production
Medical Plan
lease confirm receipt of this letter by replying to this e-mail.
lease let me know if I can be of further assistance.
incerely,
ANDERSEN:000247
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andy Habit
epartment of Health and Human Services
ffice of Consumer Information and Insurance Oversight
01-492-4175
NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly
sclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu
r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full e
f the law.
ANDERSEN:000248
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///co-adshare/...FOI%20Processing%20Team/Brandon/Andersen%20Corporation/Approval%20receipt%2012.30.10.htm[11/03/2011 4:09
rom: Prondzinski, Kathy [[email protected]]Sent: Thursday, December 30, 2010 4:45 PMo: Habit, Sandra (HHS/OCIIO)
Subject: Re: Andersen Corporation Approval Letter for a Waiver of the Annual Limits Requirements 12-010hank you for your very prompt response to our request. I confirm receipt of our approval of the Silver Line union plans.
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, December 30, 2010 02:15 PM
o: Prondzinski, Kathyubject: Andersen Corporation Approval Letter for a Waiver of the Annual Limits Requirements 12-30-2010
ood Afternoon,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act
ection 2711 for Andersen Corporation. HHS has reviewed your application and made its determination.
lease see the attached letter. The following plans have been approved:
Silver Line
New Jersey
Union
GrandfatheredProduction
and Driver
Medical Plan
Silver Line
New Jersey
Union
Grandfathered
Production
and Driver
Medical Plan
Silver Line
New JerseyUnion
Production
Medical Plan
Silver Line
New Jersey
Union
Production
Medical Plan
Silver Line
Illinois Union
ProductionMedical Plan
Silver Line
Illinois Union
Production
Medical Plan
lease confirm receipt of this letter by replying to this e-mail.
ANDERSEN:000249
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///co-adshare/...FOI%20Processing%20Team/Brandon/Andersen%20Corporation/Approval%20receipt%2012.30.10.htm[11/03/2011 4:09
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
NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly
sclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu
r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full e
f the law.
ANDERSEN:000250
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rom: Habit, Sandra (HHS/OCIIO)ent: Tuesday, December 21, 2010 10:51 AMo: 'Prondzinski, Kathy'ubject: RE: Waiver Application - Andersen Corporation
December 21, 2010
Ms. Prondzinski,
hank you for your information.
Your application is now complete and you will receive a determination of your application within 30 days. Take careave a happy holiday!
hank you,andy
rom: Prondzinski, Kathy [mailto:[email protected]]ent: Monday, December 20, 2010 4:28 PMo: Habit, Sandra (HHS/OCIIO)
c: Parrucci, Tammyubject: RE: Waiver Application - Andersen Corporation
ttached please find:
I. The completed annual limits spreadsheets.
II. The following information is also being provided as requested:
I am confirming that the plan was created pursuant to the Taft-Hartley Act. The expiration of the last collective
bargaining agreement is December 31, 2012.
I confirm that the plan was in existence before March 23, 2010. We will be complying with the requirements of th
Grandfathering Regulation, 45 CFR 147.140.
his should constitute a complete application. As stated in our earlier emails, time is of the essence, due to the suspension of our
ollectively bargained negotiations. A timely response is most appreciated.
Kathy Prondzinski
irector, Corporate Benefits Design
ndersen Corporation
00 Fourth Avenue North
ayport, MN 55003
el: 651-264-2836 Fax: 651-275-6585
Thi nk of the environment before you print!
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, December 16, 2010 2:05 PMo: Prondzinski, Kathyubject: Waiver Application - Andersen Corporation
Ms. Prondzinski,hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (P
Act) Section 2711. In order to expedite your application, please provide the following information:ANDERSEN:000251
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///co-adshare/...0Waivers%20-%20Torres/DFOI%20Processing%20Team/Brandon/Andersen%20Corporation/Completion%2012.21.10.htm[11/03/2011 4:09
. Please complete the entire annual limits spreadsheet, available at:ttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheet to this emaddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouldontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None, anrovide an explanation regarding why you are unable to complete that particular cell in a separate document.
I. In addition, please provide the following information:
Confirm whether the plan was created pursuant to the Taft-Hartley Act. And if so, please state the expiration of t
ast collective bargaining agreement.
Please confirm that your plan was in existence before March 23, 2010, and if so, whether it will be complying witrequirements of the Grandfathering Regulation, 45 CFR 147.140?
Once this information is received and the application is complete, it will be processed by the Department of Health anHuman Services (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision wi
0 days of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decis
hank you,andy
andy Habit
epartment of Health and Human Services
ffice of Consumer Information and Insurance Oversight01-492-4175
NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly
sclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed,
opied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full extent o
w.
_________________________________________________________________________________________________________
o Whom It May Concern:
n November 16, 2010, Andersen Corporation submitted to HHS an application for a waiver from the restricted annual limits set fo
the interim final regulations under the Patient Protection and Affordable Care Act for three of its medical plans. The waiver would
pply for the plan year beginning on January 1, 2011 and ending on December 31, 2011.
We understand that HHS intends to rule on complete waiver applications within 30 days of receipt. Therefore, we anticipate receivi
esponse by the close of business today, Thursday, December 16 th.
s stated in our earlier email (below), time is of the essence due to the suspension of critically important collective bargaining
egotiations with our union. A further bargaining session is scheduled Monday, December 20 th in anticipation of receiving a respon
our waiver application by December 16 th. If we do not receive a timely response from HHS, the bargaining process will be delay
rther to the prejudice of the Company, the Union and the employees.
our attention and cooperation are greatly appreciated.
athy
Kathy Prondzinski
irector, Corporate Benefits Design
ndersen Corporation
00 Fourth Avenue North
ayport, MN 55003
ANDERSEN:000252
http://www.hhs.gov/ociio/regulations/annual_limit_waivers.htmlhttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.htmlmailto:[email protected]:[email protected]://www.hhs.gov/ociio/regulations/annual_limit_waivers.html8/22/2019 Andersen Corporation - Redacted HWM
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el: 651-264-2836 Fax: 651-275-6585
rom: Prondzinski, Kathyent: Wednesday, December 01, 2010 5:11 PMo: [email protected]: FW: Waiver - 2nd requestmportance: High
o whom it may concern:
lthough I know that HHS has 30 days in which to determine if we will be granted a waiver, our union has refused to continue to
argain until we hear back from HHS on whether or not a waiver has been granted. I therefore am respectfully asking if there is an
nswer to our request for a waiver yet. The sooner we hear back, the sooner we can proceed with either informing our associates
e annual limits will remain in place, and that their plan will remain unchanged, or, in the case that the waiver is not granted,
ontinuing to bargain with the union and try to offset the additional cost of raising the limits by changing plan design and/or increas
ontributions.
our attention to this matter is greatly appreciated.
athy Prondzinski
Kathy Prondzinski
irector, Corporate Benefits Design
ndersen Corporation
00 Fourth Avenue North
ayport, MN 55003
el: 651-264-2836 Fax: 651-275-6585
Thi nk of the environment before you print!
rom: Prondzinski, Kathyent: Tuesday, November 16, 2010 2:03 PM
o: [email protected]:ubject: Waivermportance: High
ttached please find:
Andersen Corporations application for waiver from the restricted annual limits set forth in the interim final regulations und
the Patient Protection and Affordable Care Act (PPACA)
Exhibits A and B (actuarial support of the cost impact of health care reform and employee contributions for 2010 and 2011
Summary Plan Descriptions (SPDs) for the three plans for which we are requesting a waiver
Excerpts from the Silver Line New Jersey Union Contract and The Silver Line Illinois Production Union Contract, outlining
employee contribution agreements with the company
hould you need any further information, please feel free to contact me, using the information below.
hank you,
athy Prondzinski
Kathy Prondzinski
irector, Corporate Benefits Design
ndersen Corporation
00 Fourth Avenue North
ayport, MN 55003
ANDERSEN:000253
mailto:[email protected]:[email protected]:[email protected]:kprondzinski@