Teamsters Local Union No. 72 - Redacted Bates HW

7/27/2019 Teamsters Local Union No. 72 - Redacted Bates HW

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//T|/...20NO%2012600%20Response%20[YELLOW]/Teamsters%20Local%20Union%20%2372%20Welfare%20Fund/WAIVER.htm[08/04/2011 12:09:13

rom: Jennifer Goldstein [[email protected]]ent: Tuesday, November 09, 2010 1:09 PMo: HHS HealthInsurance (HHS)c: [email protected]: "WAIVER"

ollow Up Flag: Follow uplag Status: Completed

Attachments: Waiver from restrictions of annual limits.pdf

hanks and regards,

ennifer S. Goldsteinitan Administrator

65 West 14 th Street, Suite 704, New York, NY 10011hone: 212-691-4228ax: 212-645-5026mail: [email protected]

Teams L72:000001

Document obtained by CompleteColorado.com
mailto:[email protected]:[email protected]


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Teams L72:000003



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/T|/...OW]/Teamsters%20Local%20Union%20%2372%20Welfare%20Fund/Request%20for%20additional%20info%2011.16.10.htm[08/04/2011 12:09:15 PM]

rom: Moultrie, Cam (HHS/OCIIO)ent: Tuesday, November 16, 2010 1:40 PMo: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Teamsters Local 72 Welfare Fundear Ms. Goldstein:

hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. In order

o complete your application, please provide the following information:

Please state your plans overall annual limit.

Please provide the current monthly premium rates and the projected monthly premium rates applicable to theplan or policy forms if the plan were to comply with the restricted annual benefits. In other words, we would likea chart that reflects the following information:

2010 January Premium(current level)

2011 January Premium(renewal)

2011 January Premium(if $750,000 annual

limit was applied)EE EE + Child (if applicableor other appropriatetier)

EE + Spouse (if applicable or otherappropriate tier)

Family (if applicable orother appropriate tier)

n order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look orward to receiving your completed application. Thank you.

am L. Moultrierogram Analystffice of Consumer Information and Insurance Oversight

.S. Department of Health and Human Services301) [email protected]

Teams L72:000005



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/T|/...ters%20Local%20Union%20%2372%20Welfare%20Fund/Request%20for%20additional%20info%20response%2011.17.10.htm[08/04/2011 12:09:15 PM]

rom: Moultrie, Cam (HHS/OCIIO)ent: Wednesday, November 17, 2010 12:53 PMo: Habit, Sandra (HHS/OCIIO)ubject: FW: Waiver Application for Teamsters Local 72 Welfare Fund

am Lynne Moultrierogram Analyst

ffice of Consumer Information and Insurance Oversight.S. Department of Health and Human Services

301) [email protected]

rom: Moultrie, Cam (HHS/OCIIO)ent: Wednesday, November 17, 2010 12:27 PMo: '[email protected]'ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

hank you for your response. On you application you stated that the The Plan currently has an overall calendar year limit of

n medical benefits and the following annual limits on specific medical benefits. What is the Plans overall calendar yearmit?

o you have premium rates for employee+ family?

hanks again.

am Moultrie

rom: Jennifer Goldstein [mailto:[email protected]]

ent: Tuesday, November 16, 2010 2:25 PMo: Moultrie, Cam (HHS/OCIIO)c: Kevin Clor; Pavesi, Matthew C.ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

Ms. Moultrie,

have attached the additional information you were looking for.

hanks and regards,



rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, November 16, 2010 1:40 PMo: [email protected]

Teams L72:000006



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/T|/...ters%20Local%20Union%20%2372%20Welfare%20Fund/Request%20for%20additional%20info%20response%2011.17.10.htm[08/04/2011 12:09:15 PM]

c: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Teamsters Local 72 Welfare Fund

ear Ms. Goldstein:

hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. In ordero complete your application, please provide the following information:





2011 January Premium(if $750,000 annuallimit was applied)

EE

EE + Child (if applicableor other appropriatetier)




am L. Moultrierogram Analystffice of Consumer Information and Insurance Oversight.S. Department of Health and Human Services


Teams L72:000007



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/T|/...0Local%20Union%20%2372%20Welfare%20Fund/Request%20for%20additional%20info%20correspondence%2011.171.0.htm[08/04/2011 12:09:16 PM]

rom: Moultrie, Cam (HHS/OCIIO)ent: Thursday, November 18, 2010 10:51 AMo: Habit, Sandra (HHS/OCIIO)ubject: FW: Waiver Application for Teamsters Local 72 Welfare Fund

am Lynne Moultrierogram Analyst



rom: Jennifer Goldstein [mailto:[email protected]]ent: Wednesday, November 17, 2010 3:29 PMo: Moultrie, Cam (HHS/OCIIO)ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

he Plan is a supplemental benefit plan that provides prescription drug and dental benefits to its active participants

nd their eligible dependents. This supplemental coverage is paid for by a contribution rate agreed upon inollective bargaining between the New York State Thruway Authority and the Union. The New York State Thruwayuthority provides these same participants with hospital and medical coverage.

he Plan has a $ calendar year maximum on its prescription drug benefit, and that is the only essentialenefit the Fund sting a waiver for.

hanks and regards,



rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, November 17, 2010 12:27 PMo: [email protected]: RE: Waiver Application for Teamsters Local 72 Welfare Fund

hank you for your response. On you application you stated that the The Plan currently has an overall calendar year limit of n medical benefits and the following annual limits on specific medical benefits. What is the Plans overall calendar yearmit?


hanks again.

am Moultrie

Teams L72:000008



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rom: Jennifer Goldstein [mailto:[email protected]]ent: Tuesday, November 16, 2010 2:25 PMo: Moultrie, Cam (HHS/OCIIO)c: Kevin Clor; Pavesi, Matthew C.ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

Ms. Moultrie,


hanks and regards,



rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, November 16, 2010 1:40 PMo: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Teamsters Local 72 Welfare Fund

ear Ms. Goldstein:







EE EE + Child (if applicableor other appropriatetier)



Teams L72:000009



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am L. Moultrierogram Analyst



Teams L72:000010



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/T|/...eamsters%20Local%20Union%20%2372%20Welfare%20Fund/2nd%20Request%20for%20addtional%20info%2011.18.10.htm[08/04/2011 12:09:16 PM]

rom: Moultrie, Cam (HHS/OCIIO)ent: Thursday, November 18, 2010 11:39 AMo: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fundhank you.

lease provide the COBRA equivalency rates.

am Lynne Moultrierogram Analystffice of Consumer Information and Insurance Oversight.S. Department of Health and Human Services



he Plan is a supplemental benefit plan that provides prescription drug and dental benefits to its active participantsnd their eligible dependents. This supplemental coverage is paid for by a contribution rate agreed upon inollective bargaining between the New York State Thruway Authority and the Union. The New York State Thruwayuthority provides these same participants with hospital and medical coverage.

he Plan has a $ calendar year maximum on its prescription drug benefit, and that is the only essentialenefit the Fund is requesting a waiver for.

hanks and regards,






Teams L72:000011



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hanks again.

am Moultrie


Ms. Moultrie,


hanks and regards,


65 West 14 th Street, Suite 704, New York, NY 10011

hone: 212-691-4228ax: 212-645-5026mail: [email protected]


ear Ms. Goldstein:





2011 January Premium(renewal) 2011 January Premium(if $750,000 annuallimit was applied)



Teams L72:000012



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Teams L72:000013



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/T|/...Local%20Union%20%2372%20Welfare%20Fund/2nd%20Request%20for%20additional%20info%20response%2011.18.10.htm[08/04/2011 12:09:17 PM]

rom: Moultrie, Cam (HHS/OCIIO)ent: Thursday, November 18, 2010 4:21 PMo: Habit, Sandra (HHS/OCIIO)ubject: FW: Waiver Application for Teamsters Local 72 Welfare Fund

am Lynne Moultrieffice of Consumer Information and Insurance Oversight

.S. Department of Health and Human Services301) [email protected]

rom: Jennifer Goldstein [mailto:[email protected]]ent: Thursday, November 18, 2010 12:02 PMo: Moultrie, Cam (HHS/OCIIO)c: Kevin Clor; Pavesi, Matthew C.ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

rescription COBRA for an individual is $ and for a family it is $

lease forward any future questions to the Funds Council, Kevin C. Clor Esq. at [email protected] and regards,



rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, November 18, 2010 11:39 AMo: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

hank you.





Teams L72:000014

mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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he Plan has a $ calendar year maximum on its prescription drug benefit, and that is the only essentialenefit the Fund esting a waiver for.

hanks and regards,






hanks again.

am Moultrie


Ms. Moultrie,


hanks and regards,


65 West 14 th Street, Suite 704, New York, NY 10011hone: 212-691-4228

Teams L72:000015



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ax: 212-645-5026mail: [email protected]


ear Ms. Goldstein:








EE + Spouse (if applicable or other

appropriate tier)





Teams L72:000016

mailto:[email protected]:[email protected]:[email protected]:[email protected]


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/T|/...eamsters%20Local%20Union%20%2372%20Welfare%20Fund/3rd%20Request%20for%20additional%20info%2011.18.10.htm[08/04/2011 12:09:17 PM]

rom: Moultrie, Cam (HHS/OCIIO)ent: Thursday, November 18, 2010 4:33 PMo: Kevin Clor c: [email protected]; Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

Mr. Clor,

am interested in COBRA equivalencies for 2010, 2011 (if waiver is approved) and 2011 (if the waiver is not approved). I have

rovided a sample chart below for your convenience:





EE + Spouse (if

applicable or otherappropriate tier)


hank you.

am Lynne Moultrieffice of Consumer Information and Insurance Oversight.S. Department of Health and Human Services







Teams L72:000017



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hank you.







hanks and regards,






Teams L72:000018



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hanks again.

am Moultrie


Ms. Moultrie,


hanks and regards,



hone: 212-691-4228ax: 212-645-5026mail: [email protected]


ear Ms. Goldstein:





2011 January Premium(renewal) 2011 January Premium(if $750,000 annuallimit was applied)



Teams L72:000019



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Teams L72:000020



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/T|/...20Response%20[YELLOW]/Teamsters%20Local%20Union%20%2372%20Welfare%20Fund/Correspondence%2012.2.10.htm[08/04/2011 12:09:18 PM]

rom: Moultrie, Cam (HHS/OCIIO)ent: Thursday, December 02, 2010 7:31 PMo: Kevin Clor c: [email protected]; Pavesi, Matthew C.; Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

Mr. Clor,

er my voicemail, please call me to discuss your response.

hank you,

am



INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:

his information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, orcopied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

rom: Kevin Clor [mailto:[email protected]]ent: Thursday, December 02, 2010 7:27 PMo: Moultrie, Cam (HHS/OCIIO)c: [email protected]; Pavesi, Matthew C.; Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Teamsters Local 72 Welfare Fund

Ms. Moultrie:

he COBRA equivalency for 20 1 with the $ max and w/o the $ max are based on the rates we have alreadyncluded in the application plus % which is wed under the law. ope this answers your question. Please advise

you need any additional infor ation. Thank you.

KCC

**** Confidentiality Statement******he information contained in this transmission may contain privileged andonfidential information. It is intended only for the use of the person(s)amed above. If you are not the intended recipient, you are hereby notifiedat any review, dissemination, distribution or duplication of this

ommunication is strictly prohibited. If you are not the intended recipient,ease contact the sender by reply e-mail and destroy all copies of theiginal message.

Kevin C. Clor, Esq.8 Thomas Jefferson Lane

Teams L72:000021



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nyder, New York 14226Office (716) 839-0418

ax (716) 839-1834Email: [email protected]

On Dec 2, 2010, at 7:19 PM, Moultrie, Cam (HHS/OCIIO) wrote:

o, I did not receive a response to my last email regarding the COBRA equivalencies for 2010 and 2011.

lease note that we cannot process your application until we have received all of the necessary information. You will receivedecision within 30 days of when we receive all of the requested information. We look forward to receiving your completedpplication.





rom: Jennifer Goldstein [mailto:[email protected]]ent: Thursday, December 02, 2010 10:15 AMo: Moultrie, Cam (HHS/OCIIO)c: Kevin Clor; Pavesi, Matthew C.ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

ood Morning,

am just checking in to make sure you received all the information that you needed for our waiver application.

hanks and regards,



Teams L72:000022

http://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]


23/46



rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, November 18, 2010 4:33 PMo: Kevin Clorc: [email protected] ; Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

Mr. Clor,

am interested in COBRA equivalencies for 2010, 2011 (if waiver is approved) and 2011 (if the waiver is not approved). I haverovided a sample chart below for your convenience:




EE EE + Child (if applicable

or other appropriatetier)



hank you.








Teams L72:000023

http://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]


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hank you.







hanks and regards,





Teams L72:000024

http://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]


25/46



hanks again.

am Moultrie



Ms. Moultrie,


hanks and regards,




ear Ms. Goldstein:



Please provide the current monthly premium rates and the projected monthly premium rates applicable to the

plan or policy forms if the plan were to comply with the restricted annual benefits. In other words, we would likea chart that reflects the following information:





Teams L72:000025



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n order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look

orward to receiving your completed application. Thank you.



Teams L72:000026

http://x-msg//1996/[email protected]://x-msg//1996/[email protected]


27/46

/T|/...onse%20[YELLOW]/Teamsters%20Local%20Union%20%2372%20Welfare%20Fund/Request%20for%20info%2012.2.10.htm[08/04/2011 12:09:19 PM]

rom: Moultrie, Cam (HHS/OCIIO)ent: Thursday, December 02, 2010 7:20 PMo: [email protected]: Kevin Clor; Pavesi, Matthew C.; Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fundo, I did not receive a response to my last email regarding the COBRA equivalencies for 2010 and 2011.

lease note that we cannot process your application until we have received all of the necessary information. You will receive

decision within 30 days of when we receive all of the requested information. We look forward to receiving your completedpplication.





rom: Jennifer Goldstein [mailto:[email protected]]ent: Thursday, December 02, 2010 10:15 AMo: Moultrie, Cam (HHS/OCIIO)c: Kevin Clor; Pavesi, Matthew C.

ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

ood Morning,


hanks and regards,



rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, November 18, 2010 4:33 PMo: Kevin Clorc: [email protected]; Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

Teams L72:000027



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Mr. Clor,








hank you.



rom: Jennifer Goldstein [mailto:[email protected]]ent: Thursday, November 18, 2010 12:02 PM

o: Moultrie, Cam (HHS/OCIIO)c: Kevin Clor; Pavesi, Matthew C.ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund






Teams L72:000028

mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


29/46


hank you.





he Plan is a supplemental benefit plan that provides prescription drug and dental benefits to its active participantsnd their eligible dependents. This supplemental coverage is paid for by a contribution rate agreed upon inollective bargaining between the New York State Thruway Authority and the Union. The New York State Thruway

uthority provides these same participants with hospital and medical coverage.


hanks and regards,






hanks again.

am Moultrie


Teams L72:000029



30/46



Ms. Moultrie,


hanks and regards,



rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]

ent: Tuesday, November 16, 2010 1:40 PMo: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Teamsters Local 72 Welfare Fund

ear Ms. Goldstein:







EE EE + Child (if applicable

or other appropriatetier)



n order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look Teams L72:000030



31/46


orward to receiving your completed application. Thank you.



Teams L72:000031



32/46

/T|/...LLOW]/Teamsters%20Local%20Union%20%2372%20Welfare%20Fund/Request%20for%20info%20response%2012.2.10.htm[08/04/2011 12:09:19 PM]

rom: Kevin Clor [[email protected]]ent: Thursday, December 02, 2010 7:27 PMo: Moultrie, Cam (HHS/OCIIO)c: [email protected]; Pavesi, Matthew C.; Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Teamsters Local 72 Welfare Fund

Ms. Moultrie:

he COBRA equivalency for 2011 with the $ max and w/o the $ max are based on the rates we have already

ncluded in the application plus % which is a wed under the law. ope this answers your question. Please adviseyou need any additional infor ation. Thank you.

KCC



Kevin C. Clor, Esq.8 Thomas Jefferson Lanenyder, New York 14226

Office (716) 839-0418ax (716) 839-1834mail: [email protected]


No, I did not receive a response to my last email regarding the COBRA equivalencies for 2010 and 2011.Please note that we cannot process your application until we have received all of the necessary information.You will receive a decision within 30 days of when we receive all of the requested information. We look forwardto receiving your completed application.Cam Lynne MoultrieOffice of Consumer Information and Insurance OversightU.S. Department of Health and Human Services(301) [email protected]


This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not bedisseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full

extent of the law.

From: Jennifer Goldstein [mailto:[email protected]]Sent: Thursday, December 02, 2010 10:15 AMTo: Moultrie, Cam (HHS/OCIIO)

Teams L72:000032



33/46


Cc: Kevin Clor; Pavesi, Matthew C.Subject: RE: Waiver Application for Teamsters Local 72 Welfare FundGood Morning,I am just checking in to make sure you received all the information that you needed for our waiver application.Thanks and regards,Jennifer S. GoldsteinTitan Administrator


Phone: 212-691-4228Fax: 212-645-5026Email: [email protected]

From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]Sent: Thursday, November 18, 2010 4:33 PMTo: Kevin ClorCc: [email protected] ; Habit, Sandra (HHS/OCIIO)Subject: RE: Waiver Application for Teamsters Local 72 Welfare FundMr. Clor,I am interested in COBRA equivalencies for 2010, 2011 (if waiver is approved) and 2011 (if the waiver is notapproved). I have provided a sample chart below for your convenience:

2010 January Premium(current level) 2011 January Premium(renewal) 2011 January Premium(if $750,000 annuallimit was applied)

EEEE + Child (if applicableor other appropriatetier)EE + Spouse (if applicable or otherappropriate tier)

Family (if applicable orother appropriate tier)Thank you.Cam Lynne MoultrieOffice of Consumer Information and Insurance OversightU.S. Department of Health and Human Services(301) [email protected]

From: Jennifer Goldstein [mailto:[email protected]]Sent: Thursday, November 18, 2010 12:02 PMTo: Moultrie, Cam (HHS/OCIIO)

Cc: Kevin Clor; Pavesi, Matthew C.Subject: RE: Waiver Application for Teamsters Local 72 Welfare FundPrescription COBRA for an individual is $ and for a family it is $ Please forward any future questions to the Funds Council, Kevin C. Clor Esq. at [email protected] and regards,Jennifer S. GoldsteinTitan Administrator

265 West 14 th Street, Suite 704, New York, NY 10011Phone: 212-691-4228Fax: 212-645-5026

Teams L72:000033

http://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]


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Email: [email protected]

From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]Sent: Thursday, November 18, 2010 11:39 AMTo: [email protected]: Habit, Sandra (HHS/OCIIO)Subject: RE: Waiver Application for Teamsters Local 72 Welfare FundThank you.Please provide the COBRA equivalency rates.Cam Lynne Moultrie

Program AnalystOffice of Consumer Information and Insurance OversightU.S. Department of Health and Human Services(301) [email protected]

From: Jennifer Goldstein [mailto:[email protected]]Sent: Wednesday, November 17, 2010 3:29 PMTo: Moultrie, Cam (HHS/OCIIO)Subject: RE: Waiver Application for Teamsters Local 72 Welfare FundThe Plan is a supplemental benefit plan that provides prescription drug and dental benefits to its activeparticipants and their eligible dependents. This supplemental coverage is paid for by a contribution rate

agreed upon in collective bargaining between the New York State Thruway Authority and the Union.The New York State Thruway Authority provides these same participants with hospital and medicalcoverage.The Plan has a $ calendar year maximum on its prescription drug benefit, and that is the onlyessential benefit the Fund is requesting a waiver for.Thanks and regards,Jennifer S. GoldsteinTitan Administrator

265 West 14 th Street, Suite 704, New York, NY 10011Phone: 212-691-4228Fax: 212-645-5026Email: [email protected]

From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]Sent: Wednesday, November 17, 2010 12:27 PMTo: [email protected]: RE: Waiver Application for Teamsters Local 72 Welfare FundThank you for your response. On you application you stated that the The Plan currently has an overall calendaryear limit of on medical benefits and the following annual limits on specific medical benefits. What is the Plansoverall calendar year limit?Do you have premium rates for employee+ family?Thanks again.Cam Moultrie

From: Jennifer Goldstein [mailto:[email protected]]Sent: Tuesday, November 16, 2010 2:25 PMTo: Moultrie, Cam (HHS/OCIIO)Cc: Kevin Clor; Pavesi, Matthew C.Subject: RE: Waiver Application for Teamsters Local 72 Welfare FundMs. Moultrie,I have attached the additional information you were looking for.Thanks and regards,Jennifer S. GoldsteinTitan Administrator

Teams L72:000034

http://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]


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265 West 14 th Street, Suite 704, New York, NY 10011Phone: 212-691-4228Fax: 212-645-5026Email: [email protected]

From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]Sent: Tuesday, November 16, 2010 1:40 PMTo: [email protected]: Habit, Sandra (HHS/OCIIO)Subject: Waiver Application for Teamsters Local 72 Welfare FundDear Ms. Goldstein:Thank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section2711. In order to complete your application, please provide the following information:

Please state your plans overall annual limit.Please provide the current monthly premium rates and the projected monthly premium ratesapplicable to the plan or policy forms if the plan were to comply with the restricted annual benefits.In other words, we would like a chart that reflects the following information:




EEEE + Child (if applicableor other appropriatetier)EE + Spouse (if applicable or otherappropriate tier)Family (if applicable orother appropriate tier)

In order to complete your application, please provide this information by 5:00 pm, November 17, 2010. Welook forward to receiving your completed application. Thank you.Cam L. MoultrieProgram AnalystOffice of Consumer Information and Insurance OversightU.S. Department of Health and Human Services(301) [email protected]

Teams L72:000035

http://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]


36/46


rom: Pavesi, Matthew C. [[email protected]]ent: Friday, December 03, 2010 5:05 PMo: Moultrie, Cam (HHS/OCIIO); Kevin Clor c: [email protected]; Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fundam,

As a follow-up to our telephone conversation from today, here is the information you requested:

Aggregate employer contributions for 2010: $ Average monthly employer contributions for 2010: $

he plan provides dental benefits, life insurance and a disability benefit as well that is paid for with thesemployer contributions along with reasonable administrative expenses.

The 2010 per member per month expense for the Plans current $ annual dollar maximum for prescription drugs is $ Applying trend, the 2011 projected mber per month expense for the Plans current $ annmaximum for prescription drugs is $ Applying trend, the 2011 projected per member per month expense increasing the annual maximum to$750,000 is $

lease let me know if there is any further information you need to consider the Funds application.

est regards,MattMatthew Pavesi

enefits Consultanthe Segal Company

33 West 34th Street, New York, New York 10001-2402Tel 212.251.5339 | Fax [email protected]

rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, December 02, 2010 7:31 PMo: Kevin Clorc: [email protected]; Pavesi, Matthew C.; Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

Mr. Clor,

er my voicemail, please call me to discuss your response.

hank you,

am


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rom: Kevin Clor [mailto:[email protected]]ent: Thursday, December 02, 2010 7:27 PMo: Moultrie, Cam (HHS/OCIIO)c: [email protected]; Pavesi, Matthew C.; Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Teamsters Local 72 Welfare Fund

Ms. Moultrie:

he COBRA equivalency for 2 1 with the $ max and w/o the $ max are based on the rates we have alreadyncluded in the application plus % which is wed under the law. ope this answers your question. Please advise

you need any additional infor ation. Thank you.

KCC



Kevin C. Clor, Esq.8 Thomas Jefferson Lanenyder, New York 14226

Office (716) 839-0418ax (716) 839-1834

Email: [email protected]


o, I did not receive a response to my last email regarding the COBRA equivalencies for 2010 and 2011.

lease note that we cannot process your application until we have received all of the necessary information. You will receiveTeams L72:000037



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decision within 30 days of when we receive all of the requested information. We look forward to receiving your completedpplication.


301) 492-4174

[email protected]




ent: Thursday, December 02, 2010 10:15 AMo: Moultrie, Cam (HHS/OCIIO)c: Kevin Clor; Pavesi, Matthew C.ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

ood Morning,


hanks and regards,



rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, November 18, 2010 4:33 PMo: Kevin Clorc: [email protected] ; Habit, Sandra (HHS/OCIIO)

ubject: RE: Waiver Application for Teamsters Local 72 Welfare Fund

Mr. Clor,





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http://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]


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hank you.









hank you.



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hanks and regards,






hanks again.

am Moultrie


Ms. Moultrie,


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http://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]://x-msg//1996/[email protected]


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hanks and regards,




ear Ms. Goldstein:












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THIS MESSAGE IS INTENDED ONLY FOR THE USE OF THE

ADDRESSEE. IT MAY CONTAIN PRIVILEGED OR CONFIDENTIALNFORMATION THAT IS EXEMPT FROM DISCLOSURE. Dissemination,distribution or copying of this message by anyone other than the addressee istrictly prohibited. If you received this message in error, please notify usmmediately by replying: "Received in error" and delete the message.

Thank you.

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/T|/...sters%20Local%20Union%20No.%2072%20Waiver%20of%20the%20Annual%20Limits%20Requirements%2012-29-2010.htm[08/04/2011 12:09:21 PM]

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, December 29, 2010 1:45 PMo: [email protected]: Teamsters Local Union No. 72 Waiver of the Annual Limits Requirements 12-29-2010

mportance: High

Attachments: Updated Jan 1 Approval Letter .pdf

Good Afternoon,hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act ection 2711 for Teamsters Local Union No. 72. HHS has reviewed your application and made itsetermination. Please see the attached letter.

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

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

incerely,

Alexandra Botwinick

Office of Oversight HHS/OCIIO

[email protected]

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Teamsters Local Union No. 72 - Redacted Bates HW

Documents