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///co-adshare/...20and%20Employers'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Waiver%20application.htm[11/15/2011 2:10:
rom: William H. Tobin [[email protected]]ent: Tuesday, November 30, 2010 6:40 PM
To: HHS HealthInsurance (HHS); OCIIO Oversightubject: Waiver application
Attachments: waiver application.pdf
Dear Sir or Madam:
On behalf of the the UFCW Unions' and Employers' Health and Welfare Plan of Central Ohio
the "Plan"), I attach correspondence and supporting documentation regarding the Plan's application fo
waiver from restricted annual limits.
lease review the attached and respond at your earliest convenience. My e-mail address is
[email protected], and my direct phone number is 414-298-8279.
t is my understanding that the email inbox [email protected] may be full, and therefore I
ending to both that email address [email protected] in order to ensure receipt.
Thank you for your attention to this matter.
William H. Tobin
einhart Boerner Van Deuren s.c.
000 North Water Street, Suite 1700 | Milwaukee, WI 53202
ffice: 414-298-8279 | Fax: 414-298-8097
[email protected] | bio | vCard | reinhartlaw.com
UFCW COH:000001
mailto:[email protected]:[email protected]:[email protected]:[email protected]://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://reinhartlaw.com/http://reinhartlaw.com/http://reinhartlaw.com/http://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinmailto:[email protected]:[email protected]:[email protected]:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
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///co-adshare/...20and%20Welfare%20Plan%20of%20Central%20Ohio/Reqeust%20for%20info%20response%20(2)%2012.13.10.htm[11/15/2011 2:10:
rom: William H. Tobin [[email protected]]ent: Monday, December 13, 2010 4:47 PM
To: William H. Tobin; Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application - UFCW Unions' and Employers' Health and Welfare Plan of Central Ohio
Attachments: Central OH H&W Waiver Application & Exh A.PDF; Central OH H&W Annual Limit WaiverApplication (HHS spreadsheet).PDFDear Ms. Habit,
Attached please find the materials requested in your email below. Thank you for your consideration of the Plan'swaiver application.
lease contact me with any questions or comments.
ill Tobin
William H. Tobin
einhart Boerner Van Deuren s.c.
000 North Water Street, Suite 1700 | Milwaukee, WI 53202
ffice: 414-298-8279 | Fax: 414-298-8097
[email protected] | bio | vCard | reinhartlaw.com
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Friday, December 10, 2010 10:51 AMo: William H. Tobinubject: Waiver Application - UFCW Unions' and Employers' Health and Welfare Plan of Central Ohio
Dear Mr. Tobin,
hank you for your waiver application on behalf of UFCW Unions and Employers' Health and Welfare Plan ofCentral Ohio.We would like to expedite processing your application and request that you provide the following
nformation to facilitate this:
Please complete the entire annual limits spreadsheet, attached to this email. Please return the completed
spreadsheet to this email address as an attachment. We will only be able to process spreadsheets that arfully complete (i.e., every cell should contain the information requested). If a cell on the spreadsheet donot pertain to your plan, please write None, and/or provide an explanation regarding why you are unabto complete that particular cell in a separate document.
Please confirm that your plan was in existence before March 23, 2010, and if so, whether it will be
complying with the requirements of the Grandfathering Regulation, 45 CFR 147.140?
You may wish to provide a statement explaining how compliance with the annual limits will result in a
decrease in access to benefits.
What is the date on which the last collective bargaining agreement pursuant to which the plan was
negotiated will expire?
n order to complete your application, please provide this information by 5:00 pm, December 13, 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
Kind regards,andy
UFCW COH:000021
mailto:[email protected]://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://reinhartlaw.com/http://reinhartlaw.com/http://reinhartlaw.com/http://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinmailto:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
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///co-adshare/...20and%20Welfare%20Plan%20of%20Central%20Ohio/Reqeust%20for%20info%20response%20(2)%2012.13.10.htm[11/15/2011 2:10:
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.
UFCW COH:000022
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UFCW COH:000023
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///co-adshare/...ployers'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Reqeust%20for%20info%20response.htm[11/15/2011 2:10:
rom: William H. Tobin [[email protected]]ent: Monday, December 13, 2010 4:45 PM
To: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application - UFCW Unions' and Employers' Health and Welfare Plan of Central Ohio
Attachments: Central OH H&W Waiver Application & Exh A.PDF; Central OH H&W Annual Limit WaiverApplication (HHS spreadsheet).PDF
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Friday, December 10, 2010 10:51 AMo: William H. Tobinubject: Waiver Application - UFCW Unions' and Employers' Health and Welfare Plan of Central Ohio
Dear Mr. Tobin,
hank you for your waiver application on behalf of UFCW Unions and Employers' Health and Welfare Plan ofCentral Ohio.We would like to expedite processing your application and request that you provide the followingnformation to facilitate this:
Please complete the entire annual limits spreadsheet, attached to this email. Please return the completed
spreadsheet to this email address as an attachment. We will only be able to process spreadsheets that arfully complete (i.e., every cell should contain the information requested). If a cell on the spreadsheet donot pertain to your plan, please write None, and/or provide an explanation regarding why you are unabto complete that particular cell in a separate document.
Please confirm that your plan was in existence before March 23, 2010, and if so, whether it will be
complying with the requirements of the Grandfathering Regulation, 45 CFR 147.140?
You may wish to provide a statement explaining how compliance with the annual limits will result in a
decrease in access to benefits.
What is the date on which the last collective bargaining agreement pursuant to which the plan was
negotiated will expire?
n order to complete your application, please provide this information by 5:00 pm, December 13, 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
Kind regards,andy
andy Habitepartment 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
UFCW COH:000029
mailto:[email protected]:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
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///co-adshare/...ployers'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Reqeust%20for%20info%20response.htm[11/15/2011 2:10:
r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full e
f the law.
UFCW COH:000030
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///co-adshare/...Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Request%20for%20info%20response%2012.16.10.htm[11/15/2011 2:10
rom: Maire Mills Greenya [[email protected]]ent: Thursday, December 16, 2010 11:03 AM
To: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application Spreadsheet (Excel) - UFCW Unions' and Employers' Health and Welfare Plan of
Central Ohio
mportance: High
Attachments: 021001_ HHS excel waiver application (12_10).XLS.XLSDear Ms. Habit:
ursuant to your request, I attach the Waiver Application for the UFCW Unions' and Employers' Health
nd Welfare Plan of Central Ohio in Excel (instead of .pdf format), which was originally submitted to yo
n December 13, 2010.
f you have any questions or comments, please do not hesitate to contact Bill Tobin at 414-298-8279 and/
incerely,
Maire Mills Greenya,ssistant to William H. Tobin
einhart Boerner Van Deuren s.c.
000 North Water Street, Suite 1700 | Milwaukee, WI 53202
ffice: 414-298-8454 | Fax: 414-298-8097
[email protected] | reinhartlaw.com
rom: William H. Tobinent: Monday, December 13, 2010 3:47 PMo: William H. Tobin; 'Habit, Sandra (HHS/OCIIO)'ubject: RE: Waiver Application - UFCW Unions' and Employers' Health and Welfare Plan of Central Ohio
Dear Ms. Habit,
Attached please find the materials requested in your email below. Thank you for your consideration of the Plan'swaiver application.
lease contact me with any questions or comments.
ill Tobin
William H. Tobineinhart Boerner Van Deuren s.c.
000 North Water Street, Suite 1700 | Milwaukee, WI 53202
ffice: 414-298-8279 | Fax: 414-298-8097
UFCW COH:000031
mailto:[email protected]:[email protected]:[email protected]://reinhartlaw.com/http://reinhartlaw.com/http://reinhartlaw.com/mailto:[email protected]:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
32/68
///co-adshare/...Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Request%20for%20info%20response%2012.16.10.htm[11/15/2011 2:10
[email protected] | bio | vCard | reinhartlaw.com
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Friday, December 10, 2010 10:51 AMo: William H. Tobinubject: Waiver Application - UFCW Unions' and Employers' Health and Welfare Plan of Central Ohio
Dear Mr. Tobin,
hank you for your waiver application on behalf of UFCW Unions and Employers' Health and Welfare Plan ofCentral Ohio.We would like to expedite processing your application and request that you provide the followingnformation to facilitate this:
Please complete the entire annual limits spreadsheet, attached to this email. Please return the completed
spreadsheet to this email address as an attachment. We will only be able to process spreadsheets that arfully complete (i.e., every cell should contain the information requested). If a cell on the spreadsheet donot pertain to your plan, please write None, and/or provide an explanation regarding why you are unabto complete that particular cell in a separate document.
Please confirm that your plan was in existence before March 23, 2010, and if so, whether it will be
complying with the requirements of the Grandfathering Regulation, 45 CFR 147.140? You may wish to provide a statement explaining how compliance with the annual limits will result in a
decrease in access to benefits.
What is the date on which the last collective bargaining agreement pursuant to which the plan was
negotiated will expire?
n order to complete your application, please provide this information by 5:00 pm, December 13, 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
Kind regards,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.
ny advice expressed in this writing as to tax matters was neither written nor intended by the sender or Reinhart Boerner Van
euren s.c. to be used and cannot be used by any taxpayer for the purpose of avoiding tax penalties that may be imposed on
UFCW COH:000032
mailto:[email protected]://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://reinhartlaw.com/http://reinhartlaw.com/mailto:[email protected]:[email protected]://reinhartlaw.com/http://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinmailto:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
33/68
///co-adshare/...Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Request%20for%20info%20response%2012.16.10.htm[11/15/2011 2:10
axpayer. If any such tax advice is made to any person or party other than to our client to whom the advice is directed and
tended, then the advice expressed is being delivered to support the promotion or marketing (by a person other than Reinhart
oerner Van Deuren s.c.) of the transaction or matter discussed or referenced. Each taxpayer should seek advice based on the
axpayer's particular circumstances from an independent tax advisor.
his e-mail and any attachments may contain privileged or confidential information. This e-mail is intended solely for the use of
dividual or entity to which it is addressed. If you are not the intended recipient of this e-mail, you are hereby notified that any
opying, distribution, dissemination or action taken in relation to the contents of this e-mail and any of its attachments is strictly
rohibited and may be unlawful. If you have received this e-mail in error, please notify the sender immediately and permanentelete the original e-mail and destroy any copies or printouts of this e-mail as well as any attachments. To the extent
epresentations are made herein concerning matters of a client of the firm, be advised that such representations are not those o
he client and do not purport to bind them.
UFCW COH:000033
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///co-adshare/...0and%20Employers'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Completion%2012.20.10.htm[11/15/2011 2:10
rom: Habit, Sandra (HHS/OCIIO)ent: Monday, December 20, 2010 11:10 AM
To: '[email protected]'ubject: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
December 20, 2010
Mr. Tobin
hank you for your information.
Your application is now complete and you will receive a determination of your application within 30 days. Take cnd have a happy holiday!
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, distribu
r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full e
f the law.
UFCW COH:000034
mailto:[email protected]:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
35/68
///co-adshare/...rs'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Additional%20info%20needed%2012.22.10.htm[11/15/2011 2:10
rom: Pham, Erica (HHS/OCIIO)ent: Wednesday, December 22, 2010 7:09 PM
To: Habit, Sandra (HHS/OCIIO)Cc: Curtis, Barbara (HHS/OCIIO)ubject: UFCW Unions' & Ers' Health & Welfare Plan of Central Ohioi Sandy:
We reviewed the plan below. Can you please communicate to them that we need more information, otherwise we will deny the
pplication? Unfortunately, the rational is insufficient, and unless they provide more information/specifics in regards to the
ecrease in access to benefits (the rise in costs would unexpectedly deplete plan assets and reserves). Please resubmit toarbara if and when they provide more information.
hanks!
rica
082
UFCW
Unions' &
Ers' Health
& Welfare
Plan of
Central
Ohio
Plan 51B
(part-time)
082
UFCW
Unions' &
Ers' Health
& Welfare
Plan of
Central
Ohio
Plan 53A
(part-time)
UFCW
Unions' &
Ers' Health
& Welfare
Plan of
UFCW COH:000035
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///co-adshare/...rs'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Additional%20info%20needed%2012.22.10.htm[11/15/2011 2:10
082
Central
Ohio
Plan 55A
(part-time)
082
UFCWUnions' &
Ers' Health
& Welfare
Plan of
Central
Ohio
Plan 57A
(part-time)
082
UFCW
Unions' &
Ers' Health
& Welfare
Plan of
Central
Ohio
Plan 61
(part-time)
082
UFCW
Unions' &
Ers' Health
& Welfare
Plan of
Central
Ohio
Plan 20
(retiree)
rica Pham
ivision of Enforcement
ffice of Oversight
CIIO/HHS
01-492-4108
UFCW COH:000036
mailto:[email protected]:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
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///co-adshare/...%20and%20Welfare%20Plan%20of%20Central%20Ohio/Additional%20info%20needed%20response%2012.23.10.htm[11/15/2011 2:10
rom: Habit, Sandra (HHS/OCIIO)ent: Thursday, December 23, 2010 12:17 PM
To: Pham, Erica (HHS/OCIIO); Curtis, Barbara (HHS/OCIIO)ubject: RE: UFCW Unions' & Ers' Health & Welfare Plan of Central Ohio
Attachments: Central OH HW Waiver Application Exh A (2).pdfdditional information can be found on pages 1-5 of the attached document. I will see if this is something we can put in front o
teve next week.
hanks,andy
rom: Pham, Erica (HHS/OCIIO)ent: Wednesday, December 22, 2010 7:09 PMo: Habit, Sandra (HHS/OCIIO)c: Curtis, Barbara (HHS/OCIIO)ubject: UFCW Unions' & Ers' Health & Welfare Plan of Central Ohio
i Sandy:
We reviewed the plan below. Can you please communicate to them that we need more information, otherwise we will deny the
pplication? Unfortunately, the rational is insufficient, and unless they provide more information/specifics in regards to the
ecrease in access to benefits (the rise in costs would unexpectedly deplete plan assets and reserves). Please resubmit to
arbara if and when they provide more information.
hanks!
rica
082
UFCW
Unions' &
Ers' Health
& Welfare
Plan of
Central
Ohio
Plan 51B
(part-time)
UFCW
Unions' &
Ers' Health
& Welfare
Plan of
Central Plan 53A
UFCW COH:000037
7/27/2019 UFCW Cent Ohio - Redacted HWM
38/68
///co-adshare/...%20and%20Welfare%20Plan%20of%20Central%20Ohio/Additional%20info%20needed%20response%2012.23.10.htm[11/15/2011 2:10
082 Ohio (part-time)
082
UFCW
Unions' &Ers' Health
& Welfare
Plan of
Central
Ohio
Plan 55A
(part-time)
082
UFCW
Unions' &
Ers' Health
& Welfare
Plan of
Central
Ohio
Plan 57A
(part-time)
082
UFCW
Unions' &
Ers' Health
& Welfare
Plan of
Central
Ohio
Plan 61
(part-time)
UFCW
Unions' &
Ers' Health
& Welfare
Plan of
Central Plan 20
UFCW COH:000038
7/27/2019 UFCW Cent Ohio - Redacted HWM
39/68
///co-adshare/...%20and%20Welfare%20Plan%20of%20Central%20Ohio/Additional%20info%20needed%20response%2012.23.10.htm[11/15/2011 2:10
082 Ohio (retiree)
rica Pham
ivision of Enforcement
ffice of Oversight
CIIO/HHS
01-492-4108
UFCW COH:000039
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///co-adshare/...s'%20and%20Employers'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Question%201.11.11.htm[11/15/2011 2:10
ny advice expressed in this writing as to tax matters was neither written nor intended by the sender or Reinhart Boerner Van
euren s.c. to be used and cannot be used by any taxpayer for the purpose of avoiding tax penalties that may be imposed on
axpayer. If any such tax advice is made to any person or party other than to our client to whom the advice is directed and
tended, then the advice expressed is being delivered to support the promotion or marketing (by a person other than Reinhart
oerner Van Deuren s.c.) of the transaction or matter discussed or referenced. Each taxpayer should seek advice based on the
axpayer's particular circumstances from an independent tax advisor.
his e-mail and any attachments may contain privileged or confidential information. This e-mail is intended solely for the use of dividual or entity to which it is addressed. If you are not the intended recipient of this e-mail, you are hereby notified that any
opying, distribution, dissemination or action taken in relation to the contents of this e-mail and any of its attachments is strictly
rohibited and may be unlawful. If you have received this e-mail in error, please notify the sender immediately and permanent
elete the original e-mail and destroy any copies or printouts of this e-mail as well as any attachments. To the extent
epresentations are made herein concerning matters of a client of the firm, be advised that such representations are not those o
he client and do not purport to bind them.
UFCW COH:000041
7/27/2019 UFCW Cent Ohio - Redacted HWM
42/68
///co-adshare/...0Employers'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Question%20response%201.12.11.htm[11/15/2011 2:1
rom: Habit, Sandra (HHS/OCIIO)ent: Wednesday, January 12, 2011 6:13 PM
To: 'William H. Tobin'ubject: RE: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohioill,
apologize for the delay. I sent your application for leadership review. I will get a response for you expedited.
hank you,
andy
rom: William H. Tobin [mailto:[email protected]]ent: Tuesday, January 11, 2011 10:08 AMo: Habit, Sandra (HHS/OCIIO)c: William H. Tobinubject: RE: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
andra,ust wanted to follow-up on this and see if you had any questions. I realize it has not been 30 days sinceour 12/20/2010 email, but we originally submitted the application on 11/30/2010 and responded to the 12/10/2010
equest for the spreadsheet on 12/13/2010.hanks for your assistance.ill Tobin
William H. Tobin
einhart Boerner Van Deuren s.c.
000 North Water Street, Suite 1700 | Milwaukee, WI 53202
ffice: 414-298-8279 | Fax: 414-298-8097
[email protected] | bio | vCard | reinhartlaw.com
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Monday, December 20, 2010 10:10 AMo: William H. Tobinubject: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
December 20, 2010
Mr. Tobin
hank you for your information.
Your application is now complete and you will receive a determination of your application within 30 days. Take cnd have a happy holiday!
hank you,andy
andy Habit
epartment of Health and Human Services
ffice of Consumer Information and Insurance Oversight
UFCW COH:000042
mailto:[email protected]://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://reinhartlaw.com/http://reinhartlaw.com/http://reinhartlaw.com/http://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinmailto:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
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///co-adshare/...lth%20and%20Welfare%20Plan%20of%20Central%20Ohio/Question%20response%20correspondence%201.12.11.htm[11/15/2011 2:10
rom: William H. Tobin [[email protected]]ent: Wednesday, January 12, 2011 7:01 PM
To: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohiohanks very much.ill
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, January 12, 2011 5:13 PMo: William H. Tobinubject: RE: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
ill,
apologize for the delay. I sent your application for leadership review. I will get a response for you expedited.
hank you,
andy
rom: William H. Tobin [mailto:[email protected]]ent: Tuesday, January 11, 2011 10:08 AMo: Habit, Sandra (HHS/OCIIO)c: William H. Tobinubject: RE: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
andra,ust wanted to follow-up on this and see if you had any questions. I realize it has not been 30 days sinceour 12/20/2010 email, but we originally submitted the application on 11/30/2010 and responded to the 12/10/2010equest for the spreadsheet on 12/13/2010.hanks for your assistance.ill Tobin
William H. Tobin
einhart Boerner Van Deuren s.c.
000 North Water Street, Suite 1700 | Milwaukee, WI 53202
ffice: 414-298-8279 | Fax: 414-298-8097
[email protected] | bio | vCard | reinhartlaw.com
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Monday, December 20, 2010 10:10 AM
o: William H. Tobinubject: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
December 20, 2010
Mr. Tobin
hank you for your information.
Your application is now complete and you will receive a determination of your application within 30 days. Take cnd have a happy holiday!
UFCW COH:000044
mailto:[email protected]://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://reinhartlaw.com/http://reinhartlaw.com/http://reinhartlaw.com/http://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinmailto:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
45/68
///co-adshare/...lth%20and%20Welfare%20Plan%20of%20Central%20Ohio/Question%20response%20correspondence%201.12.11.htm[11/15/2011 2:10
hank you,andy
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.
ny advice expressed in this writing as to tax matters was neither written nor intended by the sender or Reinhart Boerner Van
euren s.c. to be used and cannot be used by any taxpayer for the purpose of avoiding tax penalties that may be imposed on
axpayer. If any such tax advice is made to any person or party other than to our client to whom the advice is directed and
tended, then the advice expressed is being delivered to support the promotion or marketing (by a person other than Reinhart
oerner Van Deuren s.c.) of the transaction or matter discussed or referenced. Each taxpayer should seek advice based on the
axpayer's particular circumstances from an independent tax advisor.
his e-mail and any attachments may contain privileged or confidential information. This e-mail is intended solely for the use of
dividual or entity to which it is addressed. If you are not the intended recipient of this e-mail, you are hereby notified that any
opying, distribution, dissemination or action taken in relation to the contents of this e-mail and any of its attachments is strictly
rohibited and may be unlawful. If you have received this e-mail in error, please notify the sender immediately and permanentelete the original e-mail and destroy any copies or printouts of this e-mail as well as any attachments. To the extent
epresentations are made herein concerning matters of a client of the firm, be advised that such representations are not those o
he client and do not purport to bind them.
UFCW COH:000045
mailto:[email protected]:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
46/68
App li cant
ID
Number
Annual Limit Waiver
Request Applicant
Name
Name
(use a
new row
for each
policy
applicatio
n)
Appli cant
(Plan/
Policy
Situs)
City
App li cant
(Plan/
Policy
Situs)
State
Plan/
Policy
Effective
Date
(mm/dd/yy
yy)
Contact
Name
Street
Address City State
082
UFCW Unions' &
Workers' Health &
Welfare Plan o f
Central OhioPlan 51A
(part-time) Columbus OH 01/01/2011
William
Tobin
1000 N.
Water St.,
Ste. 1700
Milwauke
e WI
UFCW Unions' &
Workers' Health &
Welfare Plan o f
Central OhioPlan 51B
(part-time) Columbus OH 01/01/2011
William
Tobin
1000 N.
Water St.,
Ste. 1700
Milwauke
e WI
UFCW Unions' &
Workers' Health &
Welfare Plan of Plan 53A William1000 N.
Water St. Milwauke
Central Ohio
(part-time) Columbus OH 01/01/2011
Tobin
Ste. 1700 e WI
UFCW Unions' &
Workers' Health &
Welfare Plan o f
Central OhioPlan 55A
(part-time) Columbus OH 01/01/2011
William
Tobin
1000 N.
Water St.,
Ste. 1700
Milwauke
e WI
7/27/2019 UFCW Cent Ohio - Redacted HWM
47/68
Coverage
(e.g.,
Limited
Benefit,
HRA, Rx
only,
Other)
Self-
Insured
Individual
or Group
Policy
Number
of
Individual
s
Covered
by Policy
(include
Current
Plan
Annual
Limit (in
dollars)
Ambulato
ry
Emergen
cy
Hospitali
zation
Laborator
y Pediatric
Maternity
/
Newborn
Limited
Benefit Yes Group
Limited
Benefit Yes Group
Limited
Benefit Yes Group
Limited
Benefit Yes Group
7/27/2019 UFCW Cent Ohio - Redacted HWM
48/68
Prescripti
on
Plan
Deductibl
e
Copay (if
applicabl
e)
Coinsura
nce (if
applicabl
e)
Copay (if
applicabl
e)
Coinsura
nce (if
applicabl
e)
Copay (if
applicabl
e)
Coinsura
nce (if
applicabl
e)
Copay (if
applicabl
e)
Coinsura
nce (if
applicabl
e)
Individual
/
Employe
e Tier*
7/27/2019 UFCW Cent Ohio - Redacted HWM
49/68
7/27/2019 UFCW Cent Ohio - Redacted HWM
50/68
Plan
Adminis trat
or/ CEO of
Health
Insurance
Issuer
Name
Title of
Individual
Providing
Attestation
Taft-Hartley
Plan
If Yes Taft-
Hartley then
Date Collecti ve
Bargaining
Agreement
Expires
Compliance
with
Grandfather
Regulat ion Lead Reviewer
Date of
Receipt
Board of
Trustees Trustee Yes 03/01/2014 Yes S. Habit 12/01/2010
Board of
Trustees Trustee Yes 03/01/2014 Yes S. Habit 12/01/2010
Boardof
Trustees Trustee Yes 03/01/2014 Yes S. Habit 12/01/2010
Board of
Trustees Trustee Yes 03/01/2014 Yes S. Habit 12/01/2010
7/27/2019 UFCW Cent Ohio - Redacted HWM
51/68
Factor 1 for
Decision
Factor 2
for
Decision
Factor 3
for
Decision
Factor 4
for
Decision
Staff
Recomm
endation
for
Approval/
Disappro
val Comments
1: A significant
decrease in
access to
benefits. Approve
Increase in annual deductible to $ from $ . Due to theTrustees' inability to increase contributions during the terms
of existing collective bargaining agreementsthe Trustees'
would be required to consider various benefits changes
which would be expected to result in a decrease in access to
benefits.
1: A significant
decrease in
access to
benefits. Approve
.
Trustees' inability to increase contributions during the terms
of existing collective bargaining agreementsthe Trustees'
would be required to consider various benefits changes
which would be expected to result in a decrease in access to
benefits
1: A significant
decrease in
access to
An increase in deductible to from . Due to the
Trustees' inability to increase contributions during the terms
of existing collective bargaining agreementsthe Trustees'
would be required to consider various benefits changes
which wouldbe ex ected to resultina decrease inaccess to
benefits. Approve
benefits
1: A significant
decrease in
access to
benefits. Approve
Increase in annual deductible to $ from $ . Due to theTrustees' inability to increase contributions during the terms
of existing collective bargaining agreementsthe Trustees'
would be required to consider various benefits changes
which would be expected to result in a decrease in access to
benefits
7/27/2019 UFCW Cent Ohio - Redacted HWM
52/68
Final
Decision
Decision
Date
Date of
Waiver
Approval/
Disappro
val Letter
Sent Y/N
Date of
Letter
Confirma
tion of
Receipt
of
Approval
Access
File
7/27/2019 UFCW Cent Ohio - Redacted HWM
53/68
App li cant
ID
Number
Annual Limit Waiver
Request Applicant
Name
Name
(use a
new row
for each
policy
applicatio
n)
Appli cant
(Plan/
Policy
Situs)
City
App li cant
(Plan/
Policy
Situs)
State
Plan/
Policy
Effective
Date
(mm/dd/yy
yy)
Contact
Name
Street
Address City State
UFCW Unions' &
Workers' Health &
Welfare Plan o f
Central OhioPlan 57A
(part-time) Columbus OH 01/01/2011
William
Tobin
1000 N.
Water St.,
Ste. 1700
Milwauke
e WI
UFCW Unions' &
Workers' Health &
Welfare Plan o f
Central Ohio
Plan 61
(part-time) Columbus OH 01/01/2011
William
Tobin
1000 N.
Water St.,
Ste. 1700
Milwauke
e WI
UFCW Unions' &
Workers' Health &
Welfare Plan o f
Central OhioPlan 20
(retiree) Columbus OH 01/01/2011
William
Tobin
1000 N.
Water St.,
Ste. 1700
Milwauke
e WI
7/27/2019 UFCW Cent Ohio - Redacted HWM
54/68
Coverage
(e.g.,
Limited
Benefit,
HRA, Rx
only,
Other)
Self-
Insured
Individual
or Group
Policy
Number
of
Individual
s
Covered
by Policy
(include
Current
Plan
Annual
Limit (in
dollars)
Ambulato
ry
Emergen
cy
Hospitali
zation
Laborator
y Pediatric
Maternity
/
Newborn
Limited
Benefit Yes Group
Limited
Benefit Yes Group
Limited
Benefit Yes Group
7/27/2019 UFCW Cent Ohio - Redacted HWM
55/68
Prescripti
on
Plan
Deductibl
e
Copay (if
applicabl
e)
Coinsura
nce (if
applicabl
e)
Copay (if
applicabl
e)
Coinsura
nce (if
applicabl
e)
Copay (if
applicabl
e)
Coinsura
nce (if
applicabl
e)
Copay (if
applicabl
e)
Coinsura
nce (if
applicabl
e)
Individual
/
Employe
e Tier*
7/27/2019 UFCW Cent Ohio - Redacted HWM
56/68
Employe
e
contributi
on
Employer
contributi
on Total
Employe
e
contributi
on
Employer
contributi
on Total
Rate Increase
that would
result from
compliance
with $750,000
Annual Limi t
Restriction (in
Decrease in Access to Benefits that w
compliance with $750,000 Annual Lim
briefly)
"The Trustees have concluded that incr
maximum to $750,000 per year for t
J anuary 1, 2011 for all benefit program
significantly, as calculated by the plan's
costs would unexpectedly deplete pla
"The Trustees have concluded that incr
maximum to $750,000 per year for t
J anuary 1, 2011 for all benefit program
significantly, as calculated by the plan's
costs would unexpectedly deplete pla
"The Trustees have concluded that incr
maximumto 750 000 er ear for th
J anuary 1, 2011 for all benefit program
significantly, as calculated by the plan's
costs would unexpectedly deplete pla
7/27/2019 UFCW Cent Ohio - Redacted HWM
57/68
Plan
Adminis trat
or/ CEO of
Health
Insurance
Issuer
Name
Title of
Individual
Providing
Attestation
Taft-Hartley
Plan
If Yes Taft-
Hartley then
Date Collecti ve
Bargaining
Agreement
Expires
Compliance
with
Grandfather
Regulat ion Lead Reviewer
Date of
Receipt
Board of
Trustees Trustee Yes 03/01/2014 Yes S. Habit 12/01/2010
Board of
Trustees Trustee Yes 03/01/2014 Yes S. Habit 12/01/2010
Board of
Trustees Trustee Yes 03/01/2014 Yes S. Habit 12/01/2010
7/27/2019 UFCW Cent Ohio - Redacted HWM
58/68
Factor 1 for
Decision
Factor 2
for
Decision
Factor 3
for
Decision
Factor 4
for
Decision
Staff
Recomm
endation
for
Approval/
Disappro
val Comments
Deny
Increase deductible to $ from $ . Due to the Trusteesinability to increase contributions during the terms of existing
collective bargaining agreementsthe Trustees' would be
required to consider various benefits changes which would
be expected to result in a decrease in access to benefits
6: The number of
enrollees under
the plan seeking
the waiver.
1: A
significant
decrease
in access
to
benefits. Approve
Increase deductible to $ from $ . Due to the Trusteesinability to increase contributions during the terms of existing
collective bargaining agreementsthe Trustees' would be
required to consider various benefits changes which would
be expected to result in a decrease in access to benefits.
1: A
significant
decrease
Increase deductible to $ from $ . Due to theTrustees' inability to increase contributions during the terms
ofexistin collective bar ainin a reementsthe Trustees'
2: The policy's
current annual
limits.
in access
to
benefits. Approve
would be required to consider various benefits changes
which would be expected to result in a decrease in access to
benefits
7/27/2019 UFCW Cent Ohio - Redacted HWM
59/68
Final
Decision
Decision
Date
Date of
Waiver
Approval/
Disappro
val Letter
Sent Y/N
Date of
Letter
Confirma
tion of
Receipt
of
Approval
Access
File
7/27/2019 UFCW Cent Ohio - Redacted HWM
60/68
///co-adshare/...%20Employers'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Status%20request%201.21.11.htm[11/15/2011 2:10
rom: William H. Tobin [[email protected]]ent: Friday, January 21, 2011 12:51 PM
To: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohioandra,
Any further word? If there is some additional information that would be helpful please let me know and I will do wcan to get it to you as soon as possible. Thanks again for your consideration.ill
William H. Tobin
einhart Boerner Van Deuren s.c.
000 North Water Street, Suite 1700 | Milwaukee, WI 53202
ffice: 414-298-8279 | Fax: 414-298-8097
[email protected] | bio | vCard | reinhartlaw.com
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, January 12, 2011 5:13 PMo: William H. Tobinubject: RE: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
ill,
apologize for the delay. I sent your application for leadership review. I will get a response for you expedited.
hank you,
andy
rom: William H. Tobin [mailto:[email protected]]ent: Tuesday, January 11, 2011 10:08 AMo: Habit, Sandra (HHS/OCIIO)
c: William H. Tobinubject: RE: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
andra,ust wanted to follow-up on this and see if you had any questions. I realize it has not been 30 days sinceour 12/20/2010 email, but we originally submitted the application on 11/30/2010 and responded to the 12/10/2010equest for the spreadsheet on 12/13/2010.hanks for your assistance.ill Tobin
William H. Tobin
einhart Boerner Van Deuren s.c.
000 North Water Street, Suite 1700 | Milwaukee, WI 53202ffice: 414-298-8279 | Fax: 414-298-8097
[email protected] | bio | vCard | reinhartlaw.com
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Monday, December 20, 2010 10:10 AMo: William H. Tobinubject: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
UFCW COH:000060
mailto:[email protected]://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://reinhartlaw.com/http://reinhartlaw.com/mailto:[email protected]://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://reinhartlaw.com/http://reinhartlaw.com/http://reinhartlaw.com/http://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinmailto:[email protected]://reinhartlaw.com/http://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinmailto:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
61/68
///co-adshare/...%20Employers'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Status%20request%201.21.11.htm[11/15/2011 2:10
December 20, 2010
Mr. Tobin
hank you for your information.
Your application is now complete and you will receive a determination of your application within 30 days. Take cnd have a happy holiday!
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.
ny advice expressed in this writing as to tax matters was neither written nor intended by the sender or Reinhart Boerner Van
euren s.c. to be used and cannot be used by any taxpayer for the purpose of avoiding tax penalties that may be imposed on
axpayer. If any such tax advice is made to any person or party other than to our client to whom the advice is directed and
tended, then the advice expressed is being delivered to support the promotion or marketing (by a person other than Reinhartoerner Van Deuren s.c.) of the transaction or matter discussed or referenced. Each taxpayer should seek advice based on the
axpayer's particular circumstances from an independent tax advisor.
his e-mail and any attachments may contain privileged or confidential information. This e-mail is intended solely for the use of
dividual or entity to which it is addressed. If you are not the intended recipient of this e-mail, you are hereby notified that any
opying, distribution, dissemination or action taken in relation to the contents of this e-mail and any of its attachments is strictly
rohibited and may be unlawful. If you have received this e-mail in error, please notify the sender immediately and permanent
elete the original e-mail and destroy any copies or printouts of this e-mail as well as any attachments. To the extent
epresentations are made herein concerning matters of a client of the firm, be advised that such representations are not those o
he client and do not purport to bind them.
UFCW COH:000061
mailto:[email protected]:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
62/68
///co-adshare/...ers'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Status%20request%20response%201.21.11.htm[11/15/2011 2:10
rom: Habit, Sandra (HHS/OCIIO)ent: Friday, January 21, 2011 2:29 PM
To: 'William H. Tobin'ubject: RE: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohioill,
he application for UFCW Unions and Employers Health and Welfare Plan of Central Ohio made it to leadership but unfortunat
more information was requested. To the best of my knowledge, the application will again go to leadership next week and as I
ttend those meetings I will be able to contact you with an answer once I know either way. Thank you for you patience in this
matter.
andy
rom: William H. Tobin [mailto:[email protected]]ent: Friday, January 21, 2011 12:51 PMo: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
andra,Any further word? If there is some additional information that would be helpful please let me know and I will do w
can to get it to you as soon as possible. Thanks again for your consideration.illWilliam H. Tobin
einhart Boerner Van Deuren s.c.
000 North Water Street, Suite 1700 | Milwaukee, WI 53202
ffice: 414-298-8279 | Fax: 414-298-8097
[email protected] | bio | vCard | reinhartlaw.com
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]
ent: Wednesday, January 12, 2011 5:13 PMo: William H. Tobinubject: RE: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
ill,
apologize for the delay. I sent your application for leadership review. I will get a response for you expedited.
hank you,
andy
rom: William H. Tobin [mailto:[email protected]]
ent: Tuesday, January 11, 2011 10:08 AMo: Habit, Sandra (HHS/OCIIO)c: William H. Tobinubject: RE: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
andra,ust wanted to follow-up on this and see if you had any questions. I realize it has not been 30 days sinceour 12/20/2010 email, but we originally submitted the application on 11/30/2010 and responded to the 12/10/2010equest for the spreadsheet on 12/13/2010.hanks for your assistance.ill Tobin
UFCW COH:000062
mailto:[email protected]://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://reinhartlaw.com/http://reinhartlaw.com/http://reinhartlaw.com/http://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinmailto:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
63/68
///co-adshare/...ers'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Status%20request%20response%201.21.11.htm[11/15/2011 2:10
William H. Tobin
einhart Boerner Van Deuren s.c.
000 North Water Street, Suite 1700 | Milwaukee, WI 53202
ffice: 414-298-8279 | Fax: 414-298-8097
[email protected] | bio | vCard | reinhartlaw.com
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Monday, December 20, 2010 10:10 AMo: William H. Tobinubject: Waiver Application - UFCW Unions and Employers Health and Welfare Plan of Central Ohio
December 20, 2010
Mr. Tobin
hank you for your information.
Your application is now complete and you will receive a determination of your application within 30 days. Take cnd have a happy holiday!
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.
ny advice expressed in this writing as to tax matters was neither written nor intended by the sender or Reinhart Boerner Vaneuren s.c. to be used and cannot be used by any taxpayer for the purpose of avoiding tax penalties that may be imposed on
axpayer. If any such tax advice is made to any person or party other than to our client to whom the advice is directed and
tended, then the advice expressed is being delivered to support the promotion or marketing (by a person other than Reinhart
oerner Van Deuren s.c.) of the transaction or matter discussed or referenced. Each taxpayer should seek advice based on the
axpayer's particular circumstances from an independent tax advisor.
his e-mail and any attachments may contain privileged or confidential information. This e-mail is intended solely for the use of
dividual or entity to which it is addressed. If you are not the intended recipient of this e-mail, you are hereby notified that any
opying, distribution, dissemination or action taken in relation to the contents of this e-mail and any of its attachments is strictly
UFCW COH:000063
mailto:[email protected]:[email protected]://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://reinhartlaw.com/http://reinhartlaw.com/mailto:[email protected]:[email protected]://reinhartlaw.com/http://www.reinhartlaw.com/People/Pages/vcard.aspx?who=wtobinhttp://www.reinhartlaw.com/People/Pages/bioredir.aspx?who=wtobinmailto:[email protected]7/27/2019 UFCW Cent Ohio - Redacted HWM
64/68
///co-adshare/...ers'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Status%20request%20response%201.21.11.htm[11/15/2011 2:10
rohibited and may be unlawful. If you have received this e-mail in error, please notify the sender immediately and permanent
elete the original e-mail and destroy any copies or printouts of this e-mail as well as any attachments. To the extent
epresentations are made herein concerning matters of a client of the firm, be advised that such representations are not those o
he client and do not purport to bind them.
UFCW COH:000064
7/27/2019 UFCW Cent Ohio - Redacted HWM
65/68
///co-adshare/...'%20and%20Employers'%20Health%20and%20Welfare%20Plan%20of%20Central%20Ohio/Approval%201.31.11.htm[11/15/2011 2:10
rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, January 31, 2011 12:22 PM
To: '[email protected]'Cc: Habit, Sandra (HHS/OCIIO)ubject: UFCW Unions' & Workers' Health & Welfare Plan of Central Ohio Waiver of the Annual Limits
Requirements 1-31-2011
mportance: High
Attachments: January 1 Approval Letter .pdf
ood Morning,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act
ection 2711 forUFCW Unions' & Workers' Health & Welfare Plan of Central Ohio. HHS has reviewed yourpplication and made its determination. Please see the attached letter.
he attached letter refers to the following plans:
Plan 51A
(part-time)
Plan 51B
(part-time)
Plan 53A
(part-time)
UFCW COH:000065
7/27/2019 UFCW Cent Ohio - Redacted HWM
66/68
7/27/2019 UFCW Cent Ohio - Redacted HWM
67/68
UFCW COH:000067
7/27/2019 UFCW Cent Ohio - Redacted HWM
68/68