UFCW Local 1000 Kroger - Redacted Bates HW

7/27/2019 UFCW Local 1000 Kroger - Redacted Bates HW

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Request for Waiver from the Restricted Annual Limits

The UFCW Local 1000 and Kroger Dallas Health and Welfare Plan, also known as MED 1000, seeks a

waiver from the Restricted Annual Limits set forth in the interim final regulations. MED 1000 is a self-

insured Taft-Hartley employee benefit fund established as the result of collective bargaining between

the United Food and Commercial Workers Local 1000(UFCW Local 1000) and the Kroger Company to

provide basic health care benefits for the non-supervisory employees, represented by UFCW Local 1000,

working in the retail grocery stores operated by the Kroger Company in Texas. These employees include

bakery, deli, produce, grocery, pharmacy and front-end department employees and clerk employees

engaged in the selling of merchandise or performing services incidental thereto. This waiver is sought

because compliance with the restricted annual limit provision of the interim final regulations would

significantly increase premiums and would result in a significant decrease in access to benefits for those

currently covered by the Plan. The employer contribution is fixed by the terms of a Collective

Bargaining Agreement and cannot be increased during the term of that Agreement. The expiration date

of the current agreement is D 1. Terms of the Plan for which a waiver is sought

Attached as Exhibit 1 Summary Plan Description

Attached as Exhibit 2 Benefit Highlights

2. The number of individuals covered by the PlanApproximately 6 mployees and dependents

3. The annual limits and rates applicable to the PlanMedical benefits annual limits Eligibility Requirements

Plan AA $ Plan A $ Plan B $Plan C $

Plan D $

UFCW L1000 Kroger:000001


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Monthly contribution, or premium, rates are set forth in the Collective Bargaining Agreement. The

employer contributes approximately 93% he premi ums, while the employees share is approximately

%.

The contribution or premium rates also cover the cost of Life Insurance, Disability, Dental and Vision

Care benefits.

4. Description of why compliance with the interim final regulations would result in significantincrease in premiums.

In order to increase the maximum annual benefit limit for this self insured plan to $750,000 and to

prudently plan for potential large claim activity, reinsurance or stop loss coverage would have to be

purchased. A representative Specific and Aggregate Stop Loss bid from HCC Life has the following cost

factors:

$200,000 Specific Stop Loss Deductible annual premium $ Additional Self Funded Liability for coverage under the $200,000 Specific Deductible $ Total Additional 2011 Medical Cost $5,313The expected 2010 medical benefit cost is expected to total $14, The increase cost would be approximately 36% ,31 /$ ).Because the employer contribution is determined by the Collective Bargaining Agreement, the

additional premiums would have to come from the employees. This would create a hardship for the

employees, most of who earn between $7.50 12.0 per hour. It is likely that many employeeswould opt out of coverage because of the necessary premium increase, thus resulting in a significant

decrease in access to benefits for those currently covered by the Plan.

If any additional information is needed in order to process and grant this waiver request please contact

the undersigned. Thank you for your consideration in this matter.



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Pages 4 through 77 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4

Exhibit


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7/17

//T|/...Applications%20with%20NO%2012600%20Response%20[YELLOW]/UFCW%20Local%201000%20&%20Kroger/Waiver.htm[07/27/2011 3:01

rom: Brian D Peters [[email protected]]ent: Tuesday, October 26, 2010 2:45 PM

To: HHS HealthInsurance (HHS)ubject: Waiver

Attachments: MED_1000_Waiver_Request.pdf; MED_1000_SPD_with_SMM.pdf;MED_1000_Benefit_Highlights.pdf

ear Mr. James Mayhew,

he United Food and Commercial Workers Local 1000 and Kroger Dallas Health & Welfare Plan is requesting a waiver from th

estricted annual limits set forth in the interim final regulations. We have attached for your review:

1. Waiver Request

2. Summary Plan Description of the Fund

3. Benefit Highlights

you need any additional information, please feel free to contact me.

egards,

rian D Peters

und Administrator

rian D. Peters, C.P.A.

ice President &

hief Information Officer

EBA, Inc.

010 N. W. 150th Avenue

uite 100

embroke Pines, Florida 33028

00.842.5899 Toll Free

54.266.632254.266.2079 Fax

mportant Warning: This e-mail, and any attachments thereto, is intended only for use by the addressee(s) named herein and may containgally privileged and/or confidential information. If you are not the intended recipient of this e-mail (or the person responsible for delivering

ocument to the intended recipient), you are hereby notified that any dissemination, distribution, printing or coping of this e-mail, and any

tachment thereto, is strictly prohibited. If you have received this e-mail in error, please respond to the individual sending the message, and

ermanently delete the original and any copy of the e-mail and printout thereof.



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//T|/...0%20Response%20[YELLOW]/UFCW%20Local%201000%20&%20Kroger/Request%20forAdditional%20Info%2011.5.10.htm[07/27/2011 3:01

rom: Keels, Lisa (HHS/OCIIO)ent: Friday, November 05, 2010 10:29 AM

To: Brian D PetersCc: 'Jim Crump'; Habit, Sandra (HHS/OCIIO)

ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Applicationi Brian,

was a pleasure speaking with you this morning as well. Please send any additional documents for UFCW Local 1000 and

roger Dallas Health & Welfare Plan to the HHS general email, so we can ensure it goes through the entire process.

lso, thank you and Jim for confirming that you plan to remove the $ lifetime limit on alcohol and substance abuse

reatment. Thank you also for confirming that, if the annual limit requirements are waived for Plan AA, Plan A, and Plan B

nly annual limits you plan to have in the next Plan year are the overall annual limit and the annual limit on prescriptions.

lease confirm via email that this is the case.

hank you again, and have a wonderful weekend.

egards,sa

rom: Brian D Peters [mailto:[email protected]]ent: Friday, November 05, 2010 10:18 AMo: Keels, Lisa (HHS/OCIIO)c: 'Jim Crump'ubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application

i Lisa,

was a pleasure speaking with you this morning. In the call I referenced a waiver that was filed on another fund we administe

he waiver was emailed on Tuesday 10/26/2010 for the United Food and Commercial Workers Local 1000 and Kroger Dallasealth & Welfare Plan. If I need to send any additional information should I send it to you or the generic HHS email? We were

reparing additional information for that Plan based on the additional information you requested for the Oklahoma Fund. Also, fo

our reference listed below is the contact information for the Fund Consultant.

lease let me know if you need any additional information.

hanks,

rian

und Consultant

ames H. Crump

rump Consulting, Inc.

913) 599-3822

[email protected]

rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Friday, October 29, 2010 4:12 PMo: Brian D Petersubject: RE: UCFW Local 1000 Oklahoma Fund Waiver Application - Request for Additional Information

hank you for the information, Mr. Peters. I will be in touch if I need additional information.

mailto:[email protected]:[email protected]


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//T|/...0%20Response%20[YELLOW]/UFCW%20Local%201000%20&%20Kroger/Request%20forAdditional%20Info%2011.5.10.htm[07/27/2011 3:01

njoy your weekend.

hank you again,

sa Keels


ice President &


EBA, Inc.


uite 100


00.842.5899 Toll Free

54.266.6322

54.266.2079 Fax



tachment thereto, is strictly prohibited. If you have received this e-mail in error, please respond to the individual sending the message, andermanently delete the original and any copy of the e-mail and printout thereof.



10/17

//T|/...00%20Response%20[YELLOW]/UFCW%20Local%201000%20&%20Kroger/2nd%20Request%20for%20info%2011.30.10.htm[07/27/2011 3:02

rom: Keels, Lisa (HHS/OCIIO)ent: Tuesday, November 30, 2010 11:28 AM

To: Jim Crump; Brian D PetersCc: Habit, Sandra (HHS/OCIIO)ubject: RE: UFCW Local 1000 and Kroger Dallas Health and Welfare Plan (MED 1000)ello, Jim,

ust checked on the status of the application, and we are still missing some information. In order to complete your

pplication, please provide the following information:

Please confirm that the effective date for the new plans will be January 1, 2011.

Please confirm that the overall lifetime limits on the plans will be removed.

Please confirm that the lifetime limits on alcohol and substance abuse treatment will be removed.

Some of the annual limits in the cover letter differ from the annual limits in the Benefits Program docum

submitted. The annual limits with discrepancies are as follows:

Cover Letter ann

1. Plan A: $

2. Plan B: $

3. Plan C: $

4. Plan D: $

Benefits Program

1. Plan A: $

2. Plan B: $

3. Plan C: $

4. Plan D: $

Please confirm w

In your application, you state that approximately employees and dependents are covered by the Pl

Please indicate how many employees and depend re covered in each particular plan (i.e., please bre

out the numbers for Plan AA, Plan A, Plan B, Plan Plan D).

For each plan (i.e., Plan AA, Plan A, Plan B, Plan C, and Plan D), please provide the current monthly premi

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 like a chart that reflects the followi

information for each plan:

2010 January Premium

(current level)


(renewal)


(if $750,000 annual

limit was applied)

EE

EE + Child (if applicable

or other appropriate



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//T|/...00%20Response%20[YELLOW]/UFCW%20Local%201000%20&%20Kroger/2nd%20Request%20for%20info%2011.30.10.htm[07/27/2011 3:02

tier)

EE + Spouse (if

applicable or other

appropriate tier)

Family (if applicable or

other appropriate tier)

n order to complete your application, please provide this information as soon as possible, preferably by 5:00pm todWe look forward to receiving your completed application.

hank you,

isa

rom: Jim Crump [mailto:[email protected]]ent: Tuesday, November 30, 2010 9:51 AMo: Keels, Lisa (HHS/OCIIO)ubject: FW: UFCW Local 1000 and Kroger Dallas Health and Welfare Plan (MED 1000)

ood morning Lisa,

m seeking an update on the status of the Waiver Application. The application was emailed to HHS on October 26.

hanks for your help.

egards,

m Crump

rump Consulting, Inc. (consultant for the Plan)13-599-3822



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//T|/...%20NO%2012600%20Response%20[YELLOW]/UFCW%20Local%201000%20&%20Kroger/Correspondence%2011.30.10.htm[07/27/2011 3:02

rom: Keels, Lisa (HHS/OCIIO)ent: Tuesday, November 30, 2010 4:03 PM

To: Brian D PetersCc: Habit, Sandra (HHS/OCIIO)

ubject: RE: UFCW Local 1000 and Kroger Dallas Health and Welfare Plan (MED 1000)hank you, Brian. I will let you know if we need additional information.

egards,

sa

rom: Brian D Peters [mailto:[email protected]]ent: Tuesday, November 30, 2010 3:38 PMo: Keels, Lisa (HHS/OCIIO)ubject: RE: UFCW Local 1000 and Kroger Dallas Health and Welfare Plan (MED 1000)

ear Ms. Keels,

ttached is a response to your questions listed below from the fund consultant. Please let me know if you need any

dditional information.

egards,

rian


ice President &


EBA, Inc.


uite 100

embroke Pines, Florida 3302800.842.5899 Toll Free

54.266.6322

54.266.2079 Fax





rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, November 30, 2010 11:28 AMo: Jim Crump; Brian D Petersc: Habit, Sandra (HHS/OCIIO)ubject: RE: UFCW Local 1000 and Kroger Dallas Health and Welfare Plan (MED 1000)

ello, Jim,

ust checked on the status of the application, and we are still missing some information. In order to complete your

pplication, please provide the following information:



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Please confirm that the effective date for the new plans will be January 1, 2011.

Please confirm that the overall lifetime limits on the plans will be removed.

Please confirm that the lifetime limits on alcohol and substance abuse treatment will be removed.

Some of the annual limits in the cover letter differ from the annual limits in the Benefits Program document

submitted. The annual limits with discrepancies are as follows:

Cover Letter annual limits:

1. Plan A: $

2. Plan B: $

3. Plan C: $

4. Plan D: $

Benefits Program annual limits:

1. Plan A: $

2. Plan B: $

3. Plan C: $ 4. Plan D: $

Please confirm what the annual limits are for each of these plans.

In your application, you state that approximately employees and dependents are covered by the Plan.

Please indicate how many employees and dependents are covered in each particular plan (i.e., please break ou

the numbers for Plan AA, Plan A, Plan B, Plan C, and Plan D).

For each plan (i.e., Plan AA, Plan A, Plan B, Plan C, and Plan D), please provide the current monthly premium ra

and the projected monthly premium rates applicable to the plan or policy forms if the plan were to comply witthe restricted annual benefits. In other words, we would like a chart that reflects the following information fo

each plan:


(current level)


(renewal)


(if $750,000 annual

limit was applied)

EE

EE + Child (if applicable

or other appropriate

tier)

EE + Spouse (if

applicable or other

appropriate tier)

Family (if applicable or

other appropriate tier)

n order to complete your application, please provide this information as soon as possible, preferably by 5:00pm today. W



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ook forward to receiving your completed application.

hank you,

sa

rom: Jim Crump [mailto:[email protected]]

ent: Tuesday, November 30, 2010 9:51 AM

o: Keels, Lisa (HHS/OCIIO)

ubject: FW: UFCW Local 1000 and Kroger Dallas Health and Welfare Plan (MED 1000)

ood morning Lisa,

m seeking an update on the status of the Waiver Application. The application was emailed to HHS on October 26.

hanks for your help.

egards,

m Crump

rump Consulting, Inc. (consultant for the Plan)

13-599-3822



15/17

//T|/...2600%20Response%20[YELLOW]/UFCW%20Local%201000%20&%20Kroger/Approval%20letter%20sent%2012-6-2010.htm[07/27/2011 3:02

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, December 06, 2010 9:14 AM

To: '[email protected]'ubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711

mportance: High

Attachments: Updated Jan 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 for UFCW Local 1000 and Kroger Dallas Health and Welfare Plan. HHS has reviewed your

pplication and made its determination. Please see the attached letter.

lease confirm receipt of this letter by replying to this e-mail address with a copy to [email protected]

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

incerely,

Alexandra Botwinick

ffice of Oversight

HHS/[email protected]



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//T|/...nse%20[YELLOW]/UFCW%20Local%201000%20&%20Kroger/Confirmation%20of%20Approval%20letter%2012-6-2010.htm[07/27/2011 3:02

rom: Brian D Peters [[email protected]]ent: Monday, December 06, 2010 9:59 AM

To: Botwinick, Alexandra (HHS/OCIIO)Cc: OCIIO Oversight; 'Jim Crump'; 'Phil Siino'

ubject: RE: Waiver of the Annual Limits Requirements of PHS Act Section 2711

ollow Up Flag: Follow uplag Status: Redood Morning,

We are confirming receipt of the below email.

egards,

rian


ice President &


EBA, Inc.


uite 100


00.842.5899 Toll Free

54.266.6322

54.266.2079 Fax





rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Monday, December 06, 2010 9:15 AMo: '[email protected]'ubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High

ood Morning,

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

ection 2711 for UFCW Local 1000 and Kroger Dallas Health and Welfare Plan. HHS has reviewed yourpplication and made its determination. Please see the attached letter.

lease confirm receipt of this letter by replying to this e-mail address with a copy to [email protected]

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

incerely,



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UFCW Local 1000 Kroger - Redacted Bates HW

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