UFCW Local 1995 - Redacted HWM

7/27/2019 UFCW Local 1995 - Redacted HWM

1/19

///co-adshare/...orce/CCIIO%20Waivers%20-%20Torres/DFOI%20Processing%20Team/Mike/UFCW%20Local%201995/Waiver.htm[11/15/2011 10:37

rom: Gregory A. Storm [[email protected]]ent: Tuesday, October 12, 2010 5:02 PM

To: HHS HealthInsurance (HHS)ubject: Waiver

Attachments: waiver.PDFear Mr. Mayhew -

n behalf of the United Food and Commercial Workers Union Local 1995 and Employers Health and Welfare Fund ("Fund"), w

ttach a request for a waiver of the restricted annual benefit limit requirement with respect to the benefit programs described in

ttachment.

you have any questions regarding the waiver application, please do not hesitate to contact the Fund's legal counsel, Tom Fun

ill Tobin or the undersigned, at 414-298-1000.

reg Storm

Gregory A. Stormeinhart Boerner Van Deuren s.c.

000 North Water Street, Suite 1700 | Milwaukee, WI 53202

ffice: 414-298-8147 | Fax: 414-298-8097

[email protected] | bio | vCard | reinhartlaw.com

UFCW L1995:000001

7/27/2019 UFCW Local 1995 - Redacted HWM

2/19

UFCW L1995:000002

7/27/2019 UFCW Local 1995 - Redacted HWM

3/19

UFCW L1995:000003

7/27/2019 UFCW Local 1995 - Redacted HWM

4/19

UFCW L1995:000004

7/27/2019 UFCW Local 1995 - Redacted HWM

5/19

UFCW L1995:000005

7/27/2019 UFCW Local 1995 - Redacted HWM

6/19

UFCW L1995:000006

7/27/2019 UFCW Local 1995 - Redacted HWM

7/19

UFCW L1995:000007

7/27/2019 UFCW Local 1995 - Redacted HWM

8/19

UFCW L1995:000008

7/27/2019 UFCW Local 1995 - Redacted HWM

9/19

UFCW L1995:000009

7/27/2019 UFCW Local 1995 - Redacted HWM

10/19

UFCW L1995:000010

7/27/2019 UFCW Local 1995 - Redacted HWM

11/19

UFCW L1995:000011

7/27/2019 UFCW Local 1995 - Redacted HWM

12/19

UFCW L1995:000012

7/27/2019 UFCW Local 1995 - Redacted HWM

13/19

///co-adshare/...IIO%20Waivers%20-%20Torres/DFOI%20Processing%20Team/Mike/UFCW%20Local%201995/FW%20Waiver.htm[11/15/2011 10:37

rom: Gregory A. Storm [[email protected]]ent: Wednesday, October 13, 2010 2:24 PM

To: HHS HealthInsurance (HHS)ubject: FW: Waiver

Attachments: waiver.PDFear Sir or Madam --

esterday, we submitted the attached waiver application on behalf of the plan referenced below. Although we provided our firm

ontact information, we inadvertently omitted the contact information for the plan itself. That information follows:

nited Food and Commercial Workers Union Local 1995 and Employers Health and Welfare Fund

/o Dennis Nast, Administrator

800 Phoenix Boulevard, Suite 310

tlanta, Georgia 30349-9834

gain, we would ask that any inquiries regarding the application be directed to our office, as legal counsel for the Fund. Please

ontact any of the following individuals with questions: Tom Funk (direct line - 414-298-8109), Bill Tobin (414-298-8279) or Gr

torm (414-298-8147).

We apologize for any confusion, and thank you for incorporating this information into the Fund's submission.

reg Storm

Gregory A. Stormeinhart Boerner Van Deuren s.c.

000 North Water Street, Suite 1700 | Milwaukee, WI 53202

ffice: 414-298-8147 | Fax: 414-298-8097

[email protected] | bio | vCard | reinhartlaw.com

rom: Gregory A. Storment: Tuesday, October 12, 2010 4:02 PMo: '[email protected]'ubject: Waiver

ear Mr. Mayhew -

n behalf of the United Food and Commercial Workers Union Local 1995 and Employers Health and Welfare Fund ("Fund"), w

ttach a request for a waiver of the restricted annual benefit limit requirement with respect to the benefit programs described in

ttachment.

you have any questions regarding the waiver application, please do not hesitate to contact the Fund's legal counsel, Tom Fun

ill Tobin or the undersigned, at 414-298-1000.

reg Storm

Gregory A. Stormeinhart Boerner Van Deuren s.c.

000 North Water Street, Suite 1700 | Milwaukee, WI 53202

ffice: 414-298-8147 | Fax: 414-298-8097

[email protected] | bio | vCard | reinhartlaw.com

UFCW L1995:000013

7/27/2019 UFCW Local 1995 - Redacted HWM

14/19

///co-adshare/...IIO%20Waivers%20-%20Torres/DFOI%20Processing%20Team/Mike/UFCW%20Local%201995/FW%20Waiver.htm[11/15/2011 10:37

UFCW L1995:000014

7/27/2019 UFCW Local 1995 - Redacted HWM

15/19

///co-adshare/...I%20Processing%20Team/Mike/UFCW%20Local%201995/Request%20for%20Additional%20Info%2010.27.10.htm[11/15/2011 10:37:1

rom: Pham, Erica (HHS/OCIIO)ent: Wednesday, October 27, 2010 3:05 PM

To: 'Gregory A. Storm'Cc: Habit, Sandra (HHS/OCIIO)ubject: UFCW Local 1995 Application for a Waiver

ear Applicant:

hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section

711. In order to complete your application, please provide the following information:

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

applicable to the3 plans if the plans were to comply with the restricted annual benefits. In other

words, we would like a chart that reflects the following information:

2009 NovemberPremium (currentlevel)

2010 NovemberPremium (renewal)

2010 NovemberPremium (if $750,000annual limit wasapplied)

EEEE + Child (ifapplicable or otherappropriate tier)

EE + Spouse (ifapplicable or otherappropriate tier)

Family (if applicableor other appropriatetier)

Please confirm that the retiree plan has less than two active participants enrolled onto the plan.

n order to complete your application, please provide this information as soon as possible. We look forwar

eceiving your completed application. Thank you.

rica Pham

ivision of Enforcement

ffice of Oversight

CIIO/HHS

01-492-4108

[email protected]

UFCW L1995:000015

7/27/2019 UFCW Local 1995 - Redacted HWM

16/19

///co-adshare/...res/DFOI%20Processing%20Team/Mike/UFCW%20Local%201995/Approval%20Letter%20Sent%2010-29-2010.htm[11/15/2011 10:37

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Friday, October 29, 2010 3:07 PM

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

mportance: High

Attachments: November Approval Letter .pdf

Mr. Storm,

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

ection for UFCW Local 1995. HHS has reviewed your application and made its determination. Please see th

ttached 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]

UFCW L1995:000016

7/27/2019 UFCW Local 1995 - Redacted HWM

17/19

UFCW L1995:000017

7/27/2019 UFCW Local 1995 - Redacted HWM

18/19

UFCW L1995:000018

7/27/2019 UFCW Local 1995 - Redacted HWM

19/19