7/27/2019 Western Growers (Combined - Redacted)-Bates HW
1/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
2/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
3/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
4/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
5/43
From: Habit, Sandra (HHS/OCIIO)Sent: Thursday, November 04, 2010 3:09 PMTo: '[email protected]'Subject: Waiver Application - Western GrowersDear Mr. Resnick:
Thank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section
2711. In order to complete your application, please provide the following information about the Western
Growers.
1. Indicate if there are essential benefit limits and the amount for the following categories :
Ambulatory: $Emergency (ER): $Hospitalization: $Laboratory: $Pediatric: $
Maternity: $Mental Health/Substance Abuse: $Rehabiliative: $Preventive: $Prescription (RX): $
2. (The premium amounts is the total cost to the employer and the employee)
Premium(current level)
Premium(renewal)
Premium(if $750,000annual limit wasapplied)
% increase if the$750,000 wasimplemented
EE
EE + Child (if
applicable orother appropriatetier)
EE + Spouse (if
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
6/43
Sandra Habit
Quality Analyst
Office of Consumer Information and Insurance Oversight
301-492-4175
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This 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,
or copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full extent
of the law.
mailto:[email protected]:[email protected]7/27/2019 Western Growers (Combined - Redacted)-Bates HW
7/43
From: Jason Resnick [[email protected]]Sent: Thursday, November 04, 2010 3:54 PMTo: Habit, Sandra (HHS/OCIIO)Subject: RE: Waiver Application - Western GrowersSandy:
Thank you very much for your email. I will forward it to the appropriate staff and get a response to you on or before this
Monday.
Regards,
Jason
Jason ResnickGeneral Counsel
Western Growers
17620 Fitch St., Irvine, CA 92614
v 949.885.2253 | f 949.809.6253
www.westerngrowers.org
This e-mail message contains information that may be confidential and privileged. Unless you are the addressee (or authorized to receivemessages for the addressee), you may not use, copy, or disclose this message (or any information contained in it) to anyone. If you have
received this message in error, please advise the sender by reply e-mail and delete this message. Thank you.
From: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]Sent: Thursday, November 04, 2010 12:09 PMTo: Jason Resnick
Subject: Waiver Application - Western Growers
Dear Mr. Resnick:
mailto:[email protected]://www.westerngrowers.org/http://www.westerngrowers.org/mailto:[email protected]7/27/2019 Western Growers (Combined - Redacted)-Bates HW
8/43
EE + Child (ifapplicable orother appropriatetier)
EE + Spouse (ifapplicable orother appropriatetier)
Family (ifapplicable orother appropriate
tier)
3. Indicate if the plan is fully-insured plan or a self-insured plan.
4. Indicate if the plan is an individual or group policy.
5. How many employees are covered under each policy?
6. How many policies are under the umbrella of Western Growers?
Please provide this information by 5:00 pm, November 8, 2010. We look forward to receiving your completed
application. If you have any questions, please feel free to contact me at 301-492-4175.
Thank you,
Sandy Habit
Sandra Habit
Quality AnalystOffice of Consumer Information and Insurance Oversight
301-492-4175
mailto:[email protected]:[email protected]7/27/2019 Western Growers (Combined - Redacted)-Bates HW
9/43
From: Habit, Sandra (HHS/OCIIO)Sent: Friday, November 05, 2010 10:35 AMTo: 'Jason Resnick'Cc: 'Jonathan D. Alexander'Subject: RE: Waiver Application - Western Growers
Hi Jason,
Unfortunately 12:00 pm ET will not work today as I have a meeting. Would 2:00 pm ET be acceptable?
Thanks,
Sandy
From: Jason Resnick [mailto:[email protected]]
Sent: Thursday, November 04, 2010 6:14 PMTo: Habit, Sandra (HHS/OCIIO)Cc: Jonathan D. AlexanderSubject: RE: Waiver Application - Western Growers
Hi Sandy:
I, and a couple members of our staff, would like to speak with you to get some additional clarification in connection with the
questions you pose below and to go over aspects of our waiver application. Would you be available by phone at 9:00 a.m.PT/12:00 p.m. ET? If that time is not convenient, please let me know the next available time. Thank you very much.
Regards.
Jason
Jason Resnick
General Counsel
Western Growers
17620 Fitch St., Irvine, CA 92614
v 949.885.2253 | f 949.809.6253
j i k@
mailto:[email protected]:[email protected]7/27/2019 Western Growers (Combined - Redacted)-Bates HW
10/43
Ambulatory: $Emergency (ER): $Hospitalization: $Laboratory: $Pediatric: $
Maternity: $Mental Health/Substance Abuse: $Rehabiliative: $Preventive: $Prescription (RX): $
2. (The premium amounts is the total cost to the employer and the employee)
Premium(current level)
Premium(renewal)
Premium(if $750,000annual limit wasapplied)
% increase if the$750,000 wasimplemented
EE
EE + Child (ifapplicable orother appropriatetier)
EE + Spouse (if
applicable orother appropriatetier)
Family (ifapplicable orother appropriatetier)
3. Indicate if the plan is fully-insured plan or a self-insured plan.4. Indicate if the plan is an individual or group policy.
5. How many employees are covered under each policy?
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
11/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
12/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
13/43
applied)
EE
EE + Child (ifapplicable orother appropriatetier)
EE + Spouse (ifapplicable orother appropriatetier)
Family (if
applicable orother appropriatetier)
3. Indicate if the plan is fully-insured plan or a self-insured plan.
4. Indicate if the plan is an individual or group policy.
5. How many employees are covered under each policy?
6. How many policies are under the umbrella of Western Growers?
Please provide this information by 5:00 pm, November 8, 2010. We look forward to receiving your completed
application. If you have any questions, please feel free to contact me at 301-492-4175.
Thank you,
Sandy Habit
Sandra Habit
Quality Analyst
Office of Consumer Information and Insurance Oversight
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
14/43
From: Jason Resnick [[email protected]]Sent: Friday, November 05, 2010 6:08 PMTo: Habit, Sandra (HHS/OCIIO)Cc: Jonathan D. AlexanderSubject: Western Growers Assurance Trust
Importance: High
Attachments: Spreadsheet for HHS (2) (2).xlsxSandy,
As discussed, attached is the additional information you requested (Premium at renewal and Premium if $750K annual limit
was applied) in support of WGATs waiver application. Should you have any further questions, please do not hesitate to
contact me. Thank you again for your attention to our application.
Regards,
Jason
Jason Resnick
General Counsel
Western Growers17620 Fitch St., Irvine, CA 92614
v 949.885.2253 | f 949.809.6253
www.westerngrowers.org
This e-mail message contains information that may be confidential and privileged. Unless you are the addressee (or authorized to receive
messages for the addressee), you may not use, copy, or disclose this message (or any information contained in it) to anyone. If you have
received this message in error, please advise the sender by reply e-mail and delete this message. Thank you.
mailto:[email protected]://www.westerngrowers.org/http://www.westerngrowers.org/mailto:[email protected]7/27/2019 Western Growers (Combined - Redacted)-Bates HW
15/43
From: Jonathan D. Alexander [[email protected]]Sent: Wednesday, November 03, 2010 2:57 PMTo: HHS HealthInsurance (HHS)Cc: Jason ResnickSubject: Waiver
Attachments: Part.3.Waiver 2010 cont- Tab 26-35 Exh B C.pdf; Part.2.Waiver 2010 cont-Tab 11-25.pdf;Part.1.Waiver Ltr 2010 Exh A Tab 1-10.pdfDear Mr. Mayhew,
I am counsel for Western Growers Assurance Trust (WGAT) and am writing to you today to provide an additional copy of
WGATs waiver application. On September 29, 2010, WGAT sent its waiver application to your office via UPS. At the same
time a courtesy copy was sent to Herb Schultz, the Region 9 Director of the Department of Health and Human Services, which
was received on 9/30/2010. However, it appears that our package was not delivered to you. We have been unable to verify
through UPS that our waiver application was actually received by your office.
For these reasons, we are sending a duplicate submission to you by email and will be sending another hard copy by UPS. In
light of the fact that we sent WGATs application on 9/29/2010 and it may not have been received, we would greatly
appreciate anything you can do to expedite review of this application. The attachments hereto, Part 1-3, include WGATs
waiver application letter, attestation, and relevant supporting documentation.
In the event that you did receive the original application, can you please verify this and contact me at your earliest
convenience. Thank you.
Very truly yours,
Jon D. Alexander, Esq.Compliance Counsel
17620 Fitch St.
I i CA 92614
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
16/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
17/43
From: Habit, Sandra (HHS/OCIIO)Sent: Friday, November 12, 2010 3:18 PMTo: 'Jason Resnick'Subject: RE: Western GrowersHi Jason,
I had your application moved to the top of the pile so leadership reviewed it yesterday. My guess is you should receive a response
by Monday. I apologize that it could not be done any sooner.
Have a good weekend.
Sandy
From: Jason Resnick [mailto:[email protected]]Sent: Friday, November 12, 2010 2:38 PMTo: Habit, Sandra (HHS/OCIIO)Subject: Western GrowersImportance: High
Hi Sandy:
Happy Friday! I just wanted to check in with you on the status of our waiver application. Is there any chance we will be able
to report the result of our wavier application when the Board of Directors meets this Monday for our Annual Convention?
Best,
Jason
Jason Resnick
General Counsel
Western Growers
17620 Fitch St., Irvine, CA 92614
v 949 885 2253 | f 949 809 6253
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
18/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
19/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
20/43
From: Botwinick, Alexandra (HHS/OCIIO)Sent: Monday, November 15, 2010 3:46 PMTo: '[email protected]'Subject: Waiver of the Annual Limits Requirements of PHS Act Section 2711
Importance: High
Attachments: Updated Jan 1 Approval Letter .pdf; January 1 Denial Letter .pdf
Good Afternoon,
Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act
Section for Western Growers. HHS has reviewed your application and made its determination. Please see the
attached letters.
Please note:
The Approval Letter refers to the following plans:
Preferred
Choice
Affinity
Unison 1
U i 3
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
21/43
Basic Plan 75
Basic Plan 25
Mexicali/San
Luis
Harvest Basic
Harvest
Imperial Gold
Harvest
Imperial Plus
Harvest
Imperial
Standard
Salud
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
22/43
etter refers to the following plans:
Please confirm receipt of this letter by replying to this e-mail address with a copy to [email protected].
Please let me know if I can be of further assistance.
Sincerely,
Alexandra Botwinick
Office of Oversight
mailto:[email protected]:[email protected]7/27/2019 Western Growers (Combined - Redacted)-Bates HW
23/43
From: Jonathan D. Alexander [[email protected]]Sent: Wednesday, November 24, 2010 8:04 PMTo: Mayhew, James A. (CMS/CPC)Cc: Habit, Sandra (HHS/OCIIO); Jason ResnickSubject: Western Growers Assurance Trust's Waiver Application Partial Denial
Attachments: WGAT.Denied.Minimed.Plans.xlsxDear Mr. Mayhew,
I represent Western Growers Assurance Trust (WGAT), a self-insured group health plan. WGAT recently submitted an
application for a waiver of the annual limits imposed by PHS Section 2711. In its application, WGAT sought a waiver for
several mini-med health benefit plans. The majority of the plans, 22 of 25, received a waiver. However, three plans were
denied a waiver.
The mini-med plans that were denied are virtually identical to those that received a waiver. In fact, the cost increase to those
plans that were denied is as much as % and the plans cover over participants.
I have attached an Excel spreadsheet that details the number of individuals participating per plan, the cost increase for each
and I can provide all of WGATs supporting documentation that we initially submitted if you so desire.
We respectfully request reconsideration of the denial of the three plans in question due the number of plan participants that
will lose access to health insurance, or in the alternative we request clarification regarding the rationale for denial of the
waiver of annual limits for these mini-med plans. Please contact me at your earliest convenience. I will be out of the office
for the remainder of the week returning on Monday, November 29, 2010. Thank you for your consideration of this matter.
Very truly yours,
Jon D. Alexander, Esq.
Western Growers Assurance Trust
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
24/43
From: Andrews, Jane (HHS/OCIIO)Sent: Friday, January 28, 2011 4:11 PMTo: Habit, Sandra (HHS/OCIIO)Subject: Did Western Growers ever appeal? If so, can you please send me appeal letter? tnx.
Jane W. Andrews
OCIIO
7501 Wisconsin Ave
Bethesda, MD 20814
301-492-4122 (desk)
202-536-6779 (Blackberry)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmentuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.
Unauthorized disclosure may result in prosecution to the full extent of the law.
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
25/43
From: Habit, Sandra (HHS/OCIIO)Sent: Monday, January 31, 2011 10:28 AMTo: Andrews, Jane (HHS/OCIIO)Subject: RE: Did Western Growers ever appeal? If so, can you please send me appeal letter? tnx.From what I know, Western Growers has not appealed.
Sandy
From: Andrews, Jane (HHS/OCIIO)Sent: Friday, January 28, 2011 4:11 PMTo: Habit, Sandra (HHS/OCIIO)Subject: Did Western Growers ever appeal? If so, can you please send me appeal letter? tnx.
Jane W. Andrews
OCIIO
7501 Wisconsin Ave
Bethesda, MD 20814
301-492-4122 (desk)
202-536-6779 (Blackberry)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmentuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.
Unauthorized disclosure may result in prosecution to the full extent of the law.
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
26/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
27/43
Jason Resnick
General Counsel
Western Growers
17620 Fitch St., Irvine, CA 92614
v 949.885.2253 | f 949.809.6253
www.westerngrowers.org
This e-mail message contains information that may be confidential and privileged. Unless you are the addressee (orauthorized to receive messages for the addressee), you may not use, copy, or disclose this message (or any informationcontained in it) to anyone. If you have received this message in error, please advise the sender by reply e-mail anddelete this message. Thank you.
From: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]Sent: Thursday, November 04, 2010 12:09 PMTo: Jason ResnickSubject: Waiver Application - Western Growers
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
28/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
29/43
EE + Child (if applicable or other appropriate tier)
EE + Spouse (if applicable or other appropriate tier)
Family (if applicable or other appropriate tier)
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
30/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
31/43
From: Jason Resnick [[email protected]]Sent: Monday, November 15, 2010 3:10 PMTo: Habit, Sandra (HHS/OCIIO)Subject: Re: Western Growers
Sandy: Aloha from Western Growers Annual Convention in Hawaii! Do you have any news (official or unofficial) Ican report at our Board of Directors meeting today? I am so sorry to be a pest. I am being asked about the status of thewaiver app by my bosses literally every hour. I know you have done all you can to expedite the decision and keep meinformed, and I sincerely appreciate all you have done. Thank you very much for your patience.
Regards,Jason
----- Original Message -----From: Habit, Sandra (HHS/OCIIO) To: Jason ResnickSent: Fri Nov 12 12:17:39 2010Subject: RE: Western Growers
Hi Jason,
I had your application moved to the top of the pile so leadership reviewed it yesterday. My guess is you shouldreceive a response by Monday. I apologize that it could not be done any sooner.
Have a good weekend.
Sandy
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
32/43
Best,
Jason
Jason Resnick
General Counsel
Western Growers
17620 Fitch St., Irvine, CA 92614
v 949.885.2253 | f 949.809.6253
www.westerngrowers.org
This e-mail message contains information that may be confidential and privileged. Unless you are the addressee (orauthorized to receive messages for the addressee), you may not use, copy, or disclose this message (or any informationcontained in it) to anyone. If you have received this message in error, please advise the sender by reply e-mail and
delete this message. Thank you.
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
33/43
From: Habit, Sandra (HHS/OCIIO)Sent: Thursday, December 02, 2010 10:34 AMTo: 'Jason Resnick'Cc: 'Jonathan D. Alexander'Subject: RE: Western Growers
Attachments: January 1 Denial Letter .pdf; Updated Jan 1 Approval Letter.pdf
Hi Jason,
Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section forWestern Growers. HHS has reviewed your application and made its determination. Please see the attached letters.
Please note-The approval letter refers to the following plans:Western Preferred: $ K, $ K, $ K, $ K, $ K Newport 2000: $ K, $ K, $ K, $ K, $ K PreferredChoice Affinity Unis 1 Unison ursery PPO rsery Indemnity Ce He h and Well CG oundationCGF La Pisca Basic Plan 75 Basic Plan 25 Mexicali/San Luis Harvest Basic Harvest Imperial Gold Harvest ImperialPlus Harvest Imperial Standard Salud Salud II Plan 22 Plan 24 Harvest Comprehensive Los Amigos
e following plans:
Please confirm receipt of this letter by replying to this email address with a copy to [email protected]. Pleaselet me know if I can be of further assistance.
Thank you,Sandy
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
34/43
From: Jason Resnick [[email protected]]Sent: Thursday, December 02, 2010 12:01 PMTo: Habit, Sandra (HHS/OCIIO)Cc: Jonathan D. AlexanderSubject: RE: Western Growers
Hi Sandy. Thank you very much for your prompt reply to our request for clarification.
Regards,
Jason ResnickGeneral CounselWestern Growers
17620 Fitch St., Irvine, CA 92614v 949.885.2253 | f [email protected]
This e-mail message contains information that may be confidential and privileged. Unless you are the addressee(or authorized to receive messages for the addressee), you may not use, copy, or disclose this message (or anyinformation contained in it) to anyone. If you have received this message in error, please advise the sender by reply e-
mail and delete this message. Thank you.
-----Original Message-----From: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]Sent: Thursday, December 02, 2010 7:34 AMTo: Jason Resnick
Cc: Jonathan D. AlexanderSubject: RE: Western Growers
Hi Jason
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
35/43
Thank you,Sandy
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
36/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
37/43
CGF Foundation
CGF La Pisca
Basic Plan 75
Basic Plan 25
Mexicali/San Luis
Harvest Basic
Harvest Imperial Gold
Harvest Imperial Plus
Harvest Imperial Standard
Salud
Salud II
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
38/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
39/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
40/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
41/43
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
42/43
Pages 42 through 58 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4
W Growers:000042
7/27/2019 Western Growers (Combined - Redacted)-Bates HW
43/43
Pages 59 through 126 redacted for the following reasons:
-----------------------------
Exemption 4
W G 000043