Professional Documents
Culture Documents
Teamsters Local Union No. 72 - Redacted Bates HW
Teamsters Local Union No. 72 - Redacted Bates HW
org] Sent: Tuesday, November 09, 2010 1:09 PM To: HHS HealthInsurance (HHS) Cc: [email protected] Subject: "WAIVER" Follow Up Flag: Follow up Flag Status: Completed
Co m
pl
et eC
ol o
ra do .
Teams L72:000001
co m
Co m
pl
et eC
ol o
ra do .
Teams L72:000002
co m
Ex. 4 Ex. 4
Ex. 4
Ex. 4
Ex. 4
ra do .
Ex. 4 4
Ex. 4
Co m
pl
et eC
ol o
co m
Ex. 4 Ex. 4
Teams L72:000003
Co m
pl
et eC
ol o
ra do .
Teams L72:000004
co m
From: Moultrie, Cam (HHS/OCIIO) Sent: Tuesday, November 16, 2010 1:40 PM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund
EE EE + Child (if applicable or other appropriate tier) EE + Spouse (if applicable or other appropriate tier) Family (if applicable or other appropriate tier)
ol o
In order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look forward to receiving your completed application. Thank you. Cam L. Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
Co m
pl
et eC
ra do .
Dear Ms. Goldstein: 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: Please state your plans overall annual limit. Please provide the current monthly premium rates and the projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the restricted annual benefits. In other words, we would like a chart that reflects the following information: 2010 January Premium 2011 January Premium 2011 January Premium (current level) (renewal) (if $750,000 annual limit was applied)
co m
Teams L72:000005
From: Moultrie, Cam (HHS/OCIIO) Sent: Wednesday, November 17, 2010 12:53 PM To: Habit, Sandra (HHS/OCIIO) Subject: FW: Waiver Application for Teamsters Local 72 Welfare Fund
Cam Lynne Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
From: Moultrie, Cam (HHS/OCIIO) Sent: Wednesday, November 17, 2010 12:27 PM To: '[email protected]' Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
From: Jennifer Goldstein [mailto:[email protected]] Sent: Tuesday, November 16, 2010 2:25 PM To: Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Ms. Moultrie, I have attached the additional information you were looking for. Thanks and regards, Jennifer S. Goldstein Titan Administrator 265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Tuesday, November 16, 2010 1:40 PM To: [email protected]
Teams L72:000006
Co m
pl
et eC
Thank you for your response. On you application you stated that the The Plan currently has an overall calendar year limit of on medical benefits and the following annual limits on specific medical benefits. What is the Plans overall calendar year limit? Do you have premium rates for employee+ family? Thanks again. Cam Moultrie
ol o
ra do .
co m
Document obtained by CompleteColorado.com Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund
ol o
EE + Child (if applicable or other appropriate tier) EE + Spouse (if applicable or other appropriate tier) Family (if applicable or other appropriate tier)
In order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look forward to receiving your completed application. Thank you. Cam L. Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
Co m
pl
et eC
ra do .
Teams L72:000007
EE
co m
Dear Ms. Goldstein: 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: Please state your plans overall annual limit. Please provide the current monthly premium rates and the projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the restricted annual benefits. In other words, we would like a chart that reflects the following information: 2010 January Premium 2011 January Premium 2011 January Premium (current level) (renewal) (if $750,000 annual limit was applied)
From: Moultrie, Cam (HHS/OCIIO) Sent: Thursday, November 18, 2010 10:51 AM To: Habit, Sandra (HHS/OCIIO) Subject: FW: Waiver Application for Teamsters Local 72 Welfare Fund
Cam Lynne Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
From: Jennifer Goldstein [mailto:[email protected]] Sent: Wednesday, November 17, 2010 3:29 PM To: Moultrie, Cam (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Wednesday, November 17, 2010 12:27 PM To: [email protected] Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Thank you for your response. On you application you stated that the The Plan currently has an overall calendar year limit of on medical benefits and the following annual limits on specific medical benefits. What is the Plans overall calendar year limit? Do you have premium rates for employee+ family? Thanks again. Cam Moultrie
Teams L72:000008
Co m
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
pl
et eC
The Plan is a supplemental benefit plan that provides prescription drug and dental benefits to its active participants and their eligible dependents.This supplemental coverageis paid for by a contribution rate agreed upon in collective bargaining between the New York State Thruway Authority and the Union. The New York State Thruway Authorityprovides these same participants withhospital and medical coverage. The Plan has a $Ex. 4 calendar year maximum on its prescription drug benefit, and that is the only essential benefit the Fund sting a waiver for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
ol o
ra do .
co m
From: Jennifer Goldstein [mailto:[email protected]] Sent: Tuesday, November 16, 2010 2:25 PM To: Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
EE
Co m
Dear Ms. Goldstein: 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: Please state your plans overall annual limit. Please provide the current monthly premium rates and the projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the restricted annual benefits. In other words, we would like a chart that reflects the following information: 2010 January Premium 2011 January Premium 2011 January Premium (current level) (renewal) (if $750,000 annual limit was applied) EE + Child (if applicable or other appropriate tier) EE + Spouse (if applicable or other appropriate tier) Family (if applicable or other appropriate tier)
pl
et eC
ol o
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Tuesday, November 16, 2010 1:40 PM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund
ra do .
Teams L72:000009
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
co m
Ms. Moultrie, I have attached the additional information you were looking for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
Co m
pl
et eC
ol o
ra do .
Teams L72:000010
co m
Document obtained by CompleteColorado.com In order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look forward to receiving your completed application. Thank you. Cam L. Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
From: Moultrie, Cam (HHS/OCIIO) Sent: Thursday, November 18, 2010 11:39 AM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Thank you. Please provide the COBRA equivalency rates. Cam Lynne Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
From: Jennifer Goldstein [mailto:[email protected]] Sent: Wednesday, November 17, 2010 3:29 PM To: Moultrie, Cam (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Wednesday, November 17, 2010 12:27 PM To: [email protected] Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Thank you for your response. On you application you stated that the The Plan currently has an overall calendar year limit of on medical benefits and the following annual limits on specific medical benefits. What is the Plans overall calendar year limit? Do you have premium rates for employee+ family?
Teams L72:000011
Co m
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
pl
The Plan is a supplemental benefit plan that provides prescription drug and dental benefits to its active participants and their eligible dependents.This supplemental coverageis paid for by a contribution rate agreed upon in collective bargaining between the New York State Thruway Authority and the Union. The New York State Thruway Authorityprovides these same participants withhospital and medical coverage. The Plan has a $ Ex. 4 calendar year maximum on its prescription drug benefit, and that is the only essential benefit the Fund is requesting a waiver for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
et eC
ol o
ra do .
co m
From: Jennifer Goldstein [mailto:[email protected]] Sent: Tuesday, November 16, 2010 2:25 PM To: Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
Dear Ms. Goldstein: 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: Please state your plans overall annual limit. Please provide the current monthly premium rates and the projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the restricted annual benefits. In other words, we would like a chart that reflects the following information: 2010 January Premium 2011 January Premium 2011 January Premium (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)
Co m
pl
et eC
ol o
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Tuesday, November 16, 2010 1:40 PM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund
ra do .
Teams L72:000012
co m
Ms. Moultrie, I have attached the additional information you were looking for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
Co m
pl
et eC
ol o
ra do .
Teams L72:000013
co m
In order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look forward to receiving your completed application. Thank you. Cam L. Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
From: Moultrie, Cam (HHS/OCIIO) Sent: Thursday, November 18, 2010 4:21 PM To: Habit, Sandra (HHS/OCIIO) Subject: FW: Waiver Application for Teamsters Local 72 Welfare Fund
Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
From: Jennifer Goldstein [mailto:[email protected]] Sent: Thursday, November 18, 2010 12:02 PM To: Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Thank you. Please provide the COBRA equivalency rates. Cam Lynne Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
From: Jennifer Goldstein [mailto:[email protected]] Sent: Wednesday, November 17, 2010 3:29 PM To: Moultrie, Cam (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Teams L72:000014
Co m
pl
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Thursday, November 18, 2010 11:39 AM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
et eC
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
ol o
Prescription COBRA for an individual is $Ex. 4 and for a family it is $Ex. 4 Please forward any future questions to the Funds Council, Kevin C. Clor Esq. at [email protected] Thanks and regards, Jennifer S. Goldstein Titan Administrator
ra do .
co m
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Wednesday, November 17, 2010 12:27 PM To: [email protected] Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Ms. Moultrie, I have attached the additional information you were looking for. Thanks and regards, Jennifer S. Goldstein Titan Administrator 265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228
Teams L72:000015
Co m
From: Jennifer Goldstein [mailto:[email protected]] Sent: Tuesday, November 16, 2010 2:25 PM To: Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
pl
Thank you for your response. On you application you stated that the The Plan currently has an overall calendar year limit of on medical benefits and the following annual limits on specific medical benefits. What is the Plans overall calendar year limit? Do you have premium rates for employee+ family? Thanks again. Cam Moultrie
et eC
ol o
ra do .
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
co m
Document obtained by CompleteColorado.com The Plan is a supplemental benefit plan that provides prescription drug and dental benefits to its active participants and their eligible dependents.This supplemental coverageis paid for by a contribution rate agreed upon in collective bargaining between the New York State Thruway Authority and the Union. The New York State Thruway Authorityprovides these same participants withhospital and medical coverage. Ex. 4 The Plan has a $ calendar year maximum on its prescription drug benefit, and that is the only essential benefit the Fund esting a waiver for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Tuesday, November 16, 2010 1:40 PM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund
et eC
EE + Child (if applicable or other appropriate tier) EE + Spouse (if applicable or other appropriate tier) Family (if applicable or other appropriate tier)
ol o
EE
In order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look forward to receiving your completed application. Thank you. Cam L. Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
Co m
pl
ra do .
Dear Ms. Goldstein: 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: Please state your plans overall annual limit. Please provide the current monthly premium rates and the projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the restricted annual benefits. In other words, we would like a chart that reflects the following information: 2010 January Premium 2011 January Premium 2011 January Premium (current level) (renewal) (if $750,000 annual limit was applied)
co m
Teams L72:000016
From: Moultrie, Cam (HHS/OCIIO) Sent: Thursday, November 18, 2010 4:33 PM To: Kevin Clor Cc: [email protected]; Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
EE EE + Child (if applicable or other appropriate tier) EE + Spouse (if applicable or other appropriate tier) Family (if applicable or other appropriate tier)
Prescription COBRA for an individual is $Ex. 4 and for a family it is $Ex. 4 Please forward any future questions to the Funds Council, Kevin C. Clor Esq. at [email protected] Thanks and regards, Jennifer S. Goldstein Titan Administrator 265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
Teams L72:000017
Co m
From: Jennifer Goldstein [mailto:[email protected]] Sent: Thursday, November 18, 2010 12:02 PM To: Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
pl
et eC
Thank you. Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
ol o
ra do .
co m
Mr. Clor, I am interested in COBRA equivalencies for 2010, 2011 (if waiver is approved) and 2011 (if the waiver is not approved). I have provided a sample chart below for your convenience: 2010 January Premium 2011 January Premium 2011 January Premium (current level) (renewal) (if $750,000 annual limit was applied)
Document obtained by CompleteColorado.com From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Thursday, November 18, 2010 11:39 AM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Wednesday, November 17, 2010 12:27 PM To: [email protected] Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Thank you for your response. On you application you stated that the The Plan currently has an overall calendar year limit of on medical benefits and the following annual limits on specific medical benefits. What is the Plans overall calendar year limit? Do you have premium rates for employee+ family?
Teams L72:000018
Co m
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
pl
The Plan is a supplemental benefit plan that provides prescription drug and dental benefits to its active participants and their eligible dependents.This supplemental coverageis paid for by a contribution rate agreed upon in collective bargaining between the New York State Thruway Authority and the Union. The New York State Thruway Authorityprovides these same participants withhospital and medical coverage. The Plan has a $Ex. 4 calendar year maximum on its prescription drug benefit, and that is the only essential benefit the Fund sting a waiver for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
et eC
ol o
ra do .
From: Jennifer Goldstein [mailto:[email protected]] Sent: Wednesday, November 17, 2010 3:29 PM To: Moultrie, Cam (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
co m
Thank you. Please provide the COBRA equivalency rates. Cam Lynne Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
From: Jennifer Goldstein [mailto:[email protected]] Sent: Tuesday, November 16, 2010 2:25 PM To: Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
Dear Ms. Goldstein: 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: Please state your plans overall annual limit. Please provide the current monthly premium rates and the projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the restricted annual benefits. In other words, we would like a chart that reflects the following information: 2010 January Premium 2011 January Premium 2011 January Premium (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)
Co m
pl
et eC
ol o
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Tuesday, November 16, 2010 1:40 PM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund
ra do .
Teams L72:000019
co m
Ms. Moultrie, I have attached the additional information you were looking for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
Co m
pl
et eC
ol o
ra do .
Teams L72:000020
co m
In order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look forward to receiving your completed application. Thank you. Cam L. Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
From: Moultrie, Cam (HHS/OCIIO) Sent: Thursday, December 02, 2010 7:31 PM To: Kevin Clor Cc: [email protected]; Pavesi, Matthew C.; Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Mr. Clor, Per my voicemail, please call me to discuss your response. Thank you, Cam Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
***** Confidentiality Statement****** The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
Co m
Ms. Moultrie: The COBRA equivalency for 20 1 with the $Ex. 4 max and w/o the $ Ex. 4 max are based onthe rates we have already included in the application plus 4 % which is wed under thelaw. ope this answers your question. Please advise if you need any additional infor ation. Thank you. KCC
pl
et eC
From: Kevin Clor [mailto:[email protected]] Sent: Thursday, December 02, 2010 7:27 PM To: Moultrie, Cam (HHS/OCIIO) Cc: [email protected]; Pavesi, Matthew C.; Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund
ol o
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 disclosure may result in prosecution to the full extent of the law.
ra do .
co m
Snyder, New York 14226 Office (716) 839-0418 Fax (716) 839-1834 Email:[email protected]
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 disclosure may result in prosecution to the full extent of the law.
Good Morning, I am just checking in to make sure you received all the information that you needed for our waiver application. Thanks and regards, Jennifer S. Goldstein Titan Administrator 265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228
Teams L72:000022
Co m
From: Jennifer Goldstein [mailto:[email protected]] Sent: Thursday, December 02, 2010 10:15 AM To:Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
pl
et eC
ol o
ra do .
co m
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Thursday, November 18, 2010 4:33 PM To:Kevin Clor Cc: [email protected]; Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
ol o
EE + Child (if applicable or other appropriate tier) EE + Spouse (if applicable or other appropriate tier) Family (if applicable or other appropriate tier)
From: Jennifer Goldstein [mailto:[email protected]] Sent: Thursday, November 18, 2010 12:02 PM To:Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Prescription COBRA for an individual is $Ex. 4 and for a family it is $Ex. 4 Please forward any future questions to the Funds Council, Kevin C. Clor Esq. [email protected] Thanks and regards, Jennifer S. Goldstein Titan Administrator 265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228
Teams L72:000023
Co m
Thank you. Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
pl
et eC
ra do .
EE
co m
Mr. Clor, I am interested in COBRA equivalencies for 2010, 2011 (if waiver is approved) and 2011 (if the waiver is not approved). I have provided a sample chart below for your convenience: 2010 January Premium 2011 January Premium 2011 January Premium (current level) (renewal) (if $750,000 annual limit was applied)
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Thursday, November 18, 2010 11:39 AM To:[email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
From: Jennifer Goldstein [mailto:[email protected]] Sent: Wednesday, November 17, 2010 3:29 PM To:Moultrie, Cam (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email:[email protected]
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Wednesday, November 17, 2010 12:27 PM To:[email protected] Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Thank you for your response. On you application you stated that the The Plan currently has an overall calendar year limit of on medical benefits and the following annual limits on specific medical benefits. What is the Plans overall calendar year limit?
Teams L72:000024
Co m
The Plan is a supplemental benefit plan that provides prescription drug and dental benefits to its active participants and their eligible dependents.This supplemental coverageis paid for by a contribution rate agreed upon in collective bargaining between the New York State Thruway Authority and the Union. The New York State Thruway Authorityprovides these same participants withhospital and medical coverage. Ex. 4 The Plan has a $ calendar year maximum on its prescription drug benefit, and that is the only essential benefit the Fund sting a waiver for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
pl
et eC
ol o
ra do .
Thank you. Please provide the COBRA equivalency rates. Cam Lynne Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
co m
Document obtained by CompleteColorado.com Do you have premium rates for employee+ family? Thanks again. Cam Moultrie
From: Jennifer Goldstein [mailto:[email protected]] Sent: Tuesday, November 16, 2010 2:25 PM To:Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Dear Ms. Goldstein: 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: Please state your plans overall annual limit. Please provide the current monthly premium rates and the projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the restricted annual benefits. In other words, we would like a chart that reflects the following information: 2010 January Premium 2011 January Premium 2011 January Premium (current level) (renewal) (if $750,000 annual limit was applied) EE EE + Child (if applicable or other appropriate tier)
Co m
pl
et eC
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Tuesday, November 16, 2010 1:40 PM To:[email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund
ol o
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email:[email protected]
ra do .
Teams L72:000025
Ms. Moultrie, I have attached the additional information you were looking for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
co m
EE + Spouse (if applicable or other appropriate tier) Family (if applicable or other appropriate tier)
Co m
pl
et eC
ol o
ra do .
In order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look forward to receiving your completed application. Thank you. Cam L. Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
co m
Teams L72:000026
From: Moultrie, Cam (HHS/OCIIO) Sent: Thursday, December 02, 2010 7:20 PM To: [email protected] Cc: Kevin Clor; Pavesi, Matthew C.; Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Thursday, November 18, 2010 4:33 PM To: Kevin Clor Cc: [email protected]; Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Teams L72:000027
Co m
Good Morning, I am just checking in to make sure you received all the information that you needed for our waiver application. Thanks and regards, Jennifer S. Goldstein Titan Administrator
pl
et eC
From: Jennifer Goldstein [mailto:[email protected]] Sent: Thursday, December 02, 2010 10:15 AM To: Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
ol o
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 disclosure may result in prosecution to the full extent of the law.
ra do .
No, I did not receive a response to my last email regarding the COBRA equivalencies for 2010 and 2011. Please note that we cannot process your application until we have received all of the necessary information. You will receive a decision within 30 days of when we receive all of the requested information. We look forward to receiving your completed application. Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
co m
Document obtained by CompleteColorado.com Mr. Clor, I am interested in COBRA equivalencies for 2010, 2011 (if waiver is approved) and 2011 (if the waiver is not approved). I have provided a sample chart below for your convenience: 2010 January Premium 2011 January Premium 2011 January Premium (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)
From: Jennifer Goldstein [mailto:[email protected]] Sent: Thursday, November 18, 2010 12:02 PM To: Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Thursday, November 18, 2010 11:39 AM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Teams L72:000028
Co m
Ex. 4 Prescription COBRA for an individual is $ and for a family it is $Ex. 4 Please forward any future questions to the Funds Council, Kevin C. Clor Esq. at [email protected] Thanks and regards, Jennifer S. Goldstein Titan Administrator
pl
et eC
ol o
Thank you. Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
ra do .
co m
Document obtained by CompleteColorado.com Thank you. Please provide the COBRA equivalency rates. Cam Lynne Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
Thank you for your response. On you application you stated that the The Plan currently has an overall calendar year limit of on medical benefits and the following annual limits on specific medical benefits. What is the Plans overall calendar year limit? Do you have premium rates for employee+ family? Thanks again. Cam Moultrie
From: Jennifer Goldstein [mailto:[email protected]]
Teams L72:000029
Co m
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Wednesday, November 17, 2010 12:27 PM To: [email protected] Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
pl
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
et eC
The Plan is a supplemental benefit plan that provides prescription drug and dental benefits to its active participants and their eligible dependents.This supplemental coverageis paid for by a contribution rate agreed upon in collective bargaining between the New York State Thruway Authority and the Union. The New York State Thruway Authorityprovides these same participants withhospital and medical coverage. Ex. 4 The Plan has a $ calendar year maximum on its prescription drug benefit, and that is the only essential benefit the Fund is requesting a waiver for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
ol o
ra do .
co m
From: Jennifer Goldstein [mailto:[email protected]] Sent: Wednesday, November 17, 2010 3:29 PM To: Moultrie, Cam (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Sent: Tuesday, November 16, 2010 2:25 PM Document obtained by CompleteColorado.com To: Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Ms. Moultrie, I have attached the additional information you were looking for. Thanks and regards, Jennifer S. Goldstein Titan Administrator 265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email: [email protected]
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Tuesday, November 16, 2010 1:40 PM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund
EE
Co m
Dear Ms. Goldstein: 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: Please state your plans overall annual limit. Please provide the current monthly premium rates and the projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the restricted annual benefits. In other words, we would like a chart that reflects the following information: 2010 January Premium 2011 January Premium 2011 January Premium (current level) (renewal) (if $750,000 annual limit was applied) EE + Child (if applicable or other appropriate tier) EE + Spouse (if applicable or other appropriate tier) Family (if applicable or other appropriate tier)
pl
et eC
ol o
In order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look
Teams L72:000030
ra do .
co m
Document obtained by CompleteColorado.com forward to receiving your completed application. Thank you. Cam L. Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
Co m
pl
et eC
ol o
ra do .
Teams L72:000031
co m
From: Kevin Clor [[email protected]] Sent: Thursday, December 02, 2010 7:27 PM To: Moultrie, Cam (HHS/OCIIO) Cc: [email protected]; Pavesi, Matthew C.; Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund Ms. Moultrie: The COBRA equivalency for 2011 with the $ Ex. 4 max and w/o the $ Ex. 4 max are based onthe rates we have already included in the application plus Ex. wed under thelaw. ope this answers your question. Please advise 4 % which is a if you need any additional infor ation. Thank you. KCC
***** Confidentiality Statement****** The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
No, I did not receive a response to my last email regarding the COBRA equivalencies for 2010 and 2011. Please note that we cannot process your application until we have received all of the necessary information. You will receive a decision within 30 days of when we receive all of the requested information. We look forward to receiving your completed application. Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
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 disclosure may result in prosecution to the full extent of the law.
From: Jennifer Goldstein [mailto:[email protected]] Sent: Thursday, December 02, 2010 10:15 AM To:Moultrie, Cam (HHS/OCIIO)
Teams L72:000032
Co m
pl
et eC
ol o
Kevin C. Clor, Esq. 38 Thomas Jefferson Lane Snyder, New York 14226 Office (716) 839-0418 Fax (716) 839-1834 Email:[email protected]
ra do .
co m
Document obtained by CompleteColorado.com Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Good Morning, I am just checking in to make sure you received all the information that you needed for our waiver application. Thanks and regards, Jennifer S. Goldstein Titan Administrator 265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email:[email protected]
From: Jennifer Goldstein [mailto:[email protected]] Sent: Thursday, November 18, 2010 12:02 PM To:Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Prescription COBRA for an individual is $Ex. 4 and for a family it is $Ex. 4 Please forward any future questions to the Funds Council, Kevin C. Clor Esq. [email protected] Thanks and regards, Jennifer S. Goldstein Titan Administrator 265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026
Teams L72:000033
Co m
Mr. Clor, I am interested in COBRA equivalencies for 2010, 2011 (if waiver is approved) and 2011 (if the waiver is not approved). I have provided a sample chart below for your convenience: 2010 January Premium 2011 January Premium 2011 January Premium (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) Thank you. Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
pl
et eC
ol o
ra do .
co m
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Thursday, November 18, 2010 4:33 PM To:Kevin Clor Cc: [email protected]; Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Email:[email protected]
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Thursday, November 18, 2010 11:39 AM To:[email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
From: Jennifer Goldstein [mailto:[email protected]] Sent: Tuesday, November 16, 2010 2:25 PM To:Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Ms. Moultrie, I have attached the additional information you were looking for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
Teams L72:000034
Co m
Thank you for your response. On you application you stated that the The Plan currently has an overall calendar year limit of on medical benefits and the following annual limits on specific medical benefits. What is the Plans overall calendar year limit? Do you have premium rates for employee+ family? Thanks again. Cam Moultrie
pl
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Wednesday, November 17, 2010 12:27 PM To:[email protected] Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
et eC
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email:[email protected]
ol o
The Plan is a supplemental benefit plan that provides prescription drug and dental benefits to its active participants and their eligible dependents.This supplemental coverageis paid for by a contribution rate agreed upon in collective bargaining between the New York State Thruway Authority and the Union. The New York State Thruway Authorityprovides these same participants withhospital and medical coverage. Ex. 4 The Plan has a $ calendar year maximum on its prescription drug benefit, and that is the only essential benefit the Fund is requesting a waiver for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
From: Jennifer Goldstein [mailto:[email protected]] Sent: Wednesday, November 17, 2010 3:29 PM To:Moultrie, Cam (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
ra do .
co m
Thank you. Please provide the COBRA equivalency rates. Cam Lynne Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
Document obtained by CompleteColorado.com 265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email:[email protected]
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Tuesday, November 16, 2010 1:40 PM To:[email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund
Co m
Dear Ms. Goldstein: 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: Please state your plans overall annual limit. Please provide the current monthly premium rates and the projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the restricted annual benefits. In other words, we would like a chart that reflects the following information: 2010 January Premium 2011 January Premium 2011 January Premium (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) In order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look forward to receiving your completed application. Thank you. Cam L. Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
pl
et eC
ol o
ra do .
co m
Teams L72:000035
Mr. Clor, Per my voicemail, please call me to discuss your response. Thank you, Cam Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services
Teams L72:000036
Co m
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Thursday, December 02, 2010 7:31 PM To: Kevin Clor Cc: [email protected]; Pavesi, Matthew C.; Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
pl
From: Pavesi, Matthew C. [[email protected]] Sent: Friday, December 03, 2010 5:05 PM To: Moultrie, Cam (HHS/OCIIO); Kevin Clor Cc: [email protected]; Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund Cam, As a follow-up to our telephone conversation from today, here is the information you requested: Ex. 4 Aggregate employer contributions for 2010: $ Average monthly employer contributions for 2010: $Ex. 4 The plan provides dental benefits, life insurance and a disability benefit as well that is paid for with these employer contributions along with reasonable administrative expenses. The 2010 per member per month expense for the Plans current $ Ex. 4 annual dollar maximum for Ex. 4 prescription drugs is $ Applying trend, the 2011 projected mber per month expense for the Plans current $Ex. 4 annual Ex. 4 maximum for prescription drugs is $ Applying trend, the 2011 projected per member per month expense increasing the annual maximum to $750,000 is $Ex. 4 Please let me know if there is any further information you need to consider the Funds application. Best regards, Matt Matthew Pavesi Benefits Consultant The Segal Company 333 West 34th Street, New York, New York 10001-2402 ( Tel 212.251.5339 | Fax 212.251.5490 . [email protected]
et eC
ol o
ra do .
co m
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 disclosure may result in prosecution to the full extent of the law.
From: Kevin Clor [mailto:[email protected]] Sent: Thursday, December 02, 2010 7:27 PM To: Moultrie, Cam (HHS/OCIIO) Cc: [email protected]; Pavesi, Matthew C.; Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund
Kevin C. Clor, Esq. 38 Thomas Jefferson Lane Snyder, New York 14226 Office (716) 839-0418 Fax (716) 839-1834 Email:[email protected]
Co m
pl
et eC
***** Confidentiality Statement****** The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
ol o
Ms. Moultrie: Ex. 4 The COBRA equivalency for 2 1 with the $ max and w/o the $ Ex. 4 max are based onthe rates we have already included in the application plus Ex. wed under thelaw. ope this answers your question. Please advise 4 % which is if you need any additional infor ation. Thank you. KCC
ra do .
co m
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 disclosure may result in prosecution to the full extent of the law.
From: Jennifer Goldstein [mailto:[email protected]] Sent: Thursday, December 02, 2010 10:15 AM To:Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Thursday, November 18, 2010 4:33 PM To:Kevin Clor Cc: [email protected]; Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Mr. Clor, I am interested in COBRA equivalencies for 2010, 2011 (if waiver is approved) and 2011 (if the waiver is not approved). I have provided a sample chart below for your convenience: 2010 January Premium 2011 January Premium 2011 January Premium (current level) (renewal) (if $750,000 annual limit was applied)
Teams L72:000038
Co m
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email:[email protected]
pl
et eC
Good Morning, I am just checking in to make sure you received all the information that you needed for our waiver application. Thanks and regards, Jennifer S. Goldstein Titan Administrator
ol o
ra do .
co m
obtained by CompleteColorado.com a decision within 30 days of when we receiveDocument all of the requested information. We look forward to receiving your completed application. Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
EE EE + Child (if applicable or other appropriate tier) EE + Spouse (if applicable or other appropriate tier) Family (if applicable or other appropriate tier)
From: Jennifer Goldstein [mailto:[email protected]] Sent: Thursday, November 18, 2010 12:02 PM To:Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Thursday, November 18, 2010 11:39 AM To:[email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Thank you. Please provide the COBRA equivalency rates. Cam Lynne Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services
Teams L72:000039
Co m
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email:[email protected]
pl
et eC
Ex. 4 Prescription COBRA for an individual is $ and for a family it is $Ex. 4 Please forward any future questions to the Funds Council, Kevin C. Clor Esq. [email protected] Thanks and regards, Jennifer S. Goldstein Titan Administrator
ol o
ra do .
Thank you. Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]
co m
From: Jennifer Goldstein [mailto:[email protected]] Sent: Wednesday, November 17, 2010 3:29 PM To:Moultrie, Cam (HHS/OCIIO) Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
From: Jennifer Goldstein [mailto:[email protected]] Sent: Tuesday, November 16, 2010 2:25 PM To:Moultrie, Cam (HHS/OCIIO) Cc: Kevin Clor; Pavesi, Matthew C. Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
Ms. Moultrie, I have attached the additional information you were looking for.
Teams L72:000040
Co m
Thank you for your response. On you application you stated that the The Plan currently has an overall calendar year limit of on medical benefits and the following annual limits on specific medical benefits. What is the Plans overall calendar year limit? Do you have premium rates for employee+ family? Thanks again. Cam Moultrie
pl
et eC
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Wednesday, November 17, 2010 12:27 PM To:[email protected] Subject: RE: Waiver Application for Teamsters Local 72 Welfare Fund
ol o
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email:[email protected]
ra do .
The Plan is a supplemental benefit plan that provides prescription drug and dental benefits to its active participants and their eligible dependents.This supplemental coverageis paid for by a contribution rate agreed upon in collective bargaining between the New York State Thruway Authority and the Union. The New York State Thruway Authorityprovides these same participants withhospital and medical coverage. Ex. 4 The Plan has a $ calendar year maximum on its prescription drug benefit, and that is the only essential benefit the Fund is requesting a waiver for. Thanks and regards, Jennifer S. Goldstein Titan Administrator
co m
265 West 14 th Street, Suite 704, New York, NY 10011 Phone: 212-691-4228 Fax: 212-645-5026 Email:[email protected]
From: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]] Sent: Tuesday, November 16, 2010 1:40 PM To:[email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Teamsters Local 72 Welfare Fund
EE EE + Child (if applicable or other appropriate tier) EE + Spouse (if applicable or other appropriate tier) Family (if applicable or other appropriate tier)
et eC
Dear Ms. Goldstein: 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: Please state your plans overall annual limit. Please provide the current monthly premium rates and the projected monthly premium rates applicable to the plan or policy forms if the plan were to comply with the restricted annual benefits. In other words, we would like a chart that reflects the following information: 2010 January Premium 2011 January Premium 2011 January Premium (current level) (renewal) (if $750,000 annual limit was applied)
ol o
pl
Co m
In order to complete your application, please provide this information by 5:00 pm, November 17, 2010. We look forward to receiving your completed application. Thank you. Cam L. Moultrie Program Analyst Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services
Teams L72:000041
ra do .
co m
Co m
pl
et eC
ol o
ra do .
Teams L72:000042
co m
From: Botwinick, Alexandra (HHS/OCIIO) Sent: Wednesday, December 29, 2010 1:45 PM To: [email protected] Subject: Teamsters Local Union No. 72 Waiver of the Annual Limits Requirements 12-29-2010 Importance: High Attachments: Updated Jan 1 Approval Letter .pdf Good Afternoon,
Co m
pl
et eC
ol o
ra do .
Teams L72:000043
Sincerely,
co m
Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Teamsters Local Union No. 72. HHS has reviewed your application and made its determination. Please see the attached letter.
From: Botwinick, Alexandra (HHS/OCIIO) Sent: Wednesday, December 29, 2010 1:45 PM To: [email protected] Subject: Teamsters Local Union No. 72 Waiver of the Annual Limits Requirements 12-29-2010 Importance: High Attachments: Updated Jan 1 Approval Letter .pdf Good Afternoon,
Co m
pl
et eC
ol o
ra do .
Teams L72:000044
Sincerely,
co m
Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Teamsters Local Union No. 72. HHS has reviewed your application and made its determination. Please see the attached letter.
Co m
pl
et eC
ol o
ra do .
Teams L72:000045
co m
Co m
pl
et eC
ol o
ra do .
Teams L72:000046
co m