operating engineers local 101 - redacted bates hwm

7/27/2019 Operating Engineers Local 101 - Redacted Bates HWM

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//T|/...600%20Response%20[YELLOW]/Operating%20Engineers%20Local%20101%20Health%20&%20Welfare%20Fund/waiver.htm[08/24/2011 4:58

rom: Robert Fitzgerald [[email protected]]ent: Tuesday, November 30, 2010 6:10 PM

To: HHS HealthInsurance (HHS)Cc: Joyce Bassettubject: waiver

Attachments: 20100930 IR proforma without HCR costs.pdf; 20100930 IR proforma with HCR costs - final.pdf;canned original letter to James Mayhew.pdfear Sir/Madam:

he undersigned represents the Operating Engineers Local 101 Health & Welfare Fund. Attached please find a copy of a lette

ent via United Parcel Service Overnight Delivery to Mr. James Mayhew in the Office of Consumer Information and Insurance

versight. The UPS package should arrive tomorrow, December 1, 2010. We inadvertently left out two enclosures which are

ttached to this email. Please add these two additional enclosures to the original letter and enclosures which are scheduled to

rrive in your office tomorrow. Please call us if you have any questions with regard to this matter. Thank you.

Robert Fitzgerald

Robert E. Fitzgerald, IIIAttorney at Law*

lake & Uhlig, P.A.

75 New Brotherhood Bldg.53 State Avenue

Kansas City, KS 66101elephone: 913-321-8884acsimile: 913-321-2396-Mail: [email protected]

Licensed in Kansas, Missouri, and Illinois

ease Note: This e-mail (including any attachments) may include privileged, confidential, or otherwise legally protected information that is for the sole f the recipient. Any review, reliance, or distribution by anyone other than the intended recipient without express permission of the sender is strictlyrohibited. If you are not the intended recipient, please notify us and permanently delete the e-mail and any attachments immediately.

RS Circular 230 Disclosureo comply with IRS regulations, we must inform you that this message, including attachments, if it contains any advice relating to federal taxes, was nottended or written to be used, and it cannot be used, for (1) the purpose of avoiding penalties that may be imposed under federal tax law, or (2) promotinarketing, or recommending any transaction, plan, arrangement, or other matter addressed herein. Under these IRS rules, a taxpayer may rely on profess

dvice to avoid federal tax penalties only if that advice is reflected in a comprehensive tax opinion that conforms to strict requirements under federal tax

OpEng L101:000001

Document obtained by CompleteColorado.com
mailto:[email protected]:[email protected]


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Pages 7 through 314 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4

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//T|/...W]/Operating%20Engineers%20Local%20101%20Health%20&%20Welfare%20Fund/Request%20for%20info%2012.18.10.htm[08/24/2011 4:58

rom: Andrews, Jane (HHS/OCIIO)ent: Saturday, December 18, 2010 4:58 PM

To: Andrews, Jane (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)

ubject: Your application for a waiver of annual limits requirements

Attachments: Waiver Application Form.xlshank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act

PHS Act) Section 2711. In order to expedite your application, please provide the following information:

I. Please complete the entire annual limits spreadsheet, [attached to the email] [and available at:http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html]. Please return the completed spreadshto this email address as an attachment. We will only be able to process spreadsheets that are fully comp(i.e., every cell should contain the information requested). If a cell on the spreadsheet does not pertain tyour plan, please write None, and/or provide an explanation regarding why you are unable to completethat particular cell in a separate document.

II. In addition, if you did not include the following information in your application and is applicable, pleaseprovide the following information:

Confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance with

grandfathering provisions, pursuant to 45 CFR 147.140?

Confirm whether the plan was created pursuant to the Taft-Hartley Act. If is is, please provide the date the

collective bargaining agreement will expire.

Confirm that your plan is either self-insured or fully insured.

If you did not complete and submit a signed attestation in accordance with the September 3, 2010 guidance,

please submit that with the spreadsheet as a separate attachment.

n order to complete your application, please provide this information by 5:00 pm, December 21, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi

hank you and feel free to contact me with questions.

ane W. Andrews

CIIO

501 Wisconsin Aveethesda, MD 20814

01-492-4122 (desk)

02-536-6779 (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 governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio

Unauthorized disclosure may result in prosecution to the full extent of the law.

OpEng L101:000010



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//T|/...g%20Engineers%20Local%20101%20Health%20&%20Welfare%20Fund/Request%20for%20info%20response%2012.22.10.htm[08/24/2011 4:58

rom: Robert Fitzgerald [[email protected]]ent: Wednesday, December 22, 2010 3:38 PM

To: Andrews, Jane (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO); Martin Walter; David J. Barry

ubject: RE: Your application for a waiver of annual limits requirements

Attachments: Waiver_application_form with COBRA rates 12 22 10.xls; Scanned original letter to JamesMayhew.pdf; Scanned original letter to Jane Andrews.pdf; Email from Jane Andrews at HHS.pdfMs. Andrews:

ursuant to our telephone conversation of earlier this week, attached please find a scanned copy of an additional attestation letgned by Mr. David Barry, Plan Administrator for the Operating Engineers Local 101 Health and Welfare Plan. You had advis

s that a scanned copy sent via email would be sufficient to substitute in lieu of sending the original. Please review the

upplemental letter and the attached completed spreadsheet which you also requested in your email below. We are sending th

ttached along with the original letter sent to Mr. Mayhew for review by the HHS Committee before the end of the year. You

dvised us that we could have more time beyond your December 21st deadline to respond to your request but that today would

he last day to get our completed application to you for the Committees review before the end of the year.

lease contact us if you require anything further in addition to the attached.

hank you.

Rob Fitzgerald


lake & Uhlig, P.A.75 New Brotherhood Bldg.53 State Avenue

Kansas City, KS 66101elephone: 913-321-8884acsimile: 913-321-2396-Mail: [email protected] in Kansas, Missouri, and Illinois

ease Note: This e-mail (including any attachments) may include privileged, confidential, or otherwise legally protected information that is for the sole

f the recipient. Any review, reliance, or distribution by anyone other than the intended recipient without express permission of the sender is strictly

rohibited. If you are not the intended recipient, please notify us and permanently delete the e-mail and any attachments immediately.

RS Circular 230 Disclosure

o comply with IRS regulations, we must inform you that this message, including attachments, if it contains any advice relating to federal taxes, was not

tended or written to be used, and it cannot be used, for (1) the purpose of avoiding penalties that may be imposed under federal tax law, or (2) promotin

arketing, or recommending any transaction, plan, arrangement, or other matter addressed herein. Under these IRS rules, a taxpayer may rely on profess

dvice to avoid federal tax penalties only if that advice is reflected in a comprehensive tax opinion that conforms to strict requirements under federal tax l

rom: Andrews, Jane (HHS/OCIIO) [mailto:[email protected]]ent: Saturday, December 18, 2010 3:58 PMo: Andrews, Jane (HHS/OCIIO)c: Habit, Sandra (HHS/OCIIO)ubject: Your application for a waiver of annual limits requirements

hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. In order to expedite your application, please provide the following information:

I. Please complete the entire annual limits spreadsheet, [attached to the email] [and available at:http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html]. Please return the completed spreadshto this email address as an attachment. We will only be able to process spreadsheets that are fully comp

OpEng L101:000011



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//T|/...g%20Engineers%20Local%20101%20Health%20&%20Welfare%20Fund/Request%20for%20info%20response%2012.22.10.htm[08/24/2011 4:58

(i.e., every cell should contain the information requested). If a cell on the spreadsheet does not pertain tyour plan, please write None, and/or provide an explanation regarding why you are unable to completethat particular cell in a separate document.

II. In addition, if you did not include the following information in your application and is applicable, pleaseprovide the following information:

Confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance with

grandfathering provisions, pursuant to 45 CFR 147.140?

Confirm whether the plan was created pursuant to the Taft-Hartley Act. If is is, please provide the date the

collective bargaining agreement will expire.

Confirm that your plan is either self-insured or fully insured.

If you did not complete and submit a signed attestation in accordance with the September 3, 2010 guidance,

please submit that with the spreadsheet as a separate attachment.

n order to complete your application, please provide this information by 5:00 pm, December 21, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi

hank you and feel free to contact me with questions.

ane W. Andrews

CIIO

501 Wisconsin Ave

ethesda, MD 20814

01-492-4122 (desk)

02-536-6779 (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 governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio

Unauthorized disclosure may result in prosecution to the full extent of the law.

OpEng L101:000012



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ANNUAL LIMIT WAIVER APPLICATION

Ann ual

Limit Waiver

Request

App licant

Name

Policy Name

(use a new

row for each

policy

application)

App licant

(Plan/ Policy

Situs) City

App licant

(Plan/

Policy

Situs)

State

Plan/ Policy

Effective Date

(mm/dd/yyyy)

Contact

Name

Street

Address City State Zip Code

Phone

Number

(including

area code)

Email

Address

C

(e.

Be

Rx o

Board of

Trustees for

the

Operating

Engineers

Local 101

Health and

Welfare

Fund

Operating

Engineers

Local 101

Health and

Welfare P lan Kansas City MO 01/01/2011

Robert

Fitzgerald

753 State

Avenue,

Suite 475 Kansas City KS 66101

1-800-ABC-

1234

ref@blake-

uhlig.com Lim

Document obtained by CompleteColorado.


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Board of

Trustees for

the

Operating

Engineers

Local 101

Health and

Welfare

Fund

Operating

Engineers

Local 101

Health and

Welfare P lan Kansas City MO 01/01/2011

Robert

Fitzgerald

753 State

Avenue,

Suite 475 Kansas City KS 66101

1-800-ABC-

1234

ref@blake-

uhlig.com Lim

PRA Disclosure Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless itdisplays a valid OMB control number. The information collection is 0938-1105. The time required to complete this information collection is estimated to average ( 8 hours) or ( 240 minutes) per response, includinsearch existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.



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Ambul ator y Emerg ency Hosp italizatio n Laboratory Pediat ri c

Maternity/

Newborn

Mental Health/

Substance

Abuse

Rehabilitative/

Devices

Preventive/

Wellness

Current Essential Benefits Ann ual Limits (Annual Li mit for Each Essential Benefit)

None None None None

None None None None



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None None None None

None None None None



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ndividual/ Employee

Tier*

Employee

contribution

(if applicable)

Employer

contribution

(if applicable) Total

Employee

contribution

(if applicable)

Employer

contribution


Employee

contribution

(if applicable)

Employer

contribution


Current Monthly Premium Rates or

Premium Equivalent Rates (in dollars)*:

Renewal Monthly Premium Rates or

Premium Equivalent Rates if Waiver Granted

(in dollars)*

Projected Rate Increase that woul d result

from compliance with $750,000 Annual Limit

Restriction (in d ollars) (Average Premium

by Individual)*

Employee



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Employee +Family

* When completing the columns requesting premium rate information, please express the premium rates as a composite rate (ifpremiums are a range based on years of service or age) and by tier (Employee, Employee +Spouse, Employee +Child, Family,etc.) as applicable. If you are an issuer, please provide the premium amount in the column titled, "Total" (Column AN, AQ and AT).



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//T|/...se%20[YELLOW]/Operating%20Engineers%20Local%20101%20Health%20&%20Welfare%20Fund/Approval%2012.29.10.htm[08/24/2011 4:5

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, December 29, 2010 4:12 PM

To: [email protected]: Board of Trustees for the Operating Engineers Local 101 Health and Welfare Fund Waiver of the Annualimits Requirements 12-29-2010

mportance: High

ollow Up Flag: Follow uplag Status: Green

Attachments: Updated Jan 1 Approval Letter .pdf

ood Afternoon,

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

ection 2711 for Board of Trustees for the Operating Engineers Local 101 Health and Welfare Fund.HHS haeviewed your application and made its determination. Please see the attached letter.

lease confirm receipt of this letter by replying to this e-mail.

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

incerely,

Alexandra Botwinick

ffice of Oversight

HHS/[email protected]

OpEng L101:000021



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//T|/...]/Operating%20Engineers%20Local%20101%20Health%20&%20Welfare%20Fund/Approval%20confirmation%2012.29.10.htm[08/24/2011 4:58

rom: Robert Fitzgerald [[email protected]]ent: Wednesday, December 29, 2010 4:22 PM

To: Botwinick, Alexandra (HHS/OCIIO)ubject: RE: Board of Trustees for the Operating Engineers Local 101 Health and Welfare Fund Waiver of the Animits Requirements 12-29-2010

ollow Up Flag: Follow uplag Status: Redhank you for your email. We will contact our client and advise them with regard to the approval.


lake & Uhlig, P.A.75 New Brotherhood Bldg.53 State Avenue

Kansas City, KS 66101elephone: 913-321-8884acsimile: 913-321-2396-Mail: [email protected]

Licensed in Kansas, Missouri, and Illinois

ease Note: This e-mail (including any attachments) may include privileged, confidential, or otherwise legally protected information that is for the sole

f the recipient. Any review, reliance, or distribution by anyone other than the intended recipient without express permission of the sender is strictly

rohibited. If you are not the intended recipient, please notify us and permanently delete the e-mail and any attachments immediately.

RS Circular 230 Disclosure

o comply with IRS regulations, we must inform you that this message, including attachments, if it contains any advice relating to federal taxes, was not

tended or written to be used, and it cannot be used, for (1) the purpose of avoiding penalties that may be imposed under federal tax law, or (2) promotin

arketing, or recommending any transaction, plan, arrangement, or other matter addressed herein. Under these IRS rules, a taxpayer may rely on profess

dvice to avoid federal tax penalties only if that advice is reflected in a comprehensive tax opinion that conforms to strict requirements under federal tax l

rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, December 29, 2010 3:12 PM

o: Robert Fitzgeraldubject: Board of Trustees for the Operating Engineers Local 101 Health and Welfare Fund Waiver of the Annual Limitsequirements 12-29-2010mportance: High

ood Afternoon,

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

ection 2711 for Board of Trustees for the Operating Engineers Local 101 Health and Welfare Fund.HHS haeviewed your application and made its determination. Please see the attached letter.

lease confirm receipt of this letter by replying to this e-mail.

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

incerely,

Alexandra Botwinick

ffice of Oversight

OpEng L101:000024



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HHS/[email protected]


operating engineers local 101 - redacted bates hwm

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