orange county ahrc - redacted bates hw

7/27/2019 Orange County AHRC - Redacted Bates HW

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//T|/...0-%20YELLOW/Applications%20with%20NO%2012600%20Response%20[YELLOW]/Orange%20County-AHRC/Waiver.htm[08/24/2011 4:17:

rom: Mike Karkowski [[email protected]]ent: Thursday, November 18, 2010 11:55 AM

To: HHS HealthInsurance (HHS)Cc: 'Joe Hamilton'; Rosemarie Caputo; Tom Burgess; [email protected]: Waiver

Attachments: the Plan - Standalone HRA 7-1-10_SIGNED.pdf; the plan - Standalone HRA SMM for July 1.pdf;Waiver Application 111710.pdf

ttached please find our Waiver Application Annual Limit Requirements of PHS Act Section 2711 along with copies of oulan Documents.

Michael Karkowski

hief Financial Officer

range County AHRC

49 Broadway

ewburgh, NY 12550

[email protected]

845) 561-0670 ext 1154 - fax (845) 561-0892

ogo

his message contains confidential information and is intended only for the individual named. If you are not the named

ddressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if

ave received this e-mail by mistake and delete this e-mail from your system. E-mail transmission cannot be guaranteee secure or error-free as information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete, or con

iruses. The sender therefore does not accept liability for any errors or omissions in the contents of this message, which

rise as a result of e-mail transmission. If verification is required please request a hard-copy version.

PPlease consider the environment before printing this e-mail.

Orange AHRC:000001

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


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Pages 3 through 17 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4

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//T|/...NO%2012600%20Response%20[YELLOW]/Orange%20County-AHRC/Request%20for%20addtional%20info%2011.23.10.htm[08/24/2011 4:17

rom: Scelzo, Kathleen (HHS/OCIIO)ent: Tuesday, November 23, 2010 3:40 PM

To: '[email protected]'Cc: Habit, Sandra (HHS/OCIIO)ubject: Orange County AHRC Waiver Application

mportance: High

Attachments: Orange County AHRC Waiver Application Questions.doceff McCaskeyam sending you this e -mail in reference to the application that you submitted for Orange County AHRC application for Annua

mits Requirements of the PHS Act Section 2711. Attached above is the document that needs to be completed in order to fin

he application process. Please contact me for any questions or concerns

Many thanks for your assistance with this document.

athleen M. Scelzo, RN, MSN

ules Compliance Division

ffice of Insurance Oversight

ffice of Consumer Information and Insurance Oversight (OCIIO)

epartment of Health and Human Services501 Wisconsin Avenue

ethesda, MD

01-492-4121

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November 23, 2010

Dear Applicant:

RE: Orange County AHRC

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 Orange County AHRC

1. Indicate if there are essential benefit limits and the amount for the followingcategories :

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)

Premium(renewal)

Premium(if $750,000annual limitwas applied)

% increase if the$750,000 wasimplemented

EE

EE + Child (ifapplicable orother appropriatetier)

EE + Spouse (ifapplicable orother appropriatetier)

Family (ifapplicable or

other appropriatetier)

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3. Indicate if there are any deductibles for the plan and the amount.4. Indicate if there are any copay/coinsurance for the plan for the following

categories and the amount for the following:

Office Visit Inpatient ER Prescription

5. Indicate if the plan is fully-insured plan or a self-insured plan.6. Indicate if this plan has Grandfather Status.

Please provide this information by 5:00 pm Friday November 26, 2010. We look

forward to receiving your completed application. Thank you.

Sincerely,

Kathleen M. Scelzo, RN, MSN

Rules Compliance Division

Office of Insurance Oversight

Office of Consumer Information and Insurance Oversight (OCIIO)

Department of Health and Human Services

301-492-4121

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//T|/...W/Applications%20with%20NO%2012600%20Response%20[YELLOW]/Orange%20County-AHRC/Approval%2012.14.10.htm[08/24/2011 4:18

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Tuesday, December 14, 2010 12:26 PM

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

mportance: High

ollow Up Flag: Follow up

lag Status: Red

Attachments: July 1 .pdf

ood Afternoon,

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

ection 2711 forOrange County AHRC. HHS has reviewed your application and made its determination. Ple

ee 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]

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//T|/...W/Applications%20with%20NO%2012600%20Response%20[YELLOW]/Orange%20County-AHRC/Approval%2012.29.10.htm[08/24/2011 4:18

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, December 29, 2010 1:41 PM

To: [email protected]: Orange County AHRC Waiver of the Annual Limits Requirements 12-29-2010

mportance: High


ood Afternoon,


ection 2711 for Orange County AHRC. HHS has reviewed your application and made its determination. Pleee the attached letter.



incerely,

Alexandra Botwinick

ffice of Oversight


Orange AHRC:000008



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//T|/...W/Applications%20with%20NO%2012600%20Response%20[YELLOW]/Orange%20County-AHRC/Approval%201.10.11.htm[08/24/2011 4:18:

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, January 10, 2011 9:28 AM

To: Habit, Sandra (HHS/OCIIO)ubject: FW: orange county ahrc Waiver of the Annual Limits Requirements of PHS Act Section 2711

mportance: High


Alexandra Botwinick

ffice of Oversight

HHS/OCIIO

301) [email protected]

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, January 10, 2011 9:27 AMo: '[email protected]'ubject: FW: Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High

Mr. Karkowski,

lease see the below e-mail and the attachment here. I apologize for the delay. I see now that the address the waiver was sen

as a .com instead of a .org

lease confirm with me that you did in fact receive this e-mail and please let me know if you have any questions.

hanks so much,

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO

301) [email protected]

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Thursday, December 16, 2010 11:14 AMo: '[email protected]'ubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High

ood Morning,


Orange AHRC:000009

mailto:[email protected]:[email protected]:[email protected]:[email protected]


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//T|/...W/Applications%20with%20NO%2012600%20Response%20[YELLOW]/Orange%20County-AHRC/Approval%201.10.11.htm[08/24/2011 4:18:

ection 2711 for Orange County AHRC. HHS has reviewed your application and made its determination. Ple

ee the attached letter.



incerely,

Alexandra Botwinick

ffice of Oversight


Orange AHRC:000010



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