southern operators health fund - redacted bates hw

7/27/2019 Southern Operators Health Fund - Redacted Bates HW

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//T|/.../Applications%20with%20NO%2012600%20Response%20[YELLOW]/Southern%20Operators%20Health%20Fund/Waiver.htm[08/08/2011 2:18:

rom: Donny Dowlen [[email protected]]ent: Tuesday, November 09, 2010 11:12 AM

To: HHS HealthInsurance (HHS)ubject: Waiver

Attachments: 119106.pdfncl osed i s document at i on f or t he Sout her n Oper ators Heal t h Fund.

onny Dowl enout her n Benef i t Admi ni st r at or s

001 Cal dwel l Dr i veoodl et t svi l l e, TN 37072

r i v a cy a n d Co n f i d e n t i a l it y N o t i c e : This message is being sent via secure SSL encryption to protect the privacy of our clients and to ensure

ompliance with HIPAA regulations. Furthermore, this message (including any attached or embedded documents) is intended for the exclusive a

onfidential use of the individual or entity to which it has been addressed, and unless otherwise expressly indicated, is confidential and privilege

formation of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you rece

is transmission in error, please notify us immediately by e-mail at [email protected], and delete the original message. Your cooper

appreciated.

SouthernOp:000001

Document obtained by CompleteColorado.com


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Pages 5 through 6 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4

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//T|/...0%20Response%20[YELLOW]/Southern%20Operators%20Health%20Fund/Request%20for%20Additional%20Information.htm[08/08/2011 2:18

rom: Keels, Lisa (HHS/OCIIO)ent: Tuesday, November 23, 2010 5:15 PM

To: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: Annual Limit Waiver Applications - Request for Additional Informationear Mr. Dowlen:

hank you for your applications for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. This emai

equest for additional information for the following applications:

1. Memphis Construction Benefit Fund

2. Atlanta Plumbers & Steamfitters Fringe Benefit Funds

3. South Central Laborers Health & Welfare Fund

4. Southeastern Pipetrades Health & Welfare Fund

5. Aerospace Contractors Trust

6. Southern Operators Health Fund

7. Sheet Metal Workers National Health Fund

8. Sheet Metal Workers Local No. 177 Health & Welfare Fund

9. Louisiana Electrical Health Fund

I. In order to complete your applications, please provide the following information for all applications mentioned

above:

In each application, you state that a certain number of eligible employees are covered. For each plan, please provid

the total number of individuals covered.

Some applications state that the plans are comprehensive. Please confirm whether each plan listed above is a

comprehensive or limited-benefit plan.

Some of the plans above include lifetime limits. Please confirm that you are removing both overall lifetime limits a

well as lifetime limits on essential health benefits in those plans.

Was each plan listed above in existence prior to March 23rd, 2010? If so, have the trustees elected to comply with the

grandfathering provisions?

For each plan, what was the date of the last collective bargaining agreement pursuant to which each plan was designe

For each plan listed above, please provide the current monthly premium rates and the projected monthly premium

rates applicable to the plan if the plan were to comply with the restricted annual benefits. In other words, we woulike a chart that reflects the following information:

2010 January Premium

(current level)


(renewal)


(if $750,000 annual

limit was applied)

EE

EE + Child (if applicable

or other appropriate

tier)

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//T|/...0%20Response%20[YELLOW]/Southern%20Operators%20Health%20Fund/Request%20for%20Additional%20Information.htm[08/08/2011 2:18

EE + Spouse (if

applicable or other

appropriate tier)

Family (if applicable or

other appropriate tier)

II. Please provide additional information for the following plans:

1. Aerospace Contractors Trust: In your cover letter, you state that the annual limit is $ . However, t

schedule of benefits states that the annual limit is $ . Please confirm which annual limit is correct.

2. Sheet Metal Workers Local No. 177 Health & Welfare Fund: In your cover letter, you state that the plan ha

annual maximum of $ . However, the schedule of benefits does not seem to have an annual limit.

Rather, it seems as though the schedule of benefits has an annual limit of $ for hospitalization

benefits. Please clarify this information.

III. I will be in touch separately about Mid South Carpenters Regional Council Health and Welfare Fund.

n order to complete your applications, please provide this information as soon as possible. We look forward to receiving

ompleted applications.

hank you,

sa Keels

sa M. Keels, J.D.

.S. Department of Health & Human Services

ffice of Consumer Information and Insurance Oversightffice of Oversight

[email protected]

01-492-4168

.S. Please note that I will be out of the office for the rest of this week, but I will be available via email tomorrow

Wednesday) morning.

SouthernOp:000007



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//T|/...esponse%20[YELLOW]/Southern%20Operators%20Health%20Fund/Request%20for%20Additional%20Information12.7.10.htm[08/08/2011 2:18

rom: Keels, Lisa (HHS/OCIIO)ent: Tuesday, December 07, 2010 12:04 PM

To: Keels, Lisa (HHS/OCIIO); [email protected]: Habit, Sandra (HHS/OCIIO)ubject: RE: Annual Limit Waiver Applications - Request for Additional Informationello again, Donny,

hank you for all your responses thus far. I have one more question for all the plans listed below (and the Mid South

arpenters Regional Council Health and Welfare Fund):

For each plan, what is the date on which the last collective bargaining agreement pursuant to which the plan was

negotiated will expire?

hank you again,

sa

rom: Keels, Lisa (HHS/OCIIO)

ent: Tuesday, November 23, 2010 5:15 PMo: '[email protected]'c: Habit, Sandra (HHS/OCIIO)ubject: Annual Limit Waiver Applications - Request for Additional Information

ear Mr. Dowlen:

hank you for your applications for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. This emai

equest for additional information for the following applications:

1. Memphis Construction Benefit Fund

2. Atlanta Plumbers & Steamfitters Fringe Benefit Funds

3. South Central Laborers Health & Welfare Fund

4. Southeastern Pipetrades Health & Welfare Fund

5. Aerospace Contractors Trust

6. Southern Operators Health Fund

7. Sheet Metal Workers National Health Fund

8. Sheet Metal Workers Local No. 177 Health & Welfare Fund

9. Louisiana Electrical Health Fund

I. In order to complete your applications, please provide the following information for all applications mentioned

above:

In each application, you state that a certain number of eligible employees are covered. For each plan, please provid

the total number of individuals covered.

Some applications state that the plans are comprehensive. Please confirm whether each plan listed above is a

comprehensive or limited-benefit plan.

Some of the plans above include lifetime limits. Please confirm that you are removing both overall lifetime limits a

SouthernOp:000008



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well as lifetime limits on essential health benefits in those plans.

Was each plan listed above in existence prior to March 23rd, 2010? If so, have the trustees elected to comply with the

grandfathering provisions?

For each plan, what was the date of the last collective bargaining agreement pursuant to which each plan was designe

For each plan listed above, please provide the current monthly premium rates and the projected monthly premium

rates applicable to the plan if the plan were to comply with the restricted annual benefits. In other words, we wou

like a chart that reflects the following information:


(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)

II. Please provide additional information for the following plans:

1. Aerospace Contractors Trust: In your cover letter, you state that the annual limit is $ However, t

schedule of benefits states that the annual limit is $ Please confirm which annual limit is correct.

2. Sheet Metal Workers Local No. 177 Health & Welfare Fund: In your cover letter, you state that the plan ha

annual maximum of $ However, the schedule of benefits does not seem to have an annual limit.

Rather, it seems as though the schedule of benefits has an annual limit of $ for hospitalization

benefits. Please clarify this information.

III. I will be in touch separately about Mid South Carpenters Regional Council Health and Welfare Fund.

n order to complete your applications, please provide this information as soon as possible. We look forward to receiving

ompleted applications.

hank you,

sa Keels

sa M. Keels, J.D.

.S. Department of Health & Human Services

ffice of Consumer Information and Insurance Oversight

ffice of Oversight

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[email protected]

01-492-4168

.S. Please note that I will be out of the office for the rest of this week, but I will be available via email tomorrow

Wednesday) morning.

SouthernOp:000010



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//T|/...%20Response%20[YELLOW]/Southern%20Operators%20Health%20Fund/Reqeust%20for%20info%20resposne%2012.7.10.htm[08/08/2011 2:1

esigned?

une, 2013

lease provide the current monthly premium rate and the projected monthly premium rate applicable to the plan if tlan were to comply with the restricted annua s.

1. The premium rate for 2011 is $ 2. The cost in 2011 in the absenc nual limits i 3. The cost in 2-011 to comply with annual limits is

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

hank you,isa Keels

isa M. Keels, J.D.U.S. Department of Health & Human ServicesOffice of Consumer Information and Insurance OversightOffice of Oversight

[email protected]

.S. Please note that I will be out of the office for the rest of this week, but I will be available via email tomorrowWednesday) morning.



onfidential use of the individual or entity to which it has been addressed, and unless otherwise expressly indicated, is confidential and privilege

formation of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receis transmission in error, please notify us immediately by e-mail at [email protected], and delete the original message. Your cooper

appreciated.

SouthernOp:000012



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//T|/...0with%20NO%2012600%20Response%20[YELLOW]/Southern%20Operators%20Health%20Fund/INformation%2012.8.10.htm[08/08/2011 2:18

rom: Keels, Lisa (HHS/OCIIO)ent: Wednesday, December 08, 2010 11:06 AM

To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Applicationshanks, Donny. Your explanation is very helpful.

sa

rom: Donny Dowlen [mailto:[email protected]]ent: Wednesday, December 08, 2010 10:55 AMo: Keels, Lisa (HHS/OCIIO)c: Habit, Sandra (HHS/OCIIO)ubject: Waiver Applications

isa, this will follow up our phone conversation this morning re the responses I sent to you tast two days. You had asked about the premium payment and cost information given on each of esponses. You asked me to put my explanation in writing.

s we discussed, these are self funded plans which cover employees who are in unions. Under eollective bargaining agreement, the employee pays so much per hour worked into the trust fundhere the money is collected and kept for the payment of medical, drug, and o tionalxpenses. Using the Southern Operators

lth Fund as an example, they pay $

per hour wor

hei lan es that they work hours per month in order to be eli le. Therefore x = $ which we show as premium for 2011.

his money goes into the trust fund where the assets are held and used as needed. Whenmployment is good, the payments from the employees will exceed the cost to run the plan. Inhose times, the money is invested and held to be used when the employee payments do not meetxpenses. We are in such a time with the current economy and many union employees workingimited schedules.

s a result of this and using the Southern Operators again as an example, the expected cost in011 will exceed these payments. he cost to the plan if it does not have to meet the $750,00nnual limit is exp d to be $ . If the plan has to meet the $750,000 annual limit, the cs expected to be $ The ass in the trust which have been accumulated in previous yearshen work was good l be used to fund the expenses for the upcoming year. The trustees areopeful that these assets will be sufficient to meet the expenses.

s noted in our responses, complying with the $750,000 annual limit requirement significantlyncreases the cost to the plan, and ultimately will significantly decrease access to benefits hose covered. The ultimate source of any additional money needed is from the employee, and tmployee will have to fund these additional expenses required if the waiver is not granted.

isa, I hope this explanation helps. Let me know if you need anything else.

onny Dowlen00-831-4914

r i v a cy a n d Co n f i d e n t i a l i t y N o t i c e : This message is being sent via secure SSL encryption to protect the priv

f our clients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attac

r embedded documents) is intended for the exclusive and confidential use of the individual or entity to which

as been addressed, and unless otherwise expressly indicated, is confidential and privileged information of

outhern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material isrohibited. If you receive this transmission in error, please notify us immediately by e-mail at

[email protected], and delete the original message. Your cooperation is appreciated.

SouthernOp:000013



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//T|/...2012600%20Response%20[YELLOW]/Southern%20Operators%20Health%20Fund/Additional%20Information%2012.8.10.htm[08/08/2011 2:18:

rom: Donny Dowlen [[email protected]]ent: Wednesday, December 08, 2010 10:55 AM

To: Keels, Lisa (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)ubject: Waiver Applicationsisa, this will follow up our phone conversation this morning re the responses I sent to you tast two days. You had asked about the premium payment and cost information given on each of esponses. You asked me to put my explanation in writing.

s we discussed, these are self funded plans which cover employees who are in unions. Under e

ollective bargaining agreement, the employee pays so much per hour worked into the trust fundhere the money is collected and kept for the payment of medical, drug, and o tionalxpenses. Using the Southern Operators lth Fund as an example, they pay $ per hour wor

hei lan es that they work hours per month in order to be el e. Therefore x = $ which we show as premium for 2011.

his money goes into the trust fund where the assets are held and used as needed. Whenmployment is good, the payments from the employees will exceed the cost to run the plan. Inhose times, the money is invested and held to be used when the employee payments do not meetxpenses. We are in such a time with the current economy and many union employees workingimited schedules.

s a result of this and using the Southern Operators again as an example, the expected cost in011 will exceed these payments. he cost to the plan if it does not have to meet the $750,00nnual limit is exp ed to be $ . If the plan has to meet the $750,000 annual limit, the cs expected to be $ . The ass in the trust which have been accumulated in previous yearshen work was good l be used to fund the expenses for the upcoming year. The trustees are

opeful that these assets will be sufficient to meet the expenses.

s noted in our responses, complying with the $750,000 annual limit requirement significantlyncreases the cost to the plan, and ultimately will significantly decrease access to benefits hose covered. The ultimate source of any additional money needed is from the employee, and tmployee will have to fund these additional expenses required if the waiver is not granted.

isa, I hope this explanation helps. Let me know if you need anything else.




onfidential use of the individual or entity to which it has been addressed, and unless otherwise expressly indicated, is confidential and privilegeformation of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you rece

is transmission in error, please notify us immediately by e-mail at [email protected], and delete the original message. Your cooper

appreciated.

SouthernOp:000014



15/22

//T|/...th%20NO%2012600%20Response%20[YELLOW]/Southern%20Operators%20Health%20Fund/Correspondence%2012.9.10.htm[08/08/2011 2:18

rom: Keels, Lisa (HHS/OCIIO)ent: Thursday, December 09, 2010 10:19 AM

To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)ubject: RE: Annual Limit Waiver Applications - Request for Additional Informationhank you, Donny. I will be sure to communicate this information.

est,

sa

rom: Donny Dowlen [mailto:[email protected]]ent: Thursday, December 09, 2010 9:54 AMo: Keels, Lisa (HHS/OCIIO)c: Habit, Sandra (HHS/OCIIO)ubject: FW: Annual Limit Waiver Applications - Request for Additional Information

isa, just so there is no misunderstanding, I want to document clarification concerning myesponses to your question below regarding premium and cost information. In #1 we are providihe premium expected for 2011. In #2, we are providing the estimated plan cost if it does notave to comply with the $750,000 annual limit. In #3, we are providing the estimated plan cosf it has to comply with the $750,000 annual limit. I know you understand this, but we want take sure that others who review this application have the same understanding. Thank you.

onny Dowlen

rom: Donny Dowlen [mailto:[email protected]]ent: Tuesday, December 07, 2010 2:59 PMo: 'Keels, Lisa (HHS/OCIIO)'c: 'Habit, Sandra (HHS/OCIIO)'ubject: RE: Annual Limit Waiver Applications - Request for Additional Information

isa, please note the responses below. Let me know if you need anything else.

e want to emphasize that complying with annual limits would significantly increase the cost the plan participants as noted below, and would significantly decrease access to benefits forhose currently covered. The eligibility rules of the plan would have to be revised in order und the expected increase.


rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, November 23, 2010 4:15 PMo: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: Annual Limit Waiver Applications - Request for Additional Information

Dear Mr. Dowlen:

hank you for your applications for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. mail is a request for additional information for the following application:

Southern Operators Health Fund

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

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You state that a certain number of eligible employees are covered. Please provide the total number of individcovered

Please confirm whether the plan listed above is a comprehensive or limited-benefit plan.ased on our conversation last week the plan would be considered a limited benefit plan.

Please confirm that you are removing both overall lifetime limit as well as lifetime limits on essential healthbenefits.

e will be removing the overall lifetime limit and the lifetime limits on essential healthenefits

Was the plan listed above in existence prior to March 23rd, 2010? If so, have the trustees elected to comply he grandfathering provisions?

he plan was in existence prior to March 23, 2010 and the trustees have elected to comply withhe grandfather provisions.

What is the expiration date of the last collective bargaining agreement pursuant to which each plan wasesigned?

une, 2013

lease provide the current monthly premium rate and the projected monthly premium rate applicable to the plan if tlan were to comply with the restricted annu fits.

1. The premium rate for 2011 is $

2. The cost in 2011 in the absenc nnual limits i 3. The cost in 2-011 to comply with annual limits is

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

hank you,isa Keels

isa M. Keels, J.D.U.S. Department of Health & Human ServicesOffice of Consumer Information and Insurance Oversight

Office of [email protected]

.S. Please note that I will be out of the office for the rest of this week, but I will be available via email tomorrowWednesday) morning.

r i v a cy a n d Co n f i d e n t i a l i t y N o t i c e : This message is being sent via secure SSL encryption to protect the priv

SouthernOp:000016



17/22


f our clients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attac

r embedded documents) is intended for the exclusive and confidential use of the individual or entity to which

as been addressed, and unless otherwise expressly indicated, is confidential and privileged information of

outhern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is

rohibited. If you receive this transmission in error, please notify us immediately by e-mail at

[email protected], and delete the original message. Your cooperation is appreciated.

SouthernOp:000017



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//T|/...O%2012600%20Response%20[YELLOW]/Southern%20Operators%20Health%20Fund/Request%20for%20info%2012.9.10.htm[08/08/2011 2:18

rom: Donny Dowlen [[email protected]]ent: Thursday, December 09, 2010 9:54 AM

To: Keels, Lisa (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)ubject: FW: Annual Limit Waiver Applications - Request for Additional Informationisa, just so there is no misunderstanding, I want to document clarification concerning myesponses to your question below regarding premium and cost information. In #1 we are providihe premium expected for 2011. In #2, we are providing the estimated plan cost if it does notave to comply with the $750,000 annual limit. In #3, we are providing the estimated plan cosf it has to comply with the $750,000 annual limit. I know you understand this, but we want t

ake sure that others who review this application have the same understanding. Thank you.

onny Dowlen

rom: Donny Dowlen [mailto:[email protected]]ent: Tuesday, December 07, 2010 2:59 PMo: 'Keels, Lisa (HHS/OCIIO)'c: 'Habit, Sandra (HHS/OCIIO)'ubject: RE: Annual Limit Waiver Applications - Request for Additional Information

isa, please note the responses below. Let me know if you need anything else.

e want to emphasize that complying with annual limits would significantly increase the cost t

he plan participants as noted below, and would significantly decrease access to benefits forhose currently covered. The eligibility rules of the plan would have to be revised in order und the expected increase.


rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, November 23, 2010 4:15 PMo: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: Annual Limit Waiver Applications - Request for Additional Information

Dear Mr. Dowlen:

hank you for your applications for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. mail is a request for additional information for the following application:

Southern Operators Health Fund

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

You state that a certain number of eligible employees are covered. Please provide the total number of individcovered

Please confirm whether the plan listed above is a comprehensive or limited-benefit plan.ased on our conversation last week the plan would be considered a limited benefit plan.

Please confirm that you are removing both overall lifetime limit as well as lifetime limits on essential healthbenefits.

SouthernOp:000018



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//T|/...20with%20NO%2012600%20Response%20[YELLOW]/Southern%20Operators%20Health%20Fund/Approval%2012.14.10.htm[08/08/2011 2:18

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Tuesday, December 14, 2010 12:37 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: 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 Southern Operators Health Fund. HHS has reviewed your application and made its

etermination. 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]

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mailto:[email protected]:[email protected]


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southern operators health fund - redacted bates hw

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