united fed teachers - combined redacted bates hwm

7/27/2019 United Fed Teachers - Combined Redacted Bates HWM

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//T|/...600%20Response%20[YELLOW]/United%20Federation%20of%20Teachers%20Fund/Waiver--UFT%20Welfare%20Fund.htm[07/12/2011 11:01:

rom: Nielsen, Mark ([email protected]) [[email protected]]ent: Thursday, September 16, 2010 5:01 PM

To: HHS HealthInsurance (HHS)Cc: Mazawey, Lou ([email protected])ubject: Waiver--UFT Welfare Fund

Attachments: 20100916 Waiver Request.pdf

ear Mr. Mayhew,

n behalf of the United Federation of Teachers Welfare Fund (the "UFT Fund"), I am submitting this application for waiver of t

estricted annual limits under Public Health Services Act 2711, pursuant to OCIIO Sub-Regulatory Guidance OCIIO 2010-1.

FT Fund has a Plan Year that commences October 1, 2010. Accordingly, we respectfully request the Department's expedited

eview of this waiver request, as provided for by 3 of the Sub-Regulatory Guidance.

We appreciate your consideration of the UFT Fund's request. Please let Lou Mazawey or me know if you have any questions

eed anything else. Lou can be reached at 202.861.6608, and I can be reached at at 202.861.5429.

est regards,

Mark C. Nielsen

Mark C. Nielsen / 1701 PennsylvaniaAve., N.W. /Washington, DC 20006 /Phone: 202-861-5429 /Fax: 202-659-4503

www.Groom.com/ [email protected]

otice: This message is intended only for use by the person or entity to which it is addressed. Because it may contain confidenformation intended solely for the addressee, you are notified that any disclosing, copying, downloading, distributing, or retainin

his message, and any attached files, is prohibited and may be a violation of state or federal law. If you received this message

rror, please notify the sender by reply mail, and delete the message and all attached files.

o comply with U.S. Treasury Regulations, we also inform you that, unless expressly stated otherwise, any tax advice containe

his communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Reven

ode, and such advice cannot be quoted or referenced to promote or market to another party any transaction or matter addres

this communication.

UFTeach000007
http://www.groom.com/http://www.groom.com/mailto:[email protected]:[email protected]://www.groom.com/


8/16

//T|/...%20Teachers%20Fund/WAIVER%20ApplicationSupplement%20to%20UFT%20Welfare%20Fund%20Waiver%20request.htm[07/12/2011 11:01

rom: Nielsen, Mark ([email protected]) [[email protected]]ent: Monday, September 20, 2010 10:28 AM

To: Pham, Erica (HHS/OCIIO)ubject: WAIVER Application/Supplement to UFT Welfare Fund Waiver request

Attachments: Supplemental Attestation.pdf; Segal Letter re Cost Increase.pdf

ear Erica,

Following up our telephone conversation Friday afternoon regarding the United Federation of Teachers Welfare Fund's (theFund's") request for waiver of the restricted annual limit that would otherwise be applicable to its prescription drug benefit prog

I am attaching two items:

1. A supplemental attestation Fund's Executive Director, attesting that an increase in the annual limit from its currelevel of $ to $750,000 would result in a decrease in access to benefits; and

2. A letter from the Fund's actuary, the Segal Company, in support of the Fund's projected cost increases.

As we discussed on Friday afternoon and as detailed in the Fund's waiver application, the City of New York is the sole sourcefunding for the Fund's benefits, and the City's contribution rate is contractually established pursuant to a collective bargainin

greement that was negotiated long before the Affordable Care Act's enactment. The parties have been un gree uponcontractual terms e 2009, and there is no source of additional revenue that can cover the additional $ in costs th

would result from a percent increase in the Fund's annual limit. Accordingly, waiver of the restricted a it is imperaif the Fund is to continue offering prescription drug benefits.

As you requested Friday afternoon, we are providing this information as early as possible today (aside from the weekend, we ad the Jewish holiday). Please let me know if you have any question or need anything else. We appreciate your consideratio

this matter, and we look forward to hearing from you.

Best regards,Mark C. Nielsen

Mark C. Nielsen / 1701 PennsylvaniaAve., N.W. /Washington, DC 20006 /Phone: 202-861-5429 /Fax: 202-659-4503 www.Groom.com/ [email protected]


his message, and any attached files, is prohibited and may be a violation of state or federal law. If you received this message rror, please notify the sender by reply mail, and delete the message and all attached files.

o comply with U.S. Treasury Regulations, we also inform you that, unless expressly stated otherwise, any tax advice containehis communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenode, and such advice cannot be quoted or referenced to promote or market to another party any transaction or matter addres

this communication.

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9/16

//T|/...onse%20[YELLOW]/United%20Federation%20of%20Teachers%20Fund/Additional%20Info%20Requested%209-24-2010.htm[07/12/2011 11:01

rom: Pham, Erica (HHS/OCIIO)ent: Friday, September 24, 2010 12:51 PM

To: 'Nielsen, Mark ([email protected])'Cc: Botwinick, Alexandra (HHS/OCIIO); Andrews, Jane (HHS/OCIIO)ubject: RE: WAIVER Application/Supplement to UFT Welfare Fund Waiver requestear Mark:

hank you for this additional information. As stated in the supplemental attestation materials you sent to us, wed like tonderstand how the addition of the $750,000 annual limit will result in Fund members losing access to valuable prescription dr

enefits, as the Fund would be forced to discontinue or drastically diminish its prescription drug package to remain solvent.

pecifically, we would like more information regarding why the addition of a % increase will dramatically affect the solvencyhe Fund. If possible, we would like this information by COB today.

ind Regards,rica Pham

rom: Nielsen, Mark ([email protected]) [mailto:[email protected]]ent: Monday, September 20, 2010 10:28 AMo: Pham, Erica (HHS/OCIIO)ubject: WAIVER Application/Supplement to UFT Welfare Fund Waiver request

ear Erica,

ollowing up our telephone conversation Friday afternoon regarding the United Federation of Teachers Welfare Fund's (theFund's") request for waiver of the restricted annual limit that would otherwise be applicable to its prescription drug benefit progam attaching two items:

A supplemental attestation from the Fund's Executive Director, attesting that an increase in the annual limit from its currenvel of $100,000 to $750,000 would result in a decrease in access to benefits; and

A letter from the Fund's actuary, the Segal Company, in support of the Fund's projected cost increases.

s we discussed on Friday afternoon and as detailed in the Fund's waiver application, the City of New York is the sole source

unding for the Fund's benefits, and the City's contribution rate is contractually established pursuant to a collective bargaininggreement that was negotiated long before the Affordable Care Act's enactment. The parties have been unable to agree uponontractual terms si 2009, and there is no source of additional revenue that can cover the additional $ in costs thatould result from a percent increase in the Fund's annual limit. Accordingly, waiver of the restricted mit is imperathe Fund is to co e offering prescription drug benefits.s you requested Friday afternoon, we are providing this information as early as possible today (aside from the weekend, we aad the Jewish holiday). Please let me know if you have any question or need anything else. We appreciate your consideratio

his matter, and we look forward to hearing from you.

est regards,Mark C. Nielsen

Groom Law Group, Chartered





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//T|/...onse%20[YELLOW]/United%20Federation%20of%20Teachers%20Fund/Additional%20Info%20Requested%209-24-2010.htm[07/12/2011 11:01

o comply with U.S. Treasury Regulations, we also inform you that, unless expressly stated otherwise, any tax advice containehis communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenode, and such advice cannot be quoted or referenced to promote or market to another party any transaction or matter addres this communication.

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//T|/...ponse%20[YELLOW]/United%20Federation%20of%20Teachers%20Fund/Additional%20Info%20Received%209-27-2010.htm[07/12/2011 11:01

rom: Nielsen, Mark ([email protected]) [[email protected]]ent: Monday, September 27, 2010 11:50 AM

To: Pham, Erica (HHS/OCIIO)Cc: Botwinick, Alexandra (HHS/OCIIO); Andrews, Jane (HHS/OCIIO); Mazawey, Lou ([email protected])ubject: RE: WAIVER Application/Supplement to UFT Welfare Fund Waiver requestear Erica,

n your email, you request additional information as to how the increase in the United Federation of Teachers Welfare Fund's (tUFT Fund" or the "Fund") annual limit for prescription drugs to $750,000 will result in an decrease in Fund members' access t

enefits.

s detailed in the UFT Fund's waiver application and its supplement, the Fund is established pursuant to a collective bargaininggreement, pursuant to which the New York City Department of Education contributes a contractually-specified amount to the Fn behalf of each participant, and Fund participants are not charged a premium for access to coverage. The Fund's actuary haalculated that increasing the Fund's annual limit for prescription drugs to $750,00 ne cause the Fund's costs to increa percent in Plan Year 10/1/2010-9/30/2011, which translates to approximately $ in that year alone. We understand The Department wishes further explanation to support the position that applica e $750,000 restricted annual limit wause a significant decrease in Fund members' access to benefits. As further explained below, we respectfully submit that givehe Fund's circumstances, the $ cost increase satisfies the criteria for waiver of the restricted annual limit set forth inCIIO's Sub-Regulatory Guidan September 3, 2010.

pecifically, as detailed in the Fund's waiver application and its supplement, the Fund cannot increase the employer contributioate to offset the $ cost increase that would result from imposition of the restricted annual limit, given that the employerontribution rate is ed by contract and the parties have been unable to agree upon the terms of a new contract since009, resulting in a freeze of the employer's contribution rate. And given that Fund members are not charged a premium forccess to Fund coverage, there is literally no source of additional revenue that the Fund can collect to offset the $ costcrease that will result from imposition of a $750,000 annual limit on prescription drugs. Accordingly, if HHS decl rant

equested waiver, the Fund (the Chair of which is the President of the United Federation of Teachers) will have to take somection that will allow it to remain solvent, which would involve: (a) eliminating the prescription drug program entirely; (b)emoving certain drugs from the Fund's formulary and perhaps excluding drugs entirely from coverage, to offset the otherwiserojected cost increase; or (c) cutting other critical benefits that the Fund provides to NYC teachers and their families -- such asental and vision benefits -- to offset the additional $ in costs that will result from the $750,000 annual limit. Underan

hese scenarios, Fund members would experience "a nt decrease in access to benefits for those currently covered by [tund]," which is what OCIIO's waiver guidance requires. (See September 3, 2010 guidance, III(4)-(5)).

f course und were forced to cut benefits in any of these these ways, it would have to explain the reason for the benefuts to its participants and dependents, who are unionized teachers in New York City public schools and who lack acco compar efits from other sources. Put simply, if HHS declines to grant the requested waiver, the Fund will be forced ut benefits currently provided to its members, which is contrary to the purpose of the Affordable Care Act, and contrary to the urpose for which the waiver program was established.

We hope this is helpful. We very much appreciate the Department's consideration of the UFT Fund's waiver application, and yourtesy in allowing additional time to respond to the Department's inquiry. As always, please call us if you have any questionseed anything else. Thanks.

est regards,

Mark C. Nielsenou Mazawey

019470/01]

rom: Pham, Erica (HHS/OCIIO) [mailto:[email protected]]ent: Friday, September 24, 2010 12:51 PMo: Nielsen, Mark ([email protected])c: Botwinick, Alexandra (HHS/OCIIO); Andrews, Jane (HHS/OCIIO)ubject: RE: WAIVER Application/Supplement to UFT Welfare Fund Waiver request

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ear Mark:

hank you for this additional information. As stated in the supplemental attestation materials you sent to us, wed like tonderstand how the addition of the $750,000 annual limit will result in Fund members losing access to valuable prescription drenefits, as the Fund would be forced to discontinue or drastically diminish its prescription drug package to remain solvent.

pecifically, we would like more information regarding why the addition of a % increase will dramatically affect the solvencyhe Fund. If possible, we would like this information by COB today.

ind Regards,rica Pham

rom: Nielsen, Mark ([email protected]) [mailto:[email protected]]ent: Monday, September 20, 2010 10:28 AMo: Pham, Erica (HHS/OCIIO)ubject: WAIVER Application/Supplement to UFT Welfare Fund Waiver request

ear Erica,

ollowing up our telephone conversation Friday afternoon regarding the United Federation of Teachers Welfare Fund's (theFund's") request for waiver of the restricted annual limit that would otherwise be applicable to its prescription drug benefit prog

am attaching two items:

A su tal attestation from the Fund's Executive Director, attesting that an increase in the annual limit from its currenvel of $ to $750,000 would result in a decrease in access to benefits; and A letter from the Fund's actuary, the Segal Company, in support of the Fund's projected cost increases.

s we discussed on Friday afternoon and as detailed in the Fund's waiver application, the City of New York is the sole source unding for the Fund's benefits, and the City's contribution rate is contractually established pursuant to a collective bargaininggreement that was negotiated long before the Affordable Care Act's enactment. The parties have been unable to agree uponontractual terms since 2009, and there is no source of additional revenue that can cover the additional $ in costs thatould result from a percent increase in the Fund's annual limit. Accordingly, waiver of the restricted mit is imperathe Fund is to co e offering prescription drug benefits.s you requested Friday afternoon, we are providing this information as early as possible today (aside from the weekend, we aad the Jewish holiday). Please let me know if you have any question or need anything else. We appreciate your consideratio

his matter, and we look forward to hearing from you.

est regards,Mark C. Nielsen

Groom Law Group, Chartered






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//T|/...Response%20[YELLOW]/United%20Federation%20of%20Teachers%20Fund/Approval%20Letter%20Sent%209-27-2010.htm[07/12/2011 11:01

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, September 27, 2010 3:19 PM

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

Attachments: OCIIO_Waiver_Acceptance_Letter.pdf

ear Applicant,

hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Actection 2711. HHS has reviewed your application and made its determination. Please see the attached letter

lease confirm receipt of this letter by replying to this e-mail address with a copy to [email protected]

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

incerely,

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO

301) [email protected]

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mailto:[email protected]:[email protected]


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//T|/...United%20Federation%20of%20Teachers%20Fund/Confirmation%20Receipt%20of%20Approval%20Letter%209-27-2010.htm[07/12/2011 11:01

rom: Nielsen, Mark ([email protected]) [[email protected]]ent: Monday, September 27, 2010 3:33 PM

To: Botwinick, Alexandra (HHS/OCIIO)Cc: Mazawey, Lou ([email protected]); Brett Herr; OCIIO Oversightubject: RE: Waiver of the Annual Limits Requirements of the PHS Act Section 2711

ear Alexandra,

s requested, this confirms receipt of the Department's email and attached letter, waiving application of the $750,000 restricted

nnual limit to the United Federation of Teachers Welfare Fund. We very much appreciate the Department's consideration of oequest, and the courtesies extended to us.

est regards,

Mark C. Nielsen



rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Monday, September 27, 2010 3:19 PMo: Nielsen, Mark ([email protected])ubject: Waiver of the Annual Limits Requirements of the PHS Act Section 2711

ear Applicant,

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

ection 2711. HHS has reviewed your application and made its determination. Please see the attached letter

lease confirm receipt of this letter by replying to this e-mail address with a copy to [email protected]

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

incerely,

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO301) [email protected]

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