From: Gregory A. Storm [gstorm@reinhartlaw.

com] Sent: Thursday, January 06, 2011 1:07 PM To: OCIIO Oversight Cc: Bennett E. Choice Subject: Waiver Application - South Central UFCW Unions and Employers Health and Welfare Trust Attachments: Waiver Letter.pdf
Dear Sir or Madam -

For your information, the Plan's contact information is as follows:

If you have any questions regarding the waiver application, please contact the Plan's legal counsel, Ben Choice or the undersigned, at 414-298-1000.

Gregory A. Storm

Any advice expressed in this writing as to tax matters was neither written nor intended by the sender or Reinhart Boerner Van Deuren s.c. to be used and cannot be used by any taxpayer for the purpose of avoiding tax penalties that may be imposed on the taxpayer. If any such tax advice is made to any person or party other than to our client to whom the advice is directed and intended, then the advice expressed is being delivered to support the promotion or marketing (by a person other than Reinhart Boerner Van Deuren s.c.) of thetransaction or matter discussed or referenced. Each taxpayer should seek advice based on the taxpayer's particular circumstances from an independent tax advisor. This e-mail and any attachments may contain privileged or confidentialinformation. This e-mail is intended solely for the use of the individual or entity to which it is addressed. If you are not the intended recipient of this e-mail, you are hereby notified that any copying, distribution, dissemination or action taken in relation to the contents of this e-mail and any of its attachments is strictly prohibited and may be unlawful. If you have received this e-mail in error, please notify the sender immediately and permanently delete the original e-mail and destroy any copies or printouts of this e-mail as well as any attachments. To the extent representations are made herein concerning matters of a client of the firm, be advised that such representations are not those of the client and do not purport to bind them.
SC UFCW:000001

file:///T|/...nd%20Employers%20Health%20and%20Welfare%20Trust/Waiver%20Application%20-%20South%20Central%20UFCW.htm[11/08/2011 10:35:45 AM]

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Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Cell: 414-588-2448| Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

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Greg Storm

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South Central United Food and Commercial Workers Unions and Employers Health and Welfare Trust c/o Dennis Nast, Administrative Manager 1800 Phoenix Boulevard, Suite 310 Atlanta, GA 30349 Phone: 770-997-9910 email: dnast@ufcwemprfund.org

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On behalf of the South Central United Food and Commercial Workers Unions and Employers Health and Welfare Trust (the "Plan"), we attach a request for a waiver of the restricted annual benefit limit requirement with respect to the benefits described in the attachment.

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SC UFCW:000002

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SC UFCW:000003

Ex. 4

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SC UFCW:000004

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SC UFCW:000005

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SC UFCW:000006

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SC UFCW:000007

Ex. 4

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Ex. 4

SC UFCW:000008

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Ex. 4

SC UFCW:000009

From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, February 02, 2011 11:01 AM To: 'gstorm@reinhartlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: Application for annual limit waiver on behalf of SouthCentral UFCW

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SC UFCW:000010

file:///T|/...20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Request%20for%20info%202.2.11.htm[11/08/2011 10:35:48 AM]

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Mr. Storm I am in receipt of your application of a waiver for South Central. I have a few questions before I can complete your application: 1) What is the expiration date of the referenced cba? 2) Is this a Taft-Hartley plan? 3) The letter mentions that the Trustees can seek guidance from the Plan Consultant to provide proposed benefit changes. Since you have entered See Explanation in the column under decrease in access to benefits, but the explanation does not specify the decrease in benefits, could you be more specific? What decrease in access to benefits would the Fund experience? Thanks.

From: Gregory A. Storm [gstorm@reinhartlaw.com] Sent: Thursday, February 03, 2011 3:36 PM To: Andrews, Jane (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Application for annual limit waiver on behalf of SouthCentral UFCW
Ms. Andrews -

Thank you for your response. Our initial reply follows: 1. The last CBA currently in effect will expire June 29, 2013. 2. This plan is a multiemployer plan subject to the Taft-Hartley Act.

We look forward to speaking with you soon. Please contact me with a request for any additional information. Greg Storm

Gregory A. Storm

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Cell: 414-588-2448| Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

From: Andrews, Jane (HHS/OCIIO) [mailto:Jane.Andrews@hhs.gov] Sent: Wednesday, February 02, 2011 10:01 AM To: Gregory A. Storm Cc: Habit, Sandra (HHS/OCIIO) Subject: Application for annual limit waiver on behalf of SouthCentral UFCW Mr. Storm I am in receipt of your application of a waiver for South Central. I have a few questions before I can complete your application: 1) What is the expiration date of the referenced cba? 2) Is this a Taft-Hartley plan? 3) The letter mentions that the Trustees can seek guidance from the Plan Consultant to provide proposed benefit changes. Since you have entered See Explanation in the column under decrease in access to benefits, but the explanation does not specify the decrease in benefits, could you be more specific? What decrease in access to benefits would the Fund experience? Thanks.

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SC UFCW:000011

file:///T|/...20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Request%20for%20info%20response%202.3.11.htm[11/08/2011 10:35:48 AM]

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3. We have contacted the Plan's consultant to request more calculations regarding the potential benefit reductions. We will send them to you shortly.

Ms. Andrews Thank you for your response. Our initial reply follows:

1. The last CBA currently in effect will expire June 29, 2013.

2. This plan is a multiemployer plan subject to the Taft-Hartley Act. 3. We have contacted the Plan's consultant to request more calculations regarding the potential benefit reductions. We will send them to you shortly.

Greg Storm

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Cell: 414-588-2448| Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

Gregory A. Storm

From: Andrews, Jane (HHS/OCIIO) [mailto:Jane.Andrews@hhs.gov] Sent: Wednesday, February 02, 2011 10:01 AM
SC UFCW:000012

file:///T|/...Central%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Correspondence%202.3.11.htm[11/08/2011 10:35:49 AM]

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We look forward to speaking with you soon. Please contact me with a request for any additional information.

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From: Gregory A. Storm [mailto:gstorm@reinhartlaw.com] Sent: Thursday, February 03, 2011 3:36 PM To: Andrews, Jane (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Application for annual limit waiver on behalf of SouthCentral UFCW

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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.

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I am transitioning off annual limits waivers. Please contact Kathleen or Sandy who are ccd on this e-mail to complete your application. Thanks. Jane W. Andrews Center for Consumer Information and Insurance Oversight (CCIIO) 7501 Wisconsin Ave Bethesda, MD 20814 (301)492-4122 (Desk) (202)536-6779 (Blackberry)

From: Andrews, Jane (HHS/OCIIO) Sent: Thursday, February 03, 2011 3:37 PM To: 'Gregory A. Storm' Cc: Habit, Sandra (HHS/OCIIO); Scelzo, Kathleen (HHS/OCIIO) Subject: RE: Application for annual limit waiver on behalf of SouthCentral UFCW

To: Gregory A. Storm Cc: Habit, Sandra (HHS/OCIIO) Subject: Application for annual limit waiver on behalf of SouthCentral UFCW Mr. Storm I am in receipt of your application of a waiver for South Central. I have a few questions before I can complete your application: 1) What is the expiration date of the referenced cba? 2) Is this a Taft-Hartley plan? 3) The letter mentions that the Trustees can seek guidance from the Plan Consultant to provide proposed benefit changes. Since you have entered See Explanation in the column under decrease in access to benefits, but the explanation does not specify the decrease in benefits, could you be more specific? What decrease in access to benefits would the Fund experience? Thanks.

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SC UFCW:000013

file:///T|/...Central%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Correspondence%202.3.11.htm[11/08/2011 10:35:49 AM]

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From: Andrews, Jane (HHS/OCIIO) Sent: Friday, February 04, 2011 1:05 PM To: Scelzo, Kathleen (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: Here is the Iron Workers and Greg Storm apps on spreadsheet in progress Attachments: jwaapps2_3_2011.xls

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SC UFCW:000014

file:///T|/.../South%20Central%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Data%202.4.11.htm[11/08/2011 10:35:49 AM]

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110105003

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110106003

South Central UFCW Unions and Employer s Health and Welfare Trust

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110106003

Iron Workers Local # 16 Health Fund South Central UFCW Unions and Employer s Health and Welfare Trust

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Street Address City State 1000 North Water Street, Suite 1700 Milwaukee WI 1000 North Water Street, Suite 1700 Milwaukee WI

Annual Limit Waiver Applicant Request Applicant ID Number Name

Policy Name (use a new row for each policy

Applicant (Plan/ Policy Situs) City

Applicant (Plan/ Policy Situs) State

Plan/ Policy Effective Date (mm/dd/y Contact yyy) Name

Phone Number (includin g area code) Email Zip Code (xxx-xxx- Address

Plan A

Dallas

TX

########

Greg Storm

53202

gstorm@r (414) 298- einhartlaw 8147 .com

Plan B

Dallas

TX

########

Greg Storm

53202

gstorm@r (414) 298- einhartlaw 8147 .com

SC UFCW:000015

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Type of Coverage (e.g., Limited Benefit, SelfHRA, Rx Insured

Total Number Mental of Rehabilit Individual Individual Current Plan Maternity Health/ Substanc ative/ or Group s Annual Limit Ambulato Emergen Hospitali Laborator / Policy Covered (in dollars) ry cy zation y Pediatric Newborn e Abuse Devices

Ex. 4

Limited Benefit

Yes

Group

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Limited Benefit

Yes

Group

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SC UFCW:000016

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Coinsura Copay (if Preventiv Plan Copay (if nce (if e/ Prescripti Deductibl applicabl applicabl applicabl e) e) Wellness on e e)

Coinsura nce (if Copay (if applicabl applicabl e) e)

Coinsura nce (if Copay (if applicabl applicabl e) e)

Coinsura nce (if applicabl e)

Individual Employee / Employee contributi on Tier*

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SC UFCW:000017

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Ex. 4

Employer contributi on Total

Employee Employer contributi contributi on on Total

Employee Employer contributi contributi on on Total

Projected Rate Increase that would result

Decrease in Access to Benefits that would

Plan Administr ator/ CEO of Health Insuranc e Issuer

Title of Individual Providing TaftAttestatio Hartley n Plan

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See Explanatio n

Paul Glenn

Chairman Yes

See Explanatio n

Paul Glenn

Chairman Yes

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########

Yes

J. Andrews

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Yes

J. Andrews

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If Yes TaftHartley then Date Collectiv e

Complian ce with Grandfat her Regulatio Lead Date of n Reviewer Receipt

OCIIO Date of Staff Complete Recomm d Factor 1 Factor 2 Factor 3 Factor 4 endation Decision for Comment Applicati Final for for for for on Decision Date Decision Decision Decision Decision Approval/ s

SC UFCW:000019

Date of Waiver

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SC UFCW:000020

Approval/ Disappro val Letter Date of Sent Y/N Letter

Confirma tion of Receipt of Access Approval File

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Annual Limit Waiver Applicant Request Applicant ID Number Name South Central UFCW Unions and Employer s Health and Welfare 110106003 Trust UFCW Unions & Participat ing Employer s Health and Welfare 110105002 Fund UFCW Unions & Participat ing Employer s Health and Welfare 110105002 Fund

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Street Address City State 1000 North Water Street, Suite 1700 Milwaukee WI 4301 Garden City Dr, #201 Landover MD 911 Ridgebroo k Road Landover MD

Policy Name (use a new row for each policy

Applicant (Plan/ Policy Situs) City

Applicant (Plan/ Policy Situs) State

Plan/ Policy Effective Date (mm/dd/y Contact yyy) Name

Phone Number (includin g area code) Email Zip Code (xxx-xxx- Address

Retirees

Dallas

TX

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Greg Storm

53202

gstorm@r (414) 298- einhartlaw 8147 .com

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Plan JS

Sparks

MD

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William Jensen

20785

billj@asso ciated301-429- adminl.co 8960 m

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Plan JSS2

Sparks

MD

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William Jensen

20785

billj@asso ciated301-429- adminl.co 8960 m

SC UFCW:000021

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Type of Coverage (e.g., Limited Benefit, SelfHRA, Rx Insured

Total Number Mental of Rehabilit Individual Individual Current Plan Maternity Health/ Substanc ative/ or Group s Annual Limit Ambulato Emergen Hospitali Laborator / Policy Covered (in dollars) ry cy zation y Pediatric Newborn e Abuse Devices
Ex. 4

Limited Benefit

Yes

Group

Other

Yes

Group

Other

Yes

Group

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SC UFCW:000022

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Coinsura Copay (if Preventiv Plan Copay (if nce (if e/ Prescripti Deductibl applicabl applicabl applicabl e) e) Wellness on e e)

Coinsura nce (if Copay (if applicabl applicabl e) e)

Coinsura nce (if Copay (if applicabl applicabl e) e)

Coinsura nce (if applicabl e)

Individual Employee / Employee contributi on Tier*

Ex. 4

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Ex. 4

Employer contributi

Employee Employer contributi contributi

Employee Employer contributi contributi

Projected Rate Increase that would

Decrease in Access to Benefits that would

Plan Administr ator/ CEO of Health Insuranc e Issuer

Title of Individual Providing TaftAttestatio Hartley n Plan

See Explanatio n

Paul Glenn

Chairman Yes

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See NOTES TAB - C Board of Trustees

Fund Administr ative Manager Yes

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See NOTES TAB - C William Jensen

Fund Administr ative Manager Yes

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Yes

J. Andrews

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J. Andrews

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J. Andrews

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If Yes TaftHartley then Date Collectiv e

Complian ce with Grandfat her Regulatio Lead Date of n Reviewer Receipt

OCIIO Date of Staff Complete Recomm d Factor 1 Factor 2 Factor 3 Factor 4 endation Decision for Comment Applicati Final for for for for on Decision Date Decision Decision Decision Decision Approval/ s

SC UFCW:000025

Date of Waiver

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SC UFCW:000026

Approval/ Disappro val Letter Date of Sent Y/N Letter

Confirma tion of Receipt of Access Approval File

Plan Y PT Family

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Annual Limit Waiver Applicant Request Applicant ID Number Name UFCW Unions & Participat ing Employer s Health and Welfare 110105002 Fund UFCW Unions & Participat ing Employer s Health and Welfare 110105002 Fund UFCW Unions & Participat ing Employer s Health and Welfare 110105002 Fund

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Street Address City State 4301 Garden City Dr, #201 Landover MD 4301 Garden City Dr, #201 Landover MD 4301 Garden City Dr, #201 Landover MD

Policy Name (use a new row for each policy

Applicant (Plan/ Policy Situs) City

Applicant (Plan/ Policy Situs) State

Plan/ Policy Effective Date (mm/dd/y Contact yyy) Name

Phone Number (includin g area code) Email Zip Code (xxx-xxx- Address

Plan Y FT

Sparks

MD

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William Jensen

20785

billj@asso ciated301-429- adminl.co 8960 m

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Plan Y PT EE

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Sparks

MD

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William Jensen

20785

billj@asso ciated301-429- adminl.co 8960 m

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Sparks

MD

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William Jensen

20785

billj@asso ciated301-429- adminl.co 8960 m

SC UFCW:000027

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Type of Coverage (e.g., Limited Benefit, SelfHRA, Rx Insured

Total Number Mental of Rehabilit Individual Individual Current Plan Maternity Health/ Substanc ative/ or Group s Annual Limit Ambulato Emergen Hospitali Laborator / Policy Covered (in dollars) ry cy zation y Pediatric Newborn e Abuse Devices
Ex. 4

Other

Yes

Group

Other

Yes

Group

Other

Yes

Group

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SC UFCW:000028

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Coinsura Copay (if Preventiv Plan Copay (if nce (if e/ Prescripti Deductibl applicabl applicabl applicabl e) e) Wellness on e e)

Coinsura nce (if Copay (if applicabl applicabl e) e)

Coinsura nce (if Copay (if applicabl applicabl e) e)

Coinsura nce (if applicabl e)

Individual Employee / Employee contributi on Tier*

Ex. 4

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SC UFCW:000029

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Ex. 4

Employer contributi on Total

Employee Employer contributi contributi on on Total

Employee Employer contributi contributi on on Total

Projected Rate Increase that would result

Decrease in Access to Benefits that would

Plan Administr ator/ CEO of Health Insuranc e Issuer

Title of Individual Providing TaftAttestatio Hartley n Plan

See NOTES TAB - C

Board of Trustees

Fund Administr ative Manager Yes

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See NOTES TAB - C Board of Trustees

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Fund Administr ative Manager Yes

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See NOTES TAB - C Board of Trustees

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Fund Administr ative Manager Yes

SC UFCW:000030

########

J. Andrews

########

########

J. Andrews

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########

J. Andrews

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If Yes TaftHartley then Date Collectiv e

Complian ce with Grandfat her Regulatio Lead Date of n Reviewer Receipt

OCIIO Date of Staff Complete Recomm d Factor 1 Factor 2 Factor 3 Factor 4 endation Decision for Comment Applicati Final for for for for on Decision Date Decision Decision Decision Decision Approval/ s

SC UFCW:000031

Date of Waiver

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SC UFCW:000032

Approval/ Disappro val Letter Date of Sent Y/N Letter

Confirma tion of Receipt of Access Approval File

110105002

UFCW Unions & Participat ing Employer s Health and Welfare Plan Y20 FT Fund UFCW Unions & Participat ing Employer s Health and Welfare Plan Y20 PT Fund UFCW Unions & Participat ing Employer s Health and Welfare Plan Z PT Fund

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Street Address City State 4301 Garden City Dr, #201 Landover MD 4301 Garden City Dr, #201 Landover MD 4301 Garden City Dr, #201 Landover MD

Annual Limit Waiver Applicant Request Applicant ID Number Name

Policy Name (use a new row for each policy

Applicant (Plan/ Policy Situs) City

Applicant (Plan/ Policy Situs) State

Plan/ Policy Effective Date (mm/dd/y Contact yyy) Name

Phone Number (includin g area code) Email Zip Code (xxx-xxx- Address

Sparks

MD

########

William Jensen

20785

billj@asso ciated301-429- adminl.co 8960 m

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110105002

Sparks

MD

########

William Jensen

20785

billj@asso ciated301-429- adminl.co 8960 m

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110105002

Sparks

MD

########

William Jensen

20785

billj@asso ciated301-429- adminl.co 8960 m

SC UFCW:000033

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Type of Coverage (e.g., Limited Benefit, SelfHRA, Rx Insured

Total Number Mental of Rehabilit Individual Individual Current Plan Maternity Health/ Substanc ative/ or Group s Annual Limit Ambulato Emergen Hospitali Laborator / Policy Covered (in dollars) ry cy zation y Pediatric Newborn e Abuse Devices
Ex. 4

Other

Yes

Group

Other

Yes

Group

Other

Yes

Group

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SC UFCW:000034

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Coinsura Copay (if Preventiv Plan Copay (if nce (if e/ Prescripti Deductibl applicabl applicabl applicabl e) e) Wellness on e e)

Coinsura nce (if Copay (if applicabl applicabl e) e)

Coinsura nce (if Copay (if applicabl applicabl e) e)

Coinsura nce (if applicabl e)

Individual Employee / Employee contributi on Tier*

Ex. 4

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SC UFCW:000035

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Ex. 4

Employer contributi on Total

Employee Employer contributi contributi on on Total

Employee Employer contributi contributi on on Total

Projected Rate Increase that would result

Decrease in Access to Benefits that would

Plan Administr ator/ CEO of Health Insuranc e Issuer

Title of Individual Providing TaftAttestatio Hartley n Plan

See NOTES TAB - C

Board of Trustees

Fund Administr ative Manager Yes

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See NOTES TAB - C Board of Trustees

Fund Administr ative Manager Yes

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See NOTES TAB - C Board of Trustees

Fund Administr ative Manager Yes

SC UFCW:000036

########

J. Andrews

########

########

J. Andrews

########

########

J. Andrews

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If Yes TaftHartley then Date Collectiv e

Complian ce with Grandfat her Regulatio Lead Date of n Reviewer Receipt

OCIIO Date of Staff Complete Recomm d Factor 1 Factor 2 Factor 3 Factor 4 endation Decision for Comment Applicati Final for for for for on Decision Date Decision Decision Decision Decision Approval/ s

SC UFCW:000037

Date of Waiver

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SC UFCW:000038

Approval/ Disappro val Letter Date of Sent Y/N Letter

Confirma tion of Receipt of Access Approval File

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SC UFCW:000039

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Ex. 4

Ex. 4

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SC UFCW:000040

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SC UFCW:000041

From: Gloria N. Sarmiento [gsarmien@reinhartlaw.com] on behalf of Gregory A. Storm [gstorm@reinhartlaw.com] Sent: Tuesday, February 08, 2011 5:13 PM To: Habit, Sandra (HHS/OCIIO) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: South Central UFCW Unions and Employers Health and Welfare Trust Attachments: Corr to S. Habit 2.8.11.pdf
Sandra -

I have attached a letter regarding the additional information for PPACA annual limits waiver application. Please contact me if you have any questions.

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

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SC UFCW:000042

file:///T|/...ntral%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Additional%20info%202.8.11.htm[11/08/2011 10:35:50 AM]

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Gregory A. Storm

From: Gloria N. Sarmiento [gsarmien@reinhartlaw.com] on behalf of Gregory A. Storm [gstorm@reinhartlaw.com] Sent: Tuesday, February 08, 2011 5:27 PM To: Habit, Sandra (HHS/OCIIO) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: South Central UFCW Unions and Employers Health and Welfare Trust Attachments: Corr to S. Habit 2.8.11.pdf; Waiver Letter.pdf; 5659273_1.XLS.XLS
Sandra -

Here it is again with the corresponding attachments. Gregory A. Storm

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SC UFCW:000043

file:///T|/...0UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Additional%20info%20(2)%202.8.11.htm[11/08/2011 10:35:50 AM]

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Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

From: Habit, Sandra (HHS/OCIIO) Sent: Wednesday, February 09, 2011 11:32 AM To: 'Gregory A. Storm' Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust Dear Gregory, Thank you for your information. Your application is now complete and you will receive a determination of your application within 30 days. Take care and if you have any questions, please feel free to contact me. Thank you, Sandy

Here it is again with the corresponding attachments. Gregory A. Storm

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Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

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SC UFCW:000044

Sandra -

file:///T|/...%20Central%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Completion%202.9.11.htm[11/08/2011 10:35:50 AM]

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From: Gloria N. Sarmiento [mailto:gsarmien@reinhartlaw.com] On Behalf Of Gregory A. Storm Sent: Tuesday, February 08, 2011 5:27 PM To: Habit, Sandra (HHS/OCIIO) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: South Central UFCW Unions and Employers Health and Welfare Trust

From: Habit, Sandra (HHS/OCIIO) Sent: Thursday, February 17, 2011 1:36 PM To: 'Gregory A. Storm' Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High Attachments: March 2011 Approval.pdf Dear Gregory,

Plan A

Plan B

Retirees

Sandra -

Here it is again with the corresponding attachments. Gregory A. Storm

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

SC UFCW:000045

file:///T|/...h%20Central%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Approval%202.17.11.htm[11/08/2011 10:35:50 AM]

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From: Gloria N. Sarmiento [mailto:gsarmien@reinhartlaw.com] On Behalf Of Gregory A. Storm Sent: Tuesday, February 08, 2011 5:27 PM To: Habit, Sandra (HHS/OCIIO) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: South Central UFCW Unions and Employers Health and Welfare Trust

pl

Please confirm receipt of this letter by replying to this e-mail address. Please let me know if I can be of further assistance. Sincerely, Sandy

et eC

ol o

ra do .

co m

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for South Central UFCW Unions and Employers Health and Welfare Trust. HHS has reviewed your application and made its determination. Please see the attached letter. The letter applies to the following plans:

Co m

pl

et eC

ol o

ra do .
SC UFCW:000046

file:///T|/...h%20Central%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Approval%202.17.11.htm[11/08/2011 10:35:50 AM]

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Co m pl et eC ol o ra do . co m

SC UFCW:000047

Co m pl et eC ol o ra do . co m

SC UFCW:000048

From: Gregory A. Storm [gstorm@reinhartlaw.com] Sent: Thursday, February 17, 2011 2:07 PM To: Habit, Sandra (HHS/OCIIO) Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust
Dear Ms. Habit -

This email confirms our receipt of the approval letter. Thank you for your correspondence and your prompt review of our application. Greg Storm

Plan A

Retirees

Please confirm receipt of this letter by replying to this e-mail address. Please let me know if I can be of further assistance. Sincerely, Sandy
From: Gloria N. Sarmiento [mailto:gsarmien@reinhartlaw.com] On Behalf Of Gregory A. Storm Sent: Tuesday, February 08, 2011 5:27 PM To: Habit, Sandra (HHS/OCIIO) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: South Central UFCW Unions and Employers Health and Welfare Trust

Sandra Here it is again with the corresponding attachments.

SC UFCW:000049

file:///T|/...al%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Approval%20receipt%202.17.11.htm[11/08/2011 10:35:51 AM]

Co m

pl

et eC

Plan B

ol o

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for South Central UFCW Unions and Employers Health and Welfare Trust. HHS has reviewed your application and made its determination. Please see the attached letter. The letter applies to the following plans:

ra do .

Dear Gregory,

co m

From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Thursday, February 17, 2011 12:36 PM To: Gregory A. Storm Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

Gregory A. Storm

Co m

pl

et eC

ol o

ra do .
SC UFCW:000050

file:///T|/...al%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Approval%20receipt%202.17.11.htm[11/08/2011 10:35:51 AM]

co m

From: Gregory A. Storm [gstorm@reinhartlaw.com] Sent: Tuesday, March 01, 2011 5:32 PM To: Habit, Sandra (HHS/OCIIO); Scelzo, Kathleen (HHS/OCIIO) Subject: FW: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High Attachments: March 2011 Approval.pdf
Sandy -

I had one follow up question on this client and its approved waiver. When we prepared the waiver application, the Plan imposed an annual limit on dental benefits of $Ex. 4 for Plan A and $Ex. 4 for Plan B. Subsequently, the annual limits on dental benefits were increased to $Ex. 4 for Plan A and $Ex. 4 for Plan B. However, the waiver was approved based on the lower limit numbers. We are in the process of preparing the notices to send to all participants, and we were wondering how we should document this change in benefit limits for dental benefits. As of now, we are proposing that we will complete the waiver form using the numbers approved by HHS in the waiver, but then we would attach another page behind the waiver notice to acknowledge that plan benefits had actually increased.

We would appreciate hearing your thoughts at your earliest convenience, as the Plan Office would like to send the notice as soon as possible. Thanks in advance for your assistance. If you have any questions or need any additional information, please do not hesitate to contact me. Greg Storm Gregory A. Storm

From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Thursday, February 17, 2011 12:36 PM To: Gregory A. Storm Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High

Dear Gregory,

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for South Central UFCW Unions and Employers Health and Welfare Trust. HHS has reviewed your application and made its determination. Please see the attached letter. The letter applies to the following plans:
Plan A
SC UFCW:000051

file:///T|/...th%20Central%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%203.1.11.htm[11/08/2011 10:35:51 AM]

Co m

pl

et eC

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Cell: 414-588-2448| Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

ol o

ra do .

As a side note, we know that dental benefits are considered essential for pediatric care, but it is unclear whether dental benefits are considered essential for adults. Our experience indicates that most consultants, attorneys, etc. are concluding that dental benefits are nonessential for adults.

co m

Plan B

Retirees

Sandra Here it is again with the corresponding attachments. Gregory A. Storm

Co m

pl

et eC

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

ol o

ra do .
SC UFCW:000052

From: Gloria N. Sarmiento [mailto:gsarmien@reinhartlaw.com] On Behalf Of Gregory A. Storm Sent: Tuesday, February 08, 2011 5:27 PM To: Habit, Sandra (HHS/OCIIO) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: South Central UFCW Unions and Employers Health and Welfare Trust

file:///T|/...th%20Central%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%203.1.11.htm[11/08/2011 10:35:51 AM]

co m

Please confirm receipt of this letter by replying to this e-mail address. Please let me know if I can be of further assistance. Sincerely, Sandy

From: Habit, Sandra (HHS/OCIIO) Sent: Wednesday, March 02, 2011 5:30 PM To: 'Gregory A. Storm' Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust

Sandy -

I had one follow up question on this client and its approved waiver.

As a side note, we know that dental benefits are considered essential for pediatric care, but it is unclear whether dental benefits are considered essential for adults. Our experience indicates that most consultants, attorneys, etc. are concluding that dental benefits are nonessential for adults.

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Cell: 414-588-2448| Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

Greg Storm Gregory A. Storm

From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Thursday, February 17, 2011 12:36 PM To: Gregory A. Storm
SC UFCW:000053

file:///T|/...l%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%20answered%203.2.11.htm[11/08/2011 10:35:51 AM]

Co m

pl

We would appreciate hearing your thoughts at your earliest convenience, as the Plan Office would like to send the notice as soon as possible. Thanks in advance for your assistance. If you have any questions or need any additional information, please do not hesitate to contact me.

et eC

When we prepared the waiver application, the Plan imposed an annual limit on dental benefits of $Ex. 4 r Plan A and $Ex. 4 for Ex. 4 Ex. 4 Plan B. Subsequently, the annual limits on dental benefits were increased to $ for Plan A and $ for Plan B. However, the waiver was approved based on the lower limit numbers. We are in the process of preparing the notices to send to all participants, and we were wondering how we should document this change in benefit limits for dental benefits. As of now, we are proposing that we will complete the waiver form using the numbers approved by HHS in the waiver, but then we would attach another page behind the waiver notice to acknowledge that plan benefits had actually increased.

ol o

ra do .

From: Gregory A. Storm [mailto:gstorm@reinhartlaw.com] Sent: Tuesday, March 01, 2011 5:32 PM To: Habit, Sandra (HHS/OCIIO); Scelzo, Kathleen (HHS/OCIIO) Subject: FW: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High

co m

Greg, In response to your questions, it will be fine that you send out a notice to all participants with the HHS approved dental benefits with the attached document that the dental benefits have been increased. Additionally, as long as a determination is made in good faith and the law is consistently applied we will accept the adult dental benefit as non-essential. Thank you, Sandy

Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High

Dear Gregory,

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for South Central UFCW Unions and Employers Health and Welfare Trust. HHS has reviewed your application and made its determination. Please see the attached letter. The letter applies to the following plans:
Plan A

Plan B

Retirees

From: Gloria N. Sarmiento [mailto:gsarmien@reinhartlaw.com] On Behalf Of Gregory A. Storm Sent: Tuesday, February 08, 2011 5:27 PM To: Habit, Sandra (HHS/OCIIO) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: South Central UFCW Unions and Employers Health and Welfare Trust Sandra -

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

Gregory A. Storm

Co m

Here it is again with the corresponding attachments.

pl

et eC

Please confirm receipt of this letter by replying to this e-mail address. Please let me know if I can be of further assistance. Sincerely, Sandy

ol o

ra do .
SC UFCW:000054

file:///T|/...l%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%20answered%203.2.11.htm[11/08/2011 10:35:51 AM]

co m

From: Lorden, Susie (HHS/OCIIO) Sent: Wednesday, March 02, 2011 5:16 PM To: Habit, Sandra (HHS/OCIIO); Kottenmeier, Erika (HHS/OCIIO) Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust
Sounds good to me. I am researching the dental issue now, before I talk to Jim about how to handle my dental plan applicant who has pediatric dependents.
From: Habit, Sandra (HHS/OCIIO) Sent: Wednesday, March 02, 2011 5:03 PM To: Kottenmeier, Erika (HHS/OCIIO); Lorden, Susie (HHS/OCIIO) Subject: FW: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High

Sandy -

I had one follow up question on this client and its approved waiver. When we prepared the waiver application, the Plan imposed an annual limit on al benefits of $ Ex. 4 for Plan A and $Ex. 4 for Ex. 4 Plan B. Subsequently, the annual limits on dental benefits were increased to $ for Plan A and $ Ex. 4 for Plan B. However, the waiver was approved based on the lower limit numbers. We are in the process of preparing the notices to send to all participants, and we were wondering how we should document this change in benefit limits for dental benefits. As of now, we are proposing that we will complete the waiver form using the numbers approved by HHS in the waiver, but then we would attach another page behind the waiver notice to acknowledge that plan benefits had actually increased.

As a side note, we know that dental benefits are considered essential for pediatric care, but it is unclear whether dental benefits are considered essential for adults. Our experience indicates that most consultants, attorneys, etc. are concluding that dental benefits are nonessential for adults.

We would appreciate hearing your thoughts at your earliest convenience, as the Plan Office would like to send the notice as soon as possible. Thanks in advance for your assistance. If you have any questions or need any additional information, please do not hesitate to contact me. Greg Storm Gregory A. Storm

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Cell: 414-588-2448| Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com
SC UFCW:000055

file:///T|/...20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%20correspondence%20(2)%203.2.11.htm[11/08/2011 10:35:52 AM]

Co m

pl

et eC

ol o

From: Gregory A. Storm [mailto:gstorm@reinhartlaw.com] Sent: Tuesday, March 01, 2011 5:32 PM To: Habit, Sandra (HHS/OCIIO); Scelzo, Kathleen (HHS/OCIIO) Subject: FW: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High

ra do .

Hi Ladies, I received the below question and I am pretty sure I know the answer but just wanted to run it by you both to see if you had additional information you wanted to add I would say that sending the notices with the HHS approved dental benefits with the attached notice that the benefits had been increased is acceptable. Also, they are correct in that dental benefits are considered essential for pediatric care but not essential for adults. Thanks, Sandy

co m


From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Thursday, February 17, 2011 12:36 PM To: Gregory A. Storm Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High

Plan A

Plan B

Retirees

From: Gloria N. Sarmiento [mailto:gsarmien@reinhartlaw.com] On Behalf Of Gregory A. Storm Sent: Tuesday, February 08, 2011 5:27 PM To: Habit, Sandra (HHS/OCIIO) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: South Central UFCW Unions and Employers Health and Welfare Trust

Sandra Here it is again with the corresponding attachments. Gregory A. Storm

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

Co m

Please confirm receipt of this letter by replying to this e-mail address. Please let me know if I can be of further assistance. Sincerely, Sandy

pl

et eC

ol o

ra do .

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for South Central UFCW Unions and Employers Health and Welfare Trust. HHS has reviewed your application and made its determination. Please see the attached letter. The letter applies to the following plans:

file:///T|/...20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%20correspondence%20(2)%203.2.11.htm[11/08/2011 10:35:52 AM]

co m

Dear Gregory,

SC UFCW:000056

Co m

pl

et eC

ol o

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SC UFCW:000057

file:///T|/...20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%20correspondence%20(2)%203.2.11.htm[11/08/2011 10:35:52 AM]

co m

From: Kottenmeier, Erika (HHS/OCIIO) Sent: Wednesday, March 02, 2011 5:24 PM To: Lorden, Susie (HHS/OCIIO); Habit, Sandra (HHS/OCIIO) Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust

I agree that your response is fine. We have been treating pediatric dental benefits as essential and adult benefits as non-essential. For gray areas like that (adult dental) we will accept their good-faith determination, so you can tell him that as long as a determination is made in good faith and the law is consistently applied (i.e., no lifetime limits on an essential benefit if they are also going to apply restricted annual limits!), we will accept the adult dental benefit as non-essential, but that HHS has not officially made a determination. You dont have to get specific about the legal aspect if you dont want to: Greg Storm is a lawyer (I believe) so he can work it out himself. Good-faith determination is sufficient. From: Lorden, Susie (HHS/OCIIO) Sent: Wednesday, March 02, 2011 5:16 PM To: Habit, Sandra (HHS/OCIIO); Kottenmeier, Erika (HHS/OCIIO) Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust

From: Gregory A. Storm [mailto:gstorm@reinhartlaw.com] Sent: Tuesday, March 01, 2011 5:32 PM To: Habit, Sandra (HHS/OCIIO); Scelzo, Kathleen (HHS/OCIIO) Subject: FW: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High

Sandy -

I had one follow up question on this client and its approved waiver. When we prepared the waiver application, the Plan imposed an annual limit on dental benefits of $Ex. 4 for Plan A and $Ex. 4 for Plan B. Subsequently, the annual limits on dental benefits were increased to $ Ex. 4 for Plan A and $Ex. 4 for Plan B. However, the waiver was approved based on the lower limit numbers. We are in the process of preparing the notices to send to all participants, and we were wondering how we should document this change in benefit limits for dental benefits. As of now, we are proposing that we will complete the waiver form using the numbers approved by HHS in the waiver, but then we would attach another page behind the waiver notice to acknowledge that plan benefits had actually increased.

SC UFCW:000058

file:///T|/...20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%20Correspondence%20(3)%203.2.11.htm[11/08/2011 10:35:52 AM]

Co m

pl

Hi Ladies, I received the below question and I am pretty sure I know the answer but just wanted to run it by you both to see if you had additional information you wanted to add I would say that sending the notices with the HHS approved dental benefits with the attached notice that the benefits had been increased is acceptable. Also, they are correct in that dental benefits are considered essential for pediatric care but not essential for adults. Thanks, Sandy

et eC

ol o

From: Habit, Sandra (HHS/OCIIO) Sent: Wednesday, March 02, 2011 5:03 PM To: Kottenmeier, Erika (HHS/OCIIO); Lorden, Susie (HHS/OCIIO) Subject: FW: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High

ra do .

Sounds good to me. I am researching the dental issue now, before I talk to Jim about how to handle my dental plan applicant who has pediatric dependents.

co m

As a side note, we know that dental benefits are considered essential for pediatric care, but it is unclear whether dental benefits are considered essential for adults. Our experience indicates that most consultants, attorneys, etc. are concluding that dental benefits are nonessential for adults.

We would appreciate hearing your thoughts at your earliest convenience, as the Plan Office would like to send the notice as soon as possible. Thanks in advance for your assistance. If you have any questions or need any additional information, please do not hesitate to contact me. Greg Storm Gregory A. Storm

From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Thursday, February 17, 2011 12:36 PM To: Gregory A. Storm Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High

Dear Gregory,

Retirees

Please confirm receipt of this letter by replying to this e-mail address. Please let me know if I can be of further assistance. Sincerely, Sandy

SC UFCW:000059

file:///T|/...20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%20Correspondence%20(3)%203.2.11.htm[11/08/2011 10:35:52 AM]

Co m

Plan B

pl

Plan A

et eC

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for South Central UFCW Unions and Employers Health and Welfare Trust. HHS has reviewed your application and made its determination. Please see the attached letter. The letter applies to the following plans:

ol o

ra do .

co m

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Cell: 414-588-2448| Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

From: Gloria N. Sarmiento [mailto:gsarmien@reinhartlaw.com] On Behalf Of Gregory A. Storm Sent: Tuesday, February 08, 2011 5:27 PM To: Habit, Sandra (HHS/OCIIO) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: South Central UFCW Unions and Employers Health and Welfare Trust

Sandra Here it is again with the corresponding attachments. Gregory A. Storm

Co m

pl

et eC

ol o

ra do .
SC UFCW:000060

file:///T|/...20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%20Correspondence%20(3)%203.2.11.htm[11/08/2011 10:35:52 AM]

co m

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

From: Gregory A. Storm [gstorm@reinhartlaw.com] Sent: Thursday, March 03, 2011 12:14 PM To: Habit, Sandra (HHS/OCIIO) Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust
Sandy -

Thanks so much for this helpful and prompt response. We really appreciate it. Greg

Sandy -

I had one follow up question on this client and its approved waiver. When we prepared the waiver application, the Plan imposed an annual limit on al benefits of $Ex. 4 for Plan A and $Ex. 4 for Ex. 4 Plan B. Subsequently, the annual limits on dental benefits were increased to $ for Plan A and $Ex. 4 for Plan B. However, the waiver was approved based on the lower limit numbers. We are in the process of preparing the notices to send to all participants, and we were wondering how we should document this change in benefit limits for dental benefits. As of now, we are proposing that we will complete the waiver form using the numbers approved by HHS in the waiver, but then we would attach another page behind the waiver notice to acknowledge that plan benefits had actually increased.

As a side note, we know that dental benefits are considered essential for pediatric care, but it is unclear whether dental benefits are considered essential for adults. Our experience indicates that most consultants, attorneys, etc. are concluding that dental benefits are nonessential for adults.

We would appreciate hearing your thoughts at your earliest convenience, as the Plan Office would like to send the notice as soon as possible. Thanks in advance for your assistance. If you have any questions or need any additional information, please do not hesitate to contact me. Greg Storm Gregory A. Storm

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Cell: 414-588-2448| Fax: 414-298-8097
SC UFCW:000061

file:///T|/...20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%20answered%20response%203.3.11.htm[11/08/2011 10:35:53 AM]

Co m

pl

et eC

From: Gregory A. Storm [mailto:gstorm@reinhartlaw.com] Sent: Tuesday, March 01, 2011 5:32 PM To: Habit, Sandra (HHS/OCIIO); Scelzo, Kathleen (HHS/OCIIO) Subject: FW: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High

ol o

ra do .

Greg, In response to your questions, it will be fine that you send out a notice to all participants with the HHS approved dental benefits with the attached document that the dental benefits have been increased. Additionally, as long as a determination is made in good faith and the law is consistently applied we will accept the adult dental benefit as non-essential. Thank you, Sandy

co m

From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Wednesday, March 02, 2011 4:30 PM To: Gregory A. Storm Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust

gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Thursday, February 17, 2011 12:36 PM To: Gregory A. Storm Subject: RE: South Central UFCW Unions and Employers Health and Welfare Trust Importance: High

Plan A

Retirees

From: Gloria N. Sarmiento [mailto:gsarmien@reinhartlaw.com] On Behalf Of Gregory A. Storm Sent: Tuesday, February 08, 2011 5:27 PM To: Habit, Sandra (HHS/OCIIO) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: South Central UFCW Unions and Employers Health and Welfare Trust

Sandra Here it is again with the corresponding attachments. Gregory A. Storm

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

Co m

Please confirm receipt of this letter by replying to this e-mail address. Please let me know if I can be of further assistance. Sincerely, Sandy

pl

et eC

ol o

Plan B

ra do .

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for South Central UFCW Unions and Employers Health and Welfare Trust. HHS has reviewed your application and made its determination. Please see the attached letter. The letter applies to the following plans:

file:///T|/...20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%20answered%20response%203.3.11.htm[11/08/2011 10:35:53 AM]

co m

Dear Gregory,

SC UFCW:000062

Co m

pl

et eC

ol o

ra do .
SC UFCW:000063

file:///T|/...20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%20answered%20response%203.3.11.htm[11/08/2011 10:35:53 AM]

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From: Gregory A. Storm [gstorm@reinhartlaw.com] Sent: Friday, March 11, 2011 4:10 PM To: Habit, Sandra (HHS/OCIIO) Subject: South Central UFCW - Timing of Waiver Notice
Hi Sandy -

As you might remember, we have corresponded regarding the waiver applications for a few different plans. I have a follow up questionfor one of those plans, the South Central UFCW plan, and I was wondering if you could assist. The South Central plan has a plan year of March 1 to February 28. The waiver guidance requires plans that have plan years beginning on or after February 1, 2011 to include the required waiver notice in educational materials, enrollment materials and documents explaining plan benefits (such as an SPD). Our recollection is that other informal guidance stated that plans with plan years after February 1, 2011 (like South Central) should also send out the waiver notice within 60 days of receiving approval of the waiver. Can you please confirm our understanding?

Thanks again for your ongoing assistance. Greg Storm Gregory A. Storm

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Cell: 414-588-2448| Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

Co m

pl

et eC

ol o

ra do .
SC UFCW:000064

file:///T|/...and%20Employers%20Health%20and%20Welfare%20Trust/Timing%20of%20Waiver%20Notice%20Question%203.11.11.htm[11/08/2011 10:35:54 AM]

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From: Habit, Sandra (HHS/OCIIO) Sent: Monday, March 14, 2011 12:19 PM To: 'Gregory A. Storm' Subject: RE: South Central UFCW - Timing of Waiver Notice

Hi Greg, You are correct. The waiver notice should be sent out within 60 days of receiving approval of the waiver. Thank you, Sandy From: Gregory A. Storm [mailto:gstorm@reinhartlaw.com] Sent: Friday, March 11, 2011 4:10 PM To: Habit, Sandra (HHS/OCIIO) Subject: South Central UFCW - Timing of Waiver Notice

Hi Sandy -

The South Central plan has a plan year of March 1 to February 28. The waiver guidance requires plans that have plan years beginning on or after February 1, 2011 to include the required waiver notice in educational materials, enrollment materials and documents explaining plan benefits (such as an SPD). Our recollection is that other informal guidance stated that plans with plan years after February 1, 2011 (like South Central) should also send out the waiver notice within 60 days of receiving approval of the waiver. Can you please confirm our understanding? Thanks again for your ongoing assistance.

Greg Storm Gregory A. Storm

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Cell: 414-588-2448| Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

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As you might remember, we have corresponded regarding the waiver applications for a few different plans. I have a follow up questionfor one of those plans, the South Central UFCW plan, and I was wondering if you could assist.

file:///T|/...%20UFCW%20Unions%20and%20Employers%20Health%20and%20Welfare%20Trust/Question%20response%203.14.11.htm[11/08/2011 10:35:54 AM]

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SC UFCW:000065