Uniformed Firefighters Assn - Redacted - Bates HW

7/27/2019 Uniformed Firefighters Assn - Redacted - Bates HW

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REQUEST FOR LIMITED PLAN WAIVERPLAN NAME: SECURITY BENEFIT FUND OF THE UNIFORMED FIREFIGHTE.RS ASSOCIATION OFNEW YORK CITYPLAN TYPE: MUNICIPAL SUPPLEMENTAL HEALTH AND WELFARE 8ENEFlT FUNDPLAN YEAR FOR WHICH WAIVER IS REQUESTED' JULY 1, 2011 - JUNE 30, 2012BACKGROUND: The Plan is a health and welfare benefit plan established under the proviSions of anAgreement and Declaration of Trust between Its Trustees and the Uniformed Firefighters Associatton ofGreater New York, Local 94 IAF.F., AFL-CIO (the UFA). Participants are firefighters, fire marshals, marineengmeers, pilots, and uniformed wipers who are covered by collective bargaining agreements between theCity of New York and the UFA.Benefits The Plan provides preSCrIption drug, dental, optical, hearing aid. life insurance. supplementalhealth insurance, certain widows' benefits and other benefits to eligible participants and their covereddependents.Contributions - The Plan is funded by employer contributions and participants' COBRA contributions.Employer contributions are determined by collective bargaining agreements between the City of New Yorkand the UFA.

APPLICATION COMPONENTS:The terms of the plan or policy fOrln(s) for which a waiver is sought

SEE ATTACHED2. The number of individuals covered by 1I1e plan or policy form(s);

APROX1MATELY_EXCLUDING DEPENDENTS3. The annual l i m i t ( ~ ; ) and rates applicable to the plan or policy form(s),

THE PRESCRIPTION DRUG BENEF!T IS LIMITED TO f I I I PER FAMILY PERCALENDAR YEAR

4. A brief description Of why compliance with the regulations would result ill a significantdecrease in access to i)enefits for those current ly covered by the plan or policy. or a significantincrease in premiums paid by those covered by the plan or polley, along with any supportingdocumentation; and

PRESCRIPTION DRUG EXPENSES REPRESENT APPROXIMATELY_/a OFTOTAL FUND BENEFIT EXPENDITURE. AS SUCH, REMOVAL OF THE .A.NNUALBENEFIT CAP ON THE PHARMACY BENEFIT WILL NECESSITATE LARGE SCALEPLAN REDESIGN RESULTING IN COST INCREASES FOR MEMBERS, EITHER INTHE FORM OF INCREASED CO PAYS/COINSURANCE AND/OR REQUIRED MEMBERCONTRIBUTUIONS TOWARDS COVERAGE. GIVEN THAT THE FUND'S INCOME ISLIMITED TO FIXED DOLL.A,R CONTRIBUTIONS FROM THE CITY OF NEW YORK, ANDIS A SUBJECT OF COLLECTIVE BARGAINING, ELIMINATION OF THE BENEFIT CJ:\PON THE PHARMACY BENEFIT WILL HAVE AN ADVERSE IMPACT ON THE FUND'S

UFireA:000001
http:///reader/full/FIREFIGHTE.RShttp:///reader/full/FIREFIGHTE.RS


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LONG-TERM ABILITY TO CONTINUE TO PROVIDE ITS MEMBERS WITH ACCESS TOPHARMACY BENEFITS AS WELL AS OTHER BENEFITS SUCH AS DENTAL, VISION,HEARING.

5. An attestation, signed by the plan administrator or clllef executive officer of the insurer,certifying thaI (i) the plan or policy was in force prior to September 23,2010, and (il) the applicationof restricted annual limits to the plan or policy would result in a significant decrease in access tobenefits for those currently covered by the plan or policy, or a significant increase in premiums paidby those covered by the plan or policy

I, THE UNDERSIGNED PLAN ADMINISTRATOR, CERTIFY THAT (i) THE PLANREFENCED IN THIS APPLICATION WAS IN FORCE PRIOR TO SEPTEMBER 23,2010.AND (ii) THAT THE APPLICATION OF RESTRICTED ANNUAL LIMITS TO THE PLANWOULD RESULT IN SIGNIFICANT DECREASE IN ACCESS TO BENEFITS FORTHOSE CURRENTLY COVERED BY THE PLAN. OR A SIGNIFICANT INCREASE IN::::1UM /J ~ R E D BY THE PLAN.Title: TFflJ ;;Uf..ff(.Date: -1J':> a I I ti __ ._._..__ .Phone 1 ~E-mail; Address: B ::n .R A UB ~ \.\ A N '1


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//C|/...ty%20Benefit%20Fund%20of%20the%20Uniformed%20Firefighters%20Assoc%20of%20New%20York%20City/WAIVER.txt[08/15/2011 11:10:

rom: Carapella,Theresa [[email protected]]ent: Monday, November 22, 2010 2:25 PMo: HHS HealthInsurance (HHS)ubject: WAIVER

Attachments: B2_Health Book_Ch01_Security Benefits Fund_11-10.pdf;imited Plan Waiver..pdf

he attached booklet summarizes Welfare Benefits for Active and Retired Firefighters although the Waiver applicas specific to the Active Fund.

TATEMENT OF CONFIDENTIALITY

he information contained in this electronic message and any attachments to this message are intended for the

xclusive use of the addressee(s) and may contain confidential or privileged information. If you are not the intendeecipient, please notify us immediately by e-mail reply to sender or by telephone to Uniformed Firefighters Associat (212) 683-4832, and destroy all copies of this message and any attachments. Please note that any views or opiniresented in this email are solely those of the author and do not necessarily represent those of the Uniformedirefighters Association.inally, the recipient should check this email and any attachments for the presence of viruses. The company accepo liability for any damage caused by any virus transmitted by this email.

UFireA:000003


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Pages 4 through 42 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4

UFireA:000004


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//C|/...ty/Uniformed%20Firefighters%20Association%20of%20New%20York%20Waiver%20Application%20Dec%209%202010.htm[08/15/2011 11:10

rom: Morales, Veronica (HHS/OCIIO)

ent: Thursday, December 09, 2010 3:02 PM

o: '[email protected]'

c: '[email protected]'; Sheer, Jennifer (HHS/OCIIO)

ubject: Uniformed Forefighters Association of New York, Waiver Application

ttachments: Waiver Application Form.xls

Dear Mr. Straub:

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

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

II. In addition, please provide the following information:

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

grandfathering provisions, pursuant to 45 CFR 147.140?

Confirm whether the plan was created pursuant to the Taft-Hartley Act.

n order to complete your application, please provide this information by 5:00 pm, December 10, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Hum

ervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi

hank you.

Veronica W. Morales, J.D.U.S. Department of Health & Human ServicesOffice of Consumer Information & Insurance OversightOffice of Consumer Support

hone# (301) 492-4249mail: [email protected]

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:his information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distrib

or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

UFireA:000005
http://www.hhs.gov/ociio/regulations/annual_limit_waivers.htmlmailto:[email protected]:[email protected]://www.hhs.gov/ociio/regulations/annual_limit_waivers.html


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//C|/...Uniformed%20Firefighters%20Assoc%20of%20New%20York%20City/Request%20for%20info%20resposne%2012.14.10.htm[08/15/2011 11:10

rom: Moultrie, Cam (HHS/OCIIO)ent: Tuesday, December 14, 2010 3:52 PM

To: Habit, Sandra (HHS/OCIIO)ubject: FW: Waiver Application for UFA Security Benefits Fund

Attachments: UFA waiver_application_form.xls

am Lynne Moultrieffice of Consumer Information and Insurance Oversight

.S. Department of Health and Human Services

301) 492-4174

[email protected]

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:

his information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu

copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

rom: Carapella,Theresa [mailto:[email protected]]ent: Tuesday, December 14, 2010 2:54 PMo: Moultrie, Cam (HHS/OCIIO)ubject: FW: Waiver Application for UFA Security Benefits Fund

I. Please complete the entire annual limits spreadsheet available at:

http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed

spreadsheet to this email address as an attachment. We will only be able to process spreadsheets tha

are fully complete (i.e., every cell should contain the information requested). If a cell on the spreadsh

does not pertain to your plan, please write None, and/or provide an explanation regarding why you

unable to complete that particular cell in a separate document.

SEE ATTACHED FOR COMPLETED SPREADSHEET



grandfathering provisions, pursuant to 45 CFR 147.140? YES, PLAN WAS IN EXISTENCE PRIOR TO MARCH

2010. PLAN IS ALSO IN COMPLIANCE WITH GRANDFATHERING PROVISIONS.

Confirm whether the plan was created pursuant to the Taft-Hartley Act. NO

lease let me know if you have questions or need anything further.

hank you.

heresa Carapella

enefits Administrator

niformed Firefighters Association

ecurity Benefit FundUFireA:000007


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//C|/...Uniformed%20Firefighters%20Assoc%20of%20New%20York%20City/Request%20for%20info%20resposne%2012.14.10.htm[08/15/2011 11:10

212) 545-6960

TATEMENT OF CONFIDENTIALITY:The information contained in this electronic message and any attachments to this message are intended for the exclusive use addressee(s) and may contain confidential or privileged information. If you are not the intended recipient, please notify us immediately by e-mail reply to sender orephone to Uniformed Firefighters Association at (212) 683-4723, and destroy all copies of this message and any attachments.

rom: Straub,Bob

ent: Monday, December 13, 2010 3:43 PMo: Carapella,Theresaubject: FW: Waiver Application for UFA Security Benefits Fund

rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Monday, December 13, 2010 2:54 PMo: Straub,Bobc: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for UFA Security Benefits Fund

ear Mr. Straub:

hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act

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





does not pertain to your plan, please write None, and/or provide an explanation regarding why youunable to complete that particular cell in a separate document.





n order to complete your application, please provide this information by 5:00 pm, December 15, 2010. Once th

nformation is received and the application is complete, it will be processed by the Department of Health and

uman Services (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision

within 30 days of receiving a complete application. You will receive an e-mail from HHS notifying you of the wai

ecision.

hank you.

UFireA:000008


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//C|/...%20Uniformed%20Firefighters%20Assoc%20of%20New%20York%20City/Additional%20info%20requested%2012.28.10.htm[08/15/2011 11:10

rom: Moultrie, Cam (HHS/OCIIO)ent: Tuesday, December 28, 2010 3:07 PM

To: Carapella,TheresaCc: Habit, Sandra (HHS/OCIIO)

ubject: RE: Waiver Application for UFA Security Benefits Fundlease provide a breakdown of individuals in each tier (column P).

hank you.

am Lynne Moultrie

ffice of Consumer Information and Insurance Oversight


301) 492-4174

[email protected]




rom: Carapella,Theresa [mailto:[email protected]]ent: Tuesday, December 14, 2010 2:54 PMo: Moultrie, Cam (HHS/OCIIO)ubject: FW: Waiver Application for UFA Security Benefits Fund


http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completedspreadsheet to this email address as an attachment. We will only be able to process spreadsheets tha











hank you.

heresa Carapella

UFireA:000010


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ecurity Benefit Fund

212) 545-6960


rom: Straub,Bobent: Monday, December 13, 2010 3:43 PMo: Carapella,Theresaubject: FW: Waiver Application for UFA Security Benefits Fund

rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Monday, December 13, 2010 2:54 PMo: Straub,Bobc: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for UFA Security Benefits Fund

ear Mr. Straub:

















ecision.

UFireA:000011


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hank you.

am Lynne Moultrie



301) 492-4174

[email protected]


This information has not been publicly disclosed and may be pr ivileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copie

persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.


he information contained in this electronic message and any attachments tohis message are intended for the exclusive use of the addressee(s) and mayontain confidential or privileged information. If you are not the intendedecipient, please notify us immediately by e-mail reply to sender or byelephone to Uniformed Firefighters Association at (212) 683-4832, and destroyll copies of this message and any attachments. Please note that any views orpinions presented in this email are solely those of the author and do notecessarily represent those of the Uniformed Firefighters Association.inally, the recipient should check this email and any attachments for theresence of viruses. The company accepts no liability for any damage caused byny virus transmitted by this email.

UFireA:000012


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//C|/...20Uniformed%20Firefighters%20Assoc%20of%20New%20York%20City/Reqeust%20for%20info%20response%201.6.11.htm[08/15/2011 11:10

rom: Carapella,Theresa [[email protected]]ent: Thursday, January 06, 2011 12:56 PM

To: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for UFA Security Benefits Fundam:

elow is the information requested

Contracts Members

ngle

amily

OTAL

hank you.

heresa Carapella


niformed Firefighters Associationecurity Benefit Fund

212) 545-6960


rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, December 28, 2010 3:07 PM

o: Carapella,Theresac: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for UFA Security Benefits Fund

lease provide a breakdown of individuals in each tier (column P).

hank you.

am Lynne Moultrie



301) 492-4174

[email protected]



UFireA:000013


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rom: Carapella,Theresa [mailto:[email protected]]

ent: Tuesday, December 14, 2010 2:54 PM

o: Moultrie, Cam (HHS/OCIIO)

ubject: FW: Waiver Application for UFA Security Benefits Fund














hank you.

heresa Carapellaenefits Administrator



212) 545-6960

TATEMENT OF CONFIDENTIALITY: The information contained in this electronic message and any attachments to this mesre intended for the exclusive use of the addressee(s) and may contain confidential or privileged information. If yore not the intended recipient, please notify us immediately by e-mail reply to sender or by telephone to Uniformedirefighters Association at (212) 683-4723, and destroy all copies of this message and any attachments.

rom: Straub,Bob

ent: Monday, December 13, 2010 3:43 PM

o: Carapella,Theresa


UFireA:000014


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rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]


o: Straub,Bob

c: Habit, Sandra (HHS/OCIIO)

ubject: Waiver Application for UFA Security Benefits Fund

ear Mr. Straub:

















ecision.

hank you.

am Lynne Moultrie



301) 492-4174

[email protected]




UFireA:000015


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he information contained in this electronic message and any attachments tohis message are intended for the exclusive use of the addressee(s) and mayontain confidential or privileged information. If you are not the intendedecipient, please notify us immediately by e-mail reply to sender or byelephone to Uniformed Firefighters Association at (212) 683-4832, and destroyll copies of this message and any attachments. Please note that any views orpinions presented in this email are solely those of the author and do notecessarily represent those of the Uniformed Firefighters Association.

inally, the recipient should check this email and any attachments for theresence of viruses. The company accepts no liability for any damage caused byny virus transmitted by this email.TATEMENT OF CONFIDENTIALITY


UFireA:000016


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ANNUAL LIMIT WAIVER APPLICATION

Annual

Limit Waiver

Request

App lic ant

Name

Policy Name

(use a new

row for each

policy

application)

Applicant

(Plan/ Policy

Situs) City

App lic ant

(Plan/

Policy

Situs)

State

Plan/ Policy

Effective Date

(mm/dd/yyyy)

Contact

Name

Street

Address City State Zip Code

Phone

Number

(including

area code)

Email

Address

C

(e.

Be

Rx o

Security

Benefit Fund

of the

Uniformed

Firefighters

Association

of New York

City

Security

Benefit Fund

of the

Uniformed

Firefighters

Association of

New York City New York NY 07/01/2011

Robert

Straub

204 East

23rd Street New York NY 10010

212-545-

6975

bstraub@ufa

nyc.org


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Annual

Limit Waiver

Request

App lic ant

Name Ambulatory Emergency Hospitalization Laboratory Pediatric

Maternity/

Newborn

Mental Health/

Substance

Abuse

Rehabilitative/

Devices

Pre

We

Current Essential Benefits Annual Limits (Annual Limi t for Each Essential Benefit)

Security

Benefit Fund

of the

Uniformed

Firefighters

Association

of New York

City


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Annual

Limit Waiver

Request

App lic ant

Name

Coinsuran

ce (if

applicable)

Individual/ Employee

Tier*

Employee

contribution

(if applicable)

Employer

contribution

(if applicable) Total

Employee

contribution

(if applicable)

Employer

contribution

(if applicable) Total

Employee

contribution

(if applicable)

Em

con

(if ap

Projected Rate Inc

from compliance wit

Restriction (in doll

by In

Current Monthly Premium Rates or

Premium Equivalent Rates (in dol lars)*:

x

ninsurance

Renewal Monthl y Premium Rates or

Premium Equivalent Rates if Waiver Granted

(in dollars)*

Security

Benefit Fund

of the

Uniformed

Firefighters

Association

of New York

City n/a Individual


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//C|/...0Uniformed%20Firefighters%20Assoc%20of%20New%20York%20City/Request%20for%20info%20response%201.10.11.htm[08/15/2011 11:10

rom: Carapella,Theresa [[email protected]]ent: Monday, January 10, 2011 9:32 AM

To: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)Cc: Straub,Bob; Eustace, John; Spollen,Jim

ubject: RE: Waiver Application for UFA Security Benefits Fund

rom: Carapella,Theresaent: Thursday, January 06, 2011 12:56 PMo: 'Moultrie, Cam (HHS/OCIIO)'; '[email protected]'

ubject: RE: Waiver Application for UFA Security Benefits Fund

am:

elow is the information requested

Contracts Members

ngle

amily

OTAL

hank you.

heresa Carapella




212) 545-6960


rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, December 28, 2010 3:07 PMo: Carapella,Theresac: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for UFA Security Benefits Fund

lease provide a breakdown of individuals in each tier (column P).

hank you.

am Lynne Moultrie



301) 492-4174

[email protected]

UFireA:000020


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rom: Carapella,Theresa [mailto:[email protected]]

ent: Tuesday, December 14, 2010 2:54 PM

o: Moultrie, Cam (HHS/OCIIO)







unable to complete that particular cell in a separate document.SEE ATTACHED FOR COMPLETED SPREADSHEET







hank you.

heresa Carapella




212) 545-6960

TATEMENT OF CONFIDENTIALITY: The information contained in this electronic message and any attachments to this mesre intended for the exclusive use of the addressee(s) and may contain confidential or privileged information. If yore not the intended recipient, please notify us immediately by e-mail reply to sender or by telephone to Uniformedirefighters Association at (212) 683-4723, and destroy all copies of this message and any attachments.

rom: Straub,Bob

ent: Monday, December 13, 2010 3:43 PMUFireA:000021


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o: Carapella,Theresa


rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]


o: Straub,Bobc: Habit, Sandra (HHS/OCIIO)

ubject: Waiver Application for UFA Security Benefits Fund

ear Mr. Straub:




http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completedspreadsheet to this email address as an attachment. We will only be able to process spreadsheets tha












ecision.

hank you.

am Lynne Moultrie



301) 492-4174

[email protected]

UFireA:000022


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he information contained in this electronic message and any attachments tohis message are intended for the exclusive use of the addressee(s) and mayontain confidential or privileged information. If you are not the intendedecipient, please notify us immediately by e-mail reply to sender or byelephone to Uniformed Firefighters Association at (212) 683-4832, and destroyll copies of this message and any attachments. Please note that any views orpinions presented in this email are solely those of the author and do notecessarily represent those of the Uniformed Firefighters Association.inally, the recipient should check this email and any attachments for theresence of viruses. The company accepts no liability for any damage caused byny virus transmitted by this email.TATEMENT OF CONFIDENTIALITY

he information contained in this electronic message and any attachments tohis message are intended for the exclusive use of the addressee(s) and mayontain confidential or privileged information. If you are not the intended

ecipient, please notify us immediately by e-mail reply to sender or byelephone to Uniformed Firefighters Association at (212) 683-4832, and destroyll copies of this message and any attachments. Please note that any views orpinions presented in this email are solely those of the author and do notecessarily represent those of the Uniformed Firefighters Association.inally, the recipient should check this email and any attachments for theresence of viruses. The company accepts no liability for any damage caused byny virus transmitted by this email.

UFireA:000023


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//C|/...und%20of%20the%20Uniformed%20Firefighters%20Assoc%20of%20New%20York%20City/Correspondence%201.11.11.htm[08/15/2011 11:10

rom: Sheer, Jennifer (HHS/OCIIO)ent: Tuesday, January 11, 2011 11:39 AM

To: '[email protected]'Cc: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO); Morales, Veronica (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of New York, Waiver Applicationi Theresa

have checked with my colleagues and we did receive your spreadsheet and the supplemental information submitted on J

, 2011 (the number of individuals in each tier). At this time, we do not require additional information; however, furthernformation may be requested during the processing of your application.

omeone from this office should be in touch with you next week.

ood luck with the snowstorm.

--------------------------------

ennifer L. O. Sheer

ffice of Consumer Support

ffice of Consumer Information and Insurance Oversight.S. Department of Health and Human Services

[email protected]

01-492-4487


his information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must n

disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecu

to the full extent of the law.

rom: Sheer, Jennifer (HHS/OCIIO)ent: Monday, January 10, 2011 4:27 PMo: '[email protected]'c: '[email protected]'ubject: Uniformed Firefighters Association of New York, Waiver Application

ello

n Dec. 9, 2010, my colleague Veronica Morales sent you the email below (please see below my signature for the original

message). We have not yet received a reply regarding this information request. Without your reply, we are unable to proc

our application for an annual limit waiver. Please provide the requested information by 5pm Tuesday, January 11, 2011.

lease feel free to email or call me if you have any questions.

hank you.

--------------------------------

ennifer L. O. Sheer


ffice of Consumer Information and Insurance OversightUFireA:000024


25/64



[email protected]

01-492-4487

ORINGAL MESSAGE]







ear Mr. Straub:

hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (PHS Act

ection 2711. In order to expedite your application, please provide the following information:

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





n order to complete your application, please provide this information by 5:00 pm, December 10, 2010. Once this informa

received and the application is complete, it will be processed by the Department of Health and Human Services (HHS). A

tated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 30 days of receiving a complet

pplication. You will receive an e-mail from HHS notifying you of the waiver decision.

hank you.



UFireA:000025


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UFireA:000026


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//C|/...it%20Fund%20of%20the%20Uniformed%20Firefighters%20Assoc%20of%20New%20York%20City/Question%201.11.11.htm[08/15/2011 11:10


To: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: Uniformed Firefighters Association of NYCi

ust wanted to check on who is handling this application. Veronica Morales had this in her set of waivers, and she passed

me when she left on annual leave. I was told that there was no response from this organization. I have since spoken with

heresa Carapella, who said she has been in contact with you two regarding her application. Could you please let me knowhis should be on your to do list or mine? Theyre hoping to hear if the application is complete or a request for more info

efore the storm hits this evening (since they are anticipating not being in the office tomorrow due to weather conditions

ke to get back to them with that much today, since the confusion on our end has led to some worries on their side. Pleas

me know how to proceed (and if you reply to Theresa about the application status, can you CC me?).

hanks.

en

--------------------------------ennifer L. O. Sheer




[email protected]

01-492-4487





UFireA:000027


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//C|/...%20of%20the%20Uniformed%20Firefighters%20Assoc%20of%20New%20York%20City/Additional%20info%201.18.11.htm[08/15/2011 11:10:

rom: Moultrie, Cam (HHS/OCIIO)ent: Tuesday, January 18, 2011 10:54 AM

To: Sheer, Jennifer (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of NYCbelieve Veronica was handling this application. I had received a redundant copy of the application and turned it back ove

eronica.

am Lynne Moultrie


301) 492-4174

[email protected]


his information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribut


rom: Sheer, Jennifer (HHS/OCIIO)ent: Tuesday, January 11, 2011 8:20 AMo: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: Uniformed Firefighters Association of NYC

i

ust wanted to check on who is handling this application. Veronica Morales had this in her set of waivers, and she passed

me when she left on annual leave. I was told that there was no response from this organization. I have since spoken with

heresa Carapella, who said she has been in contact with you two regarding her application. Could you please let me knowhis should be on your to do list or mine? Theyre hoping to hear if the application is complete or a request for more info

efore the storm hits this evening (since they are anticipating not being in the office tomorrow due to weather conditions

ke to get back to them with that much today, since the confusion on our end has led to some worries on their side. Pleas

me know how to proceed (and if you reply to Theresa about the application status, can you CC me?).

hanks.

en

--------------------------------ennifer L. O. Sheer




[email protected]

01-492-4487

UFireA:000028


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UFireA:000029


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rom: Sheer, Jennifer (HHS/OCIIO)ent: Tuesday, January 18, 2011 11:08 AMo: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of NYC

Ok, then I guess it's in my pile now. Sandra, it looks like you saved the relevant emails/materials onto the G-drive; ave any questions, I hope you won't mind if I email you (since from what I can tell this applicant sent everything ou and Cam). Thanks.

en---------------------------------ennifer L. O. Sheer

Office of Consumer SupportOffice of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services

[email protected]_______________________________________rom: Moultrie, Cam (HHS/OCIIO)ent: Tuesday, January 18, 2011 10:53 AM

o: Sheer, Jennifer (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of NYC

believe Veronica was handling this application. I had received a redundant copy of the application and turned it bver to Veronica.

Cam Lynne MoultrieOffice of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services301) [email protected]

NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:his information has not been publicly disclosed and may be privileged and confidential. It is for internal governmse 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.


o: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: Uniformed Firefighters Association of NYC

Hi

just wanted to check on who is handling this application. Veronica Morales had this in her set of waivers, and sheassed it to me when she left on annual leave. I was told that there was no response from this organization. I have spoken with Theresa Carapella, who said she has been in contact with you two regarding her application. Could yolease let me know if this should be on your to do list or mine? Theyre hoping to hear if the application is complerequest for more info before the storm hits this evening (since they are anticipating not being in the office tomorrue to weather conditions). Id like to get back to them with that much today, since the confusion on our end has le

UFireA:000030


31/64

//C|/...0the%20Uniformed%20Firefighters%20Assoc%20of%20New%20York%20City/Additional%20info%20needed%201.18.11.txt[08/15/2011 11:10

ome worries on their side. Please let me know how to proceed (and if you reply to Theresa about the applicationtatus, can you CC me?).

hanks.

en

---------------------------------ennifer L. O. Sheer


[email protected]

NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:

his information has not been publicly disclosed and may be privileged and confidential. It is for internal governm

se 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.

UFireA:000031


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//C|/...20Assoc%20of%20New%20York%20City/Follow%20up%20to%20Additional%20info%20needed%20Jan%2018%202011.txt[08/15/2011 11:10:

rom: Sheer, Jennifer (HHS/OCIIO)ent: Tuesday, January 18, 2011 11:08 AMo: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of NYC

Ok, then I guess it's in my pile now. Sandra, it looks like you saved theelevant emails/materials onto the G-drive; if I have any questions, I hopeou won't mind if I email you (since from what I can tell this applicant sent

verything to you and Cam). Thanks.


Office of Consumer SupportOffice of Consumer Information and Insurance Oversight U.S. Department ofHealth and Human Services

[email protected]_______________________________________

rom: Moultrie, Cam (HHS/OCIIO)ent: Tuesday, January 18, 2011 10:53 AMo: Sheer, Jennifer (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of NYC

believe Veronica was handling this application. I had received a redundantopy of the application and turned it back over to Veronica.

Cam Lynne MoultrieOffice of Consumer Information and Insurance Oversight U.S. Department ofHealth and Human Services

301) [email protected]

NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:his information has not been publicly disclosed and may be privileged andonfidential. It is for internal government use only and must not beisseminated, distributed, or copied to persons not authorized to receive the

nformation. Unauthorized disclosure may result in prosecution to the fullxtent of the law.

rom: Sheer, Jennifer (HHS/OCIIO)ent: Tuesday, January 11, 2011 8:20 AMo: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: Uniformed Firefighters Association of NYC

Hi

just wanted to check on who is handling this application. Veronica Morales

UFireA:000032


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rom: Scelzo, Kathleen (HHS/OCIIO)ent: Tuesday, January 25, 2011 12:09 PM

To: Habit, Sandra (HHS/OCIIO)ubject: FW: Uniformed Firefighters Association of New York, Waiver Application

athleen M. Scelzo, RN, MSN

ules Compliance Division

ffice of Insurance Oversight

ffice of Consumer Information and Insurance Oversight (OCIIO)epartment of Health and Human Services

501 Wisconsin Avenue

ethesda, MD

01-492-4121

rom: Moultrie, Cam (HHS/OCIIO)ent: Monday, January 24, 2011 2:55 PMo: Scelzo, Kathleen (HHS/OCIIO)ubject: FW: Uniformed Firefighters Association of New York, Waiver Application

forgot to send this to you. This is the conversation regarding the firefighter application that was discussed today.




rom: Carapella,Theresa [mailto:[email protected]]ent: Monday, January 24, 2011 9:24 AM

o: Sheer, Jennifer (HHS/OCIIO)c: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of New York, Waiver Application

ood Morning Jennifer:

have not heard anything with regard to the status of the Waiver Application. Please advise.

hank you.

heresa Carapella




212) 545-6960


rom: Sheer, Jennifer (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, January 11, 2011 11:39 AM

UFireA:000034


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o: Carapella,Theresac: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO); Morales, Veronica (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of New York, Waiver Application

i Theresa


, 2011 (the number of individuals in each tier). At this time, we do not require additional information; however, further

nformation may be requested during the processing of your application.



--------------------------------

ennifer L. O. Sheer




[email protected]

01-492-4487





rom: Sheer, Jennifer (HHS/OCIIO)

ent: Monday, January 10, 2011 4:27 PM


c: '[email protected]'

ubject: Uniformed Firefighters Association of New York, Waiver Application

ello


message). We have not yet received a reply regarding this information request. Without your reply, we are unable to procour application for an annual limit waiver. Please provide the requested information by 5pm Tuesday, January 11, 2011.


hank you.

--------------------------------

ennifer L. O. Sheer



UFireA:000035


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[email protected]

01-492-4487

ORINGAL MESSAGE]







ear Mr. Straub:



I. Please complete the entire annual limits spreadsheet, [attached to the email] [and available at:

http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html]. Please return the completed spreadsheet to this email ad

as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell should contain the

information requested). If a cell on the spreadsheet does not pertain to your plan, please write None, and/or provide an

explanation regarding why you are unable to complete that particular cell in a separate document.





n order to complete your application, please provide this information by 5:00 pm, December 10, 2010. Once this informa

received and the application is complete, it will be processed by the Department of Health and Human Services (HHS). A



hank you.



UFireA:000036


37/64








UFireA:000037


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//C|/...und%20of%20the%20Uniformed%20Firefighters%20Assoc%20of%20New%20York%20City/Status%20check%201.24.11.htm[08/15/2011 11:10

rom: Carapella,Theresa [[email protected]]ent: Monday, January 24, 2011 9:24 AM

To: Sheer, Jennifer (HHS/OCIIO)Cc: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)

ubject: RE: Uniformed Firefighters Association of New York, Waiver Applicationood Morning Jennifer:


hank you.

heresa Carapella




212) 545-6960


rom: Sheer, Jennifer (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, January 11, 2011 11:39 AMo: Carapella,Theresac: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO); Morales, Veronica (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of New York, Waiver Application

i Theresa


, 2011 (the number of individuals in each tier). At this time, we do not require additional information; however, furthernformation may be requested during the processing of your application.



--------------------------------

ennifer L. O. Sheer



[email protected]

01-492-4487


UFireA:000038


39/64





rom: Sheer, Jennifer (HHS/OCIIO)

ent: Monday, January 10, 2011 4:27 PM


c: '[email protected]'

ubject: Uniformed Firefighters Association of New York, Waiver Application

ello


message). We have not yet received a reply regarding this information request. Without your reply, we are unable to proc

our application for an annual limit waiver. Please provide the requested information by 5pm Tuesday, January 11, 2011.


hank you.

--------------------------------

ennifer L. O. Sheer




[email protected]

01-492-4487

ORINGAL MESSAGE]







ear Mr. Straub:



I. Please complete the entire annual limits spreadsheet, [attached to the email] [and available at:

http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html]. Please return the completed spreadsheet to this email ad

as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell should contain the

information requested). If a cell on the spreadsheet does not pertain to your plan, please write None, and/or provide an

explanation regarding why you are unable to complete that particular cell in a separate document.

UFireA:000039
http://www.hhs.gov/ociio/regulations/annual_limit_waivers.htmlhttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html


40/64






n order to complete your application, please provide this information by 5:00 pm, December 10, 2010. Once this informareceived and the application is complete, it will be processed by the Department of Health and Human Services (HHS). A



hank you.

Veronica W. Morales, J.D.U.S. Department of Health & Human ServicesOffice of Consumer Information & Insurance Oversight

Office of Consumer Supporthone# (301) 492-4249mail: [email protected]







UFireA:000040
mailto:[email protected]:[email protected]


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rom: Habit, Sandra (HHS/OCIIO)ent: Tuesday, January 25, 2011 2:51 PM

To: '[email protected]'ubject: Uniformed Firefighters Association of NYanuary 25, 2011

Dear Ms. Carapella,hank you for your information.

Your application is now complete and you will receive a determination of your application within 30 days. Take c

nd if you have any questions, please feel free to contact me.hank you,andy

andy Habit

epartment of Health and Human Services


01-492-4175

[email protected]

NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly

sclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu

r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full e

f the law.

UFireA:000041
mailto:[email protected]:[email protected]


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rom: Sheer, Jennifer (HHS/OCIIO)ent: Tuesday, January 25, 2011 7:27 AMo: Pham, Erica (HHS/OCIIO); McCune, Julie (HHS/OCIIO); Habit, Sandra

HHS/OCIIO)ubject: FW: Uniformed Firefighters Association of New York, Waiver

Application

Hello

his was one of the waivers I returned to Jane late last week (when we turned back over the waiver work). It lookshe information is on the G drive, but I did not have a chance to review it at all. Could someone please follow up wheresa?

hanks.



[email protected]_______________________________________rom: Carapella,Theresa [[email protected]]ent: Monday, January 24, 2011 9:24 AMo: Sheer, Jennifer (HHS/OCIIO)

Cc: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of New York, Waiver Application

Good Morning Jennifer:


hank you.


Uniformed Firefighters Associationecurity Benefit Fund

212) 545-6960

TATEMENT OF CONFIDENTIALITY: The information contained in this electronic message and any attachmeno this message are intended for the exclusive use of the addressee(s) and may contain confidential or privilegednformation. If you are not the intended recipient, please notify us immediately by e-mail reply to sender or byelephone to Uniformed Firefighters Association at (212) 683-4723, and destroy all copies of this message and anyttachments.

_______________________________rom: Sheer, Jennifer (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, January 11, 2011 11:39 AMo: Carapella,Theresa

UFireA:000042


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Cc: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO); Morales, Veronica (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of New York, Waiver Application

Hi Theresa

have checked with my colleagues and we did receive your spreadsheet and the supplemental information submittn Jan. 6, 2011 (the number of individuals in each tier). At this time, we do not require additional information;owever, further information may be requested during the processing of your application.


Good luck with the snowstorm.

---------------------------------ennifer L. O. Sheer


[email protected]


his information has not been publicly disclosed and may be privileged and confidential. It is for internal governmse only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.


rom: Sheer, Jennifer (HHS/OCIIO)ent: Monday, January 10, 2011 4:27 PMo: '[email protected]'

Cc: '[email protected]'ubject: Uniformed Firefighters Association of New York, Waiver Application

Hello

On Dec. 9, 2010, my colleague Veronica Morales sent you the email below (please see below my signature for theriginal message). We have not yet received a reply regarding this information request. Without your reply, we arenable to process your application for an annual limit waiver. Please provide the requested information by 5pmuesday, January 11, 2011. Please feel free to email or call me if you have any questions.

hank you.

---------------------------------ennifer L. O. Sheer


[email protected]

ORINGAL MESSAGE]UFireA:000043


44/64


rom: Morales, Veronica (HHS/OCIIO)ent: Thursday, December 09, 2010 3:02 PMo: '[email protected]'

Cc: '[email protected]'; Sheer, Jennifer (HHS/OCIIO)ubject: Uniformed Forefighters Association of New York, Waiver Application

Attachments: Waiver Application Form.xls

Dear Mr. Straub:

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

Please complete the entire annual limits spreadsheet, [attached to the email] [and available at:ttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html]. Please return the completed spreadsheet to thismail address as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cehould contain the information requested). If a cell on the spreadsheet does not pertain to your plan, please writeNone, and/or provide an explanation regarding why you are unable to complete that particular cell in a separateocument.

I. In addition, please provide the following information:

Confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance withrandfathering provisions, pursuant to 45 CFR 147.140?


n order to complete your application, please provide this information by 5:00 pm, December 10, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi

hank you.

Veronica W. Morales, J.D.

U.S. Department of Health & Human Services

Office of Consumer Information & Insurance Oversight

Office of Consumer Support

hone# (301) 492-4249

mail: [email protected]

UFireA:000044


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he information contained in this electronic message and any attachments to this message are intended for thexclusive use of the addressee(s) and may contain confidential or privileged information. If you are not the intendeecipient, please notify us immediately by e-mail reply to sender or by telephone to Uniformed Firefighters Associat (212) 683-4832, and destroy all copies of this message and any attachments. Please note that any views or opiniresented in this email are solely those of the author and do not necessarily represent those of the Uniformedirefighters Association.inally, the recipient should check this email and any attachments for the presence of viruses. The company accep

o liability for any damage caused by any virus transmitted by this email.

UFireA:000045


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//C|/...0Uniformed%20Firefighters%20Assoc%20of%20New%20York%20City/Status%20update%20response%20(1)%201.25.11.txt[08/15/2011 11:10:

rom: Habit, Sandra (HHS/OCIIO)ent: Tuesday, January 25, 2011 9:26 AMo: Sheer, Jennifer (HHS/OCIIO); Pham, Erica (HHS/OCIIO); McCune, Julie

HHS/OCIIO)Cc: Moultrie, Cam (HHS/OCIIO); Scelzo, Kathleen (HHS/OCIIO)

ubject: RE: Uniformed Firefighters Association of New York, WaiverApplication

en,

t looks like Kathleen has it but I will take the application from her so I can take care of it today. I will check the Grive to see where Veronica and Cam left off and contact Theresa with any additional questions I have.

hanks,andy

----Original Message-----rom: Sheer, Jennifer (HHS/OCIIO)ent: Tuesday, January 25, 2011 7:27 AMo: Pham, Erica (HHS/OCIIO); McCune, Julie (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)

ubject: FW: Uniformed Firefighters Association of New York, Waiver Application

Hello

his was one of the waivers I returned to Jane late last week (when we turned back over the waiver work). It lookshe information is on the G drive, but I did not have a chance to review it at all. Could someone please follow up wheresa?

hanks.

en

---------------------------------ennifer L. O. Sheer


[email protected]_______________________________________rom: Carapella,Theresa [[email protected]]ent: Monday, January 24, 2011 9:24 AMo: Sheer, Jennifer (HHS/OCIIO)

Cc: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of New York, Waiver Application

Good Morning Jennifer:


hank you.


UFireA:000046


47/64


Uniformed Firefighters Associationecurity Benefit Fund

212) 545-6960

TATEMENT OF CONFIDENTIALITY: The information contained in this electronic message and any attachmeno this message are intended for the exclusive use of the addressee(s) and may contain confidential or privilegednformation. If you are not the intended recipient, please notify us immediately by e-mail reply to sender or byelephone to Uniformed Firefighters Association at (212) 683-4723, and destroy all copies of this message and any

ttachments.

_______________________________rom: Sheer, Jennifer (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, January 11, 2011 11:39 AMo: Carapella,Theresa

Cc: Moultrie, Cam (HHS/OCIIO); Habit, Sandra (HHS/OCIIO); Morales, Veronica (HHS/OCIIO)ubject: RE: Uniformed Firefighters Association of New York, Waiver Application

Hi Theresa

have checked with my colleagues and we did receive your spreadsheet and the supplemental information submittn Jan. 6, 2011 (the number of individuals in each tier). At this time, we do not require additional information;owever, further information may be requested during the processing of your application.


Good luck with the snowstorm.

---------------------------------ennifer L. O. Sheer


[email protected]




rom: Sheer, Jennifer (HHS/OCIIO)ent: Monday, January 10, 2011 4:27 PMo: '[email protected]'

Cc: '[email protected]'ubject: Uniformed Firefighters Association of New York, Waiver Application

Hello

On Dec. 9, 2010, my colleague Veronica Morales sent you the email below (please see below my signature for theriginal message). We have not yet received a reply regarding this information request. Without your reply, we are

UFireA:000047


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nable to process your application for an annual limit waiver. Please provide the requested information by 5pmuesday, January 11, 2011. Please feel free to email or call me if you have any questions.

hank you.

---------------------------------ennifer L. O. Sheer


[email protected]

ORINGAL MESSAGE]

rom: Morales, Veronica (HHS/OCIIO)ent: Thursday, December 09, 2010 3:02 PMo: '[email protected]'

Cc: '[email protected]'; Sheer, Jennifer (HHS/OCIIO)

u

Documents

Uniformed Firefighters Assn - Redacted - Bates HW