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1/34
//T|/...Applications%20with%20NO%2012600%20Response%20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Waiver.htm[08/11/2011 10:58:
rom: Donny Dowlen [[email protected]]
ent: Monday, January 03, 2011 4:34 PM
o: HHS HealthInsurance (HHS)
ubject: Waiver
ttachments: 13115.pdf
ncl osed i s document at i on f or t he Sout heast Laborer s Heal t h Fund.
onny Dowl enout her n Benef i t Admi ni st r at or s00- 831- 4914
r i v a cy a n d Co n f i d e n t i a l i t y N o t i c e : This message is being sent via secure SSL encryption to protect the priv
f our clients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attac
r embedded documents) is intended for the exclusive and confidential use of the individual or entity to which
as been addressed, and unless otherwise expressly indicated, is confidential and privileged information of
outhern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is
rohibited. If you receive this transmission in error, please notify us immediately by e-mail at
[email protected], and delete the original message. Your cooperation is appreciated.
SE Laborers:000001
Document obtained by CompleteColorado.com
mailto:[email protected]:[email protected]7/27/2019 Southeast Laborers - Redacted Bates HW
2/34
SE Laborers:000002
Document obtained by CompleteColorado.com
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SE Laborers:000003
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Document obtained by CompleteColorado.com
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Pages 5 through 6 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4
SE Laborers:000005
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
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Annual L imit
Waiver
Request
Appl icant
Name
Policy Name
(use a new
row for each
policy
application)
Appl icant
(Plan/ Policy
Situs) City
Appl icant
(Plan/
Policy
Situs) State
Plan/ Policy
Effective Date
(mm/dd/yyyy)
Contact
Name
Street
Address City
Applicant
ABC Silver Plan Washington DC 01/01/2011 J ane Doe
100 ABC
Drive WashingtonApplicant
ABC Silver Plan Washington DC 01/01/2011 J ane Doe
100 ABC
Drive Washington
Applicant
ABC Silver Plan Washington DC 01/01/2011 J ane Doe
100 ABC
Drive Washington
Applicant
ABC Silver Plan Washington DC 01/01/2011 J ane Doe
100 ABC
Drive Washington
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund Goodlettsville TN 04/01/2011
Donny
Dowlen
2001
Caldwell
Drive Goodlettsvil
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund Goodlettsville TN 04/01/2011
Donny
Dowlen
2001
Caldwell
Drive Goodlettsvil
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund Goodlettsville TN 04/01/2011
Donny
Dowlen
2001
Caldwell
Drive Goodlettsvil
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund Goodlettsville TN 04/01/2011
Donny
Dowlen
2001
Caldwell
Drive Goodlettsvil
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
7/34
Annual L imit
Waiver
Request
Appl icant
Name
Applicant
ABCApplicant
ABC
Applicant
ABC
Applicant
ABC
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Phone
Number
(including
area code)
(xxx-xxx-
xxx)
Address
Type of
Coverage (e.g.,
Limited
Benefit, HRA,
Rx only, Other)
Self-
Insured
Individual or
Group Policy
Total Number
of
Individuals
Covered by
Policy
(include all
dependents
covered)
Current Plan
Annual L imit
(in dollars)
1-800-ABC-
1234
abc@abcheal
thplan.com Limited Benefit Yes Group 4,000 $100,0001-800-ABC-
1234
abc@abcheal
thplan.com Limited Benefit Yes Group 2,500 $100,000
1-800-ABC-
1234
abc@abcheal
thplan.com Limited Benefit Yes Group 4,000 $100,000
1-800-ABC-
1234
abc@abcheal
thplan.com Limited Benefit Yes Group 2,500 $100,000
1-800-831-
4914
donny.dowlen
@southernbe
nefit.com Limited Benefit Yes Group
1-800-831-
4914
donny.dowlen
@southernbe
nefit.com Limited Benefit Yes Group
1-800-831-
4914
donny.dowlen
@southernbe
nefit.com Limited Benefit Yes Group
1-800-831-
4914
donny.dowlen
@southernbe
nefit.com Limited Benefit Yes Group
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
8/34
Annual L imit
Waiver
Request
Appl icant
Name
Applicant
ABCApplicant
ABC
Applicant
ABC
Applicant
ABC
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Emergency Hospitalization Laboratory Pediatric
Maternity/
Newborn
Mental H
Substan
Abuse
$5,000 None None None None N
$5,000 None None None None N
$5,000 None None None None N
$5,000 None None None None N
none none none none none no
none none none none none no
none none none none none no
none none none none none no
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
9/34
Annual L imit
Waiver
Request
Appl icant
Name
Applicant
ABCApplicant
ABC
Applicant
ABC
Applicant
ABC
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Preventive/
Wellness Prescription
Plan
Deductible
Copay (if
applicable
)
Coinsuranc
e (if
applicable)
Copay (if
applicable
)
Coinsura
nce (if
applicable
)
Co
ap
)
None $3,000.00 $500.00 $15.00 50.00% $100.00 50.00% $
None $3,000.00 $500.00 $15.00 50.00% $100.00 50.00% $
None $3,000.00 $500.00 $15.00 50.00% $100.00 50.00% $
None $3,000.00 $500.00 $15.00 50.00% $100.00 50.00% $
none
none
none
none
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
10/34
Annual L imit
Waiver
Request
Appl icant
Name
Applicant
ABCApplicant
ABC
Applicant
ABC
Applicant
ABC
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Coinsurance
(if applicable)
Individual/
Employee
Tier*
Employee
contribution
Employer
contr ibuti on Total
Employee
contribution
Em
con
None Employee $100.00 $600.00 $700.00 $110.00
None
Employee +
Child $150.00 $700.00 $850.00 $150.00
None
Employee +
Spouse $150.00 $800.00 $950.00 $150.00
None
Employee +
Family $150.00 $1,100.00 $1,250.00 $150.00 $
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
11/34
Annual L imit
Waiver
Request
Appl icant
Name
Applicant
ABCApplicant
ABC
Applicant
ABC
Applicant
ABC
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Employee
contribution
Employer
contribution Total
Projected Rate Increase
that would result from
compliance with $750,000
Annual L imit Restrict ion (in
dollars)(Average Premium
by Individual) (Difference
of Column AV and AS
divided by Column AS)
Decre
Acces
Benef
would
from
comp
with $
Annua
Restr
(desc
briefly
$250.00 $800.00 $1,050.00 38.16%
Term
the
$250.00 $900.00 $1,150.00 27.78%
Term
the
$250.00 $975.00 $1,225.00 22.50%
Term
the
$250.00 $1,400.00 $1,650.00 26.92%
Term
the
for
elimi
non e
for
elimi
non e
truste
for
elimi
non e
forelimi
non e
bene
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
12/34
Annual L imit
Waiver
Request
Appl icant
Name
Applicant
ABCApplicant
ABC
Applicant
ABC
Applicant
ABC
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Southeast
Laborers
Health Fund
Taft-Hartley
Plan
If Yes Taft-
Hartley then
Date
Collective
Bargaining
Agreement
Expires
Compliance
with
Grandfather
Regulation
Lead
Reviewer
Date of
Receipt
Yes 01/01/2013 Yes E. Pham 09/01/2010
Yes 01/01/2013 Yes E. Pham 09/01/2010
Yes 01/01/2013 Yes E. Pham 09/01/2010
Yes 01/01/2013 Yes E. Pham 09/01/2010
yes 12/31/2011 yes
yes 12/31/2011 yes
yes 12/31/2011 yes
yes 12/31/2011 yes
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
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//T|/...%2012600%20Response%20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Request%20for%20info%201.31.11.htm[08/11/2011 10:58:
rom: Moultrie, Cam (HHS/OCIIO)ent: Monday, January 31, 2011 12:39 PM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Southeast Laborers Health Fundhank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act
PHS Act) Section 2711. Please provide the following information:
I.
Please complete the entire annual limits spreadsheet available at:http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheto 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 your plan provides any lifetime limits.
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective and
expiration dates of the collective bargaining agreement.
n order to complete your application, please provide this information by 5:00 pm, February 3, 2011. 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.
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: Donny Dowlen [mailto:[email protected]]ent: Monday, January 03, 2011 4:34 PMo: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeast Laborers Health Fund.
onny Dowlenouthern Benefit Administrators00-831-4914
r i v a cy a n d Co n f i d e n t i a l i t y N o t i c e : This message is being sent via secure SSL encryption to protect the priv
f our clients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attac
r embedded documents) is intended for the exclusive and confidential use of the individual or entity to which
SE Laborers:000013
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
14/34
//T|/...%2012600%20Response%20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Request%20for%20info%201.31.11.htm[08/11/2011 10:58:
as been addressed, and unless otherwise expressly indicated, is confidential and privileged information of
outhern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is
rohibited. If you receive this transmission in error, please notify us immediately by e-mail at
[email protected], and delete the original message. Your cooperation is appreciated.
SE Laborers:000014
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
15/34
//T|/...20Response%20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Request%20for%20info%20response%202.1.11.htm[08/11/2011 10:58:3
rom: Donny Dowlen [[email protected]]ent: Tuesday, February 01, 2011 3:13 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeast Laborers Health Fund
Attachments: 21116.xlsnclosed is the completed spreadsheet. Note that there is only one tier of employees covered ll employees pay the same amount for their coverage. It is therefore not necessary that we k
overage by employee, employee/child, employee/family, etc. An employee who is single pays thame as the employee with a wife and 3 children. Its the way these types of union fundsypically operate. There are no separate rates.
e have responded to your questions below. Let us know if you need anything else.
onny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Monday, January 31, 2011 11:39 AMo: Donny Dowlenc: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Southeast Laborers Health Fund
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. Please provide the following information:
Please complete the entire annual limits spreadsheet available at:ttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheet to this eddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None,nd/or provide an explanation regarding why you are unable to complete that particular cell in a separate document
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?
Yes and yes as noted in our initial submission
Confirm whether your plan provides any lifetime limits.
Yes, as noted in our initial submission. - $ maximum lifetime
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective andxpiration dates of the collective bargaining agreement.
Yes with expiration date of 12/31/2011 as noted in our initial submissionn order to complete your application, please provide this information by 5:00 pm, February 3, 2011. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humaervices (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
SE Laborers:000015
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
16/34
//T|/...20Response%20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Request%20for%20info%20response%202.1.11.htm[08/11/2011 10:58:3
hank you.
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 governm
use only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatioUnauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:[email protected]]ent: Monday, January 03, 2011 4:34 PM
To: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeast Laborers Health Fund.
Donny Dowlen
outhern Benefit Administrators00-831-4914
rivacy and Confidentiality Notice: This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at [email protected], and delete theriginal message. Your cooperation is appreciated.
rivacy and Confidentiality Notice: This message is being sent via secure SSL encryption to protect the privacy of our clients and to ensure compliance with HIPAA regulations.urthermore, this message (including any attached or embedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has been addresnd unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosaterial is prohibited. If you receive this transmission in error, please notify us immediately by e-mail at [email protected], and delete the original message. Your cooperappreciated.
SE Laborers:000016
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
17/34
//T|/...ponse%20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Question%20regarding%20lifetime%20limit%202.2.11.htm[08/11/2011 10:58:
rom: Moultrie, Cam (HHS/OCIIO)ent: Wednesday, February 02, 2011 10:04 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeast Laborers Health Fundursuant to Section 2711 of the PHS Act, you may not have any lifetime limit on your plan as of September 23, 20xcept in the case of non-essential benefits that are permitted under Federal or State law. Plans that previously hadfetime limit may add an annual limit not less than the lifetime limit without affecting the grandfather status of the
lan. Please confirm whether this lifetime limit will be eliminated from your plan.
hank you.
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: Donny Dowlen [mailto:[email protected]]ent: Tuesday, February 01, 2011 3:13 PMo: Moultrie, Cam (HHS/OCIIO)c: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Southeast Laborers Health Fund
nclosed is the completed spreadsheet. Note that there is only one tier of employees covered ll employees pay the same amount for their coverage. It is therefore not necessary that we koverage by employee, employee/child, employee/family, etc. An employee who is single pays thame as the employee with a wife and 3 children. Its the way these types of union fundsypically operate. There are no separate rates.
e have responded to your questions below. Let us know if you need anything else.
onny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Monday, January 31, 2011 11:39 AMo: Donny Dowlenc: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Southeast Laborers Health Fund
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. Please provide the following information:
Please complete the entire annual limits spreadsheet available at:
ttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheet to this eddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None,nd/or provide an explanation regarding why you are unable to complete that particular cell in a separate document
I. In addition, please provide the following information:
SE Laborers:000017
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
18/34
//T|/...ponse%20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Question%20regarding%20lifetime%20limit%202.2.11.htm[08/11/2011 10:58:
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?
Yes and yes as noted in our initial submission
Confirm whether your plan provides any lifetime limits.
Yes, as noted in our initial submission. - $ maximum lifetime
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective andxpiration dates of the collective bargaining agreement.
Yes with expiration date of 12/31/2011 as noted in our initial submissionn order to complete your application, please provide this information by 5:00 pm, February 3, 2011. 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.
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 governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:[email protected]]ent: Monday, January 03, 2011 4:34 PM
To: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeast Laborers Health Fund.
Donny Dowlenouthern Benefit Administrators00-831-4914
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at [email protected], and delete theriginal message. Your cooperation is appreciated.
ri vacy and Confi dentiali ty Notice:This message is being sent via secure SSL encryption to protect the privacy of our clients and to ensure
ompliance with HIPAA regulations. Furthermore, this message (including any attached or embedded documents) is intended for the exclusive
onfidential use of the individual or entity to which it has been addressed, and unless otherwise expressly indicated, is confidential and privile
SE Laborers:000018
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
19/34
//T|/...ponse%20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Question%20regarding%20lifetime%20limit%202.2.11.htm[08/11/2011 10:58:
formation of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you
eceive this transmission in error, please notify us immediately by e-mail at [email protected], and delete the original message. You
ooperation is appreciated.
SE Laborers:000019
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
20/34
//T|/...ELLOW]/Southeast%20Laborers%20Health%20Fund/Question%20regarding%20lifetime%20limit%20response%202.2.11.htm[08/11/2011 10:58:
rom: Donny Dowlen [[email protected]]ent: Wednesday, February 02, 2011 3:23 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO); 'Jere T. Brassell'
ubject: RE: Waiver Application for Southeast Laborers Health Fundam, thank you for the email. As you know, the lifetime limit must be removed before theeginning of the plan year on or after September 23, 2010. For this plan, the first plan yeafter September 23, 2010 is April 1, 2011. The lifetime limit will be removed by April 1, 20nd the trustees intend to maintain the plans grandfather status. Let me know if you neednything thing else regarding this application. Thank you.
onny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, February 02, 2011 9:04 AMo: Donny Dowlenc: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Southeast Laborers Health Fund
ursuant to Section 2711 of the PHS Act, you may not have any lifetime limit on your plan as of September 23, 20xcept in the case of non-essential benefits that are permitted under Federal or State law. Plans that previously hadfetime limit may add an annual limit not less than the lifetime limit without affecting the grandfather status of the
lan. Please confirm whether this lifetime limit will be eliminated from your plan.
hank you.
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 governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:[email protected]]ent: Tuesday, February 01, 2011 3:13 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeast Laborers Health Fund
nclosed is the completed spreadsheet. Note that there is only one tier of employees covered as all employees pay ame amount for their coverage. It is therefore not necessary that we keep coverage by employee, employee/child,mployee/family, etc. An employee who is single pays the same as the employee with a wife and 3 children. Its
way these types of union funds typically operate. There are no separate rates.
We have responded to your questions below. Let us know if you need anything else.
Donny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Monday, January 31, 2011 11:39 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: Waiver Application for Southeast Laborers Health FundSE Laborers:000020
Document obtained by CompleteColorado.com
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21/34
//T|/...ELLOW]/Southeast%20Laborers%20Health%20Fund/Question%20regarding%20lifetime%20limit%20response%202.2.11.htm[08/11/2011 10:58:
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. Please provide the following information:
Please complete the entire annual limits spreadsheet available at:ttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheet to this eddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None,
nd/or provide an explanation regarding why you are unable to complete that particular cell in a separate document
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?
Yes and yes as noted in our initial submission
Confirm whether your plan provides any lifetime limits.
Yes, as noted in our initial submission. - $ maximum lifetime
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective andxpiration dates of the collective bargaining agreement.
Yes with expiration date of 12/31/2011 as noted in our initial submissionn order to complete your application, please provide this information by 5:00 pm, February 3, 2011. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humaervices (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.
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 governm
use only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatioUnauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:[email protected]]ent: Monday, January 03, 2011 4:34 PM
To: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeast Laborers Health Fund.
Donny DowlenSE Laborers:000021
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//T|/...ELLOW]/Southeast%20Laborers%20Health%20Fund/Question%20regarding%20lifetime%20limit%20response%202.2.11.htm[08/11/2011 10:58:
outhern Benefit Administrators00-831-4914
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receiv
his transmission in error, please notify us immediately by e-mail at [email protected], and delete theriginal message. Your cooperation is appreciated.
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at [email protected], and delete theriginal message. Your cooperation is appreciated.
rivacy and Confidentiality Notice:This message is being sent via secure SSL encryption to protect the privacy of our clients and to ensure compliance with HIPAA regulations.urthermore, this message (including any attached or embedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has been addred unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclos
aterial is prohibited. If you receive this transmission in error, please notify us immediately by e-mail at [email protected], and delete the original message. Your cooperappreciated.
SE Laborers:000022
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
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//T|/...20Response%20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Request%20for%20additional%20info%202.3.11.htm[08/11/2011 10:58:
rom: Moultrie, Cam (HHS/OCIIO)ent: Thursday, February 03, 2011 11:55 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO); 'Jere T. Brassell'
ubject: RE: Waiver Application for Southeast Laborers Health Fundlease breakdown the number of employees in each employee tier.
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: Donny Dowlen [mailto:[email protected]]ent: Wednesday, February 02, 2011 3:23 PMo: Moultrie, Cam (HHS/OCIIO)c: Habit, Sandra (HHS/OCIIO); 'Jere T. Brassell'ubject: RE: Waiver Application for Southeast Laborers Health Fund
am, thank you for the email. As you know, the lifetime limit must be removed before theeginning of the plan year on or after September 23, 2010. For this plan, the first plan yeafter September 23, 2010 is April 1, 2011. The lifetime limit will be removed by April 1, 20nd the trustees intend to maintain the plans grandfather status. Let me know if you neednything thing else regarding this application. Thank you.
onny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, February 02, 2011 9:04 AMo: Donny Dowlenc: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Southeast Laborers Health Fund
ursuant to Section 2711 of the PHS Act, you may not have any lifetime limit on your plan as of September 23, 20xcept in the case of non-essential benefits that are permitted under Federal or State law. Plans that previously hadfetime limit may add an annual limit not less than the lifetime limit without affecting the grandfather status of thelan. Please confirm whether this lifetime limit will be eliminated from your plan.
hank you.
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 governm
use only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatioUnauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:[email protected]]ent: Tuesday, February 01, 2011 3:13 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeast Laborers Health Fund
SE Laborers:000023
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//T|/...20Response%20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Request%20for%20additional%20info%202.3.11.htm[08/11/2011 10:58:
nclosed is the completed spreadsheet. Note that there is only one tier of employees covered as all employees pay ame amount for their coverage. It is therefore not necessary that we keep coverage by employee, employee/child,mployee/family, etc. An employee who is single pays the same as the employee with a wife and 3 children. Its
way these types of union funds typically operate. There are no separate rates.
We have responded to your questions below. Let us know if you need anything else.
Donny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Monday, January 31, 2011 11:39 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: Waiver Application for Southeast Laborers Health Fund
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. Please provide the following information:
Please complete the entire annual limits spreadsheet available at:ttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheet to this eddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None,nd/or provide an explanation regarding why you are unable to complete that particular cell in a separate document
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?
Yes and yes as noted in our initial submission
Confirm whether your plan provides any lifetime limits.
Yes, as noted in our initial submission. - $ maximum lifetime
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective andxpiration dates of the collective bargaining agreement.
Yes with expiration date of 12/31/2011 as noted in our initial submissionn order to complete your application, please provide this information by 5:00 pm, February 3, 2011. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humaervices (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.
SE Laborers:000024
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
25/34
//T|/...20Response%20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Request%20for%20additional%20info%202.3.11.htm[08/11/2011 10:58:
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 governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:[email protected]]ent: Monday, January 03, 2011 4:34 PM
To: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeast Laborers Health Fund.
Donny Dowlenouthern Benefit Administrators00-831-4914
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy of
lients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at [email protected], and delete theriginal message. Your cooperation is appreciated.
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has b
ddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern BenefitAdministrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at [email protected], and delete theriginal message. Your cooperation is appreciated.
ri vacy and Confi dentiali ty Notice:This message is being sent via secure SSL encryption to protect the privacy of our clients and to ensure
ompliance with HIPAA regulations. Furthermore, this message (including any attached or embedded documents) is intended for the exclusive
onfidential use of the individual or entity to which it has been addressed, and unless otherwise expressly indicated, is confidential and privile
formation of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you
eceive this transmission in error, please notify us immediately by e-mail at [email protected], and delete the original message. You
ooperation is appreciated.
SE Laborers:000025
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
26/34
//T|/...20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Request%20for%20additional%20info%20response%202.3.11.htm[08/11/2011 10:58:3
rom: Donny Dowlen [[email protected]]ent: Thursday, February 03, 2011 12:24 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeast Laborers Health Fundam, please note my response to you on 2/1/11. There is only one tier of employees since theyll pay the same regardless of how many are covered in the family. Its the typical way Taftartley union plans work. It is not necessary for us to keep records broken down by tier andhis is not something we have. Please let me know if you need anything else.
onny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, February 03, 2011 10:55 AMo: Donny Dowlenc: Habit, Sandra (HHS/OCIIO); 'Jere T. Brassell'ubject: RE: Waiver Application for Southeast Laborers Health Fund
lease breakdown the number of employees in each employee tier.
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 governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:[email protected]]ent: Wednesday, February 02, 2011 3:23 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO); 'Jere T. Brassell'
ubject: RE: Waiver Application for Southeast Laborers Health Fund
Cam, thank you for the email. As you know, the lifetime limit must be removed before the beginning of the plan yn or after September 23, 2010. For this plan, the first plan year after September 23, 2010 is April 1, 2011. Thefetime limit will be removed by April 1, 2011 and the trustees intend to maintain the plans grandfather status. Le
me know if you need anything thing else regarding this application. Thank you.
Donny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, February 02, 2011 9:04 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeast Laborers Health Fund
ursuant to Section 2711 of the PHS Act, you may not have any lifetime limit on your plan as of September 23, 20xcept in the case of non-essential benefits that are permitted under Federal or State law. Plans that previously hadfetime limit may add an annual limit not less than the lifetime limit without affecting the grandfather status of thelan. Please confirm whether this lifetime limit will be eliminated from your plan.
hank you.
SE Laborers:000026
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
27/34
//T|/...20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Request%20for%20additional%20info%20response%202.3.11.htm[08/11/2011 10:58:3
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 governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:[email protected]]ent: Tuesday, February 01, 2011 3:13 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeast Laborers Health Fund
nclosed is the completed spreadsheet. Note that there is only one tier of employees covered as all employees pay ame amount for their coverage. It is therefore not necessary that we keep coverage by employee, employee/child,mployee/family, etc. An employee who is single pays the same as the employee with a wife and 3 children. Its
way these types of union funds typically operate. There are no separate rates.
We have responded to your questions below. Let us know if you need anything else.
Donny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Monday, January 31, 2011 11:39 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: Waiver Application for Southeast Laborers Health Fund
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. Please provide the following information:
Please complete the entire annual limits spreadsheet available at:ttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheet to this eddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None,nd/or provide an explanation regarding why you are unable to complete that particular cell in a separate document
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?
Yes and yes as noted in our initial submission
Confirm whether your plan provides any lifetime limits.
SE Laborers:000027
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7/27/2019 Southeast Laborers - Redacted Bates HW
28/34
//T|/...20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Request%20for%20additional%20info%20response%202.3.11.htm[08/11/2011 10:58:3
Yes, as noted in our initial submission. - $ maximum lifetime
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective andxpiration dates of the collective bargaining agreement.
Yes with expiration date of 12/31/2011 as noted in our initial submissionn order to complete your application, please provide this information by 5:00 pm, February 3, 2011. 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 3
ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you.
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 governm
use only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatioUnauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:[email protected]]ent: Monday, January 03, 2011 4:34 PM
To: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeast Laborers Health Fund.
Donny Dowlenouthern Benefit Administrators
00-831-4914
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at [email protected], and delete theriginal message. Your cooperation is appreciated.
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at [email protected], and delete theriginal message. Your cooperation is appreciated.
SE Laborers:000028
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
29/34
//T|/...20[YELLOW]/Southeast%20Laborers%20Health%20Fund/Request%20for%20additional%20info%20response%202.3.11.htm[08/11/2011 10:58:3
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at [email protected], and delete theriginal message. Your cooperation is appreciated.
rivacy and Confidentiality Notice:This message is being sent via secure SSL encryption to protect the privacy of our clients and to ensure compliance with HIPAA regulations.urthermore, this message (including any attached or embedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has been addred unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclos
aterial is prohibited. If you receive this transmission in error, please notify us immediately by e-mail at [email protected], and delete the original message. Your cooperappreciated.
SE Laborers:000029
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
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//T|/...outheast%20Laborers%20Health%20Fund/Waiver%20Application%20for%20Southeast%20Laborers%20Health%20Fund.htm[08/11/2011 10:58:
rom: Moultrie, Cam (HHS/OCIIO)
ent: Monday, February 14, 2011 11:18 AM
o: 'Donny Dowlen'
ubject: Waiver Application for Southeast Laborers Health Fund
ttachments: April 1 Approval .pdf
ood Morning,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711
outheast Laborers Health Fund. HHS has reviewed your application and made its determination. Please see the attac
etter.
he attached letter refers to the following plans:
Southeast Laborers Health Fund
lease confirm receipt of this letter by replying to this e-mail.
lease let me know if I can be of further assistance.
am Lynne Moultrie
ivision of Oversight
enter for Consumer Information and Insurance Oversight
.S. Department of Health & Human Services
01.492.4174
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.
SE Laborers:000030
Document obtained by CompleteColorado.com
mailto:[email protected]:[email protected]7/27/2019 Southeast Laborers - Redacted Bates HW
31/34
SE Laborers:000031
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
32/34
SE Laborers:000032
Document obtained by CompleteColorado.com
7/27/2019 Southeast Laborers - Redacted Bates HW
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//T|/...st%20Laborers%20Health%20Fund/RE%20Waiver%20Application%20for%20Southeast%20Laborers%20Health%20Fund.htm[08/11/2011 10:58
rom: Donny Dowlen [[email protected]]
ent: Monday, February 14, 2011 3:39 PM
o: Moultrie, Cam (HHS/OCIIO)
ubject: RE: Waiver Application for Southeast Laborers Health Fund
eceipt confirmed.
rom: Moultrie, Cam (HHS/OCIIO) [mailto:[email protected]]ent: Monday, February 14, 2011 10:18 AMo: Donny Dowlenubject: Waiver Application for Southeast Laborers Health Fund
Good Morning,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2orSoutheast Laborers Health Fund. HHS has reviewed your application and made its determination. Please see thttached letter.
he attached letter refers to the following plans:
Southeast Laborers Health Fund
lease confirm receipt of this letter by replying to this e-mail.
lease let me know if I can be of further assistance.
Cam Lynne Moultrie
Division of OversightCenter for Consumer Information and Insurance OversightU.S. Department of Health & Human [email protected]
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 governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
r i v a cy a n d Co n f i d e n t i a l i t y N o t i c e : This message is being sent via secure SSL encryption to protect the priv
f our clients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attac
r embedded documents) is intended for the exclusive and confidential use of the individual or entity to which
as been addressed, and unless otherwise expressly indicated, is confidential and privileged information of
outhern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is
rohibited. If you receive this transmission in error, please notify us immediately by e-mail atSE Laborers:000033
Document obtained by CompleteColorado.com
mailto:[mailto:[email protected]]mailto:[email protected]:[email protected]:[mailto:[email protected]]7/27/2019 Southeast Laborers - Redacted Bates HW
34/34
[email protected], and delete the original message. Your cooperation is appreciated.Document obtained by CompleteColorado.com
mailto:[email protected]:[email protected]