Universal Forest - Combined Redacted PDF-Bates HWM

7/27/2019 Universal Forest - Combined Redacted PDF-Bates HWM

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Corporate Headquarters

2801 E. Beltline Avenue NE Grand Rapids, MI 49525 Tel: (616) 364-6161 Fax (616) 361-7534 www.ufpi.com

September 23, 2010

Department of Health & Human ServicesOffice of Consumer Information and Insurance Oversight, Office of OversightAttn: James MayhewRoom 737-F-04200 Independence Avenue SWWashington, DC 20201Sent Via Email: [email protected]

Dear Mr. Mayhew:

Universal Forest Products, Inc. would like to apply for a waiver from the restricted annual limitsset forth in the interim final regulations issued in reference to the Public Health Service ActSection 2711.

At Universal Forest Products, we offer a comprehensive medical PPO plan to our employees andeligible dependents, with a $ in-network deductible, and no annual or lifetime limits.Therefore, this plan (our core medical plan) is in compliance with the restricted annual limitregulations.

In addition to our core medical plan, we have a unique plan called the ntalReimbursement Plan, which we refer to internally as our flex plan.

service. Newly enrolled employees are eligible to submit claims for medical, dental, and visionservices, not otherwise covered under our insurance plans, but which are still eligible IRSSection 213 expenses. Participants receive reimbursement for up to $ in expenses per planyear (which runs from May 1 April 30). There is a group of employees who weregrandfathered in at a $ and a $ reimbursement level. There is no cost to the employeeto participate in this plan. We, as the employer, pay the entire cost. Although this plan operatesmuch like an employer-paid flexible spending account, it is actually characterized as a welfarebenefits plan for legal and tax purposes. Therefore, it is our belief that this plan must meet the

restricted annual limits set forth by the interim final regulations.

It is our interpretation that, if we kept this plan in place, we would have to increase the annualreimbursement maximum to $750,000 per participant per not afford toincrease the maximum benefits from our current levels of to $750,000 perparticipant. So, unless we are granted a waiver, we will be forced to terminate this plan, leavingour employees without this supplemental benefit as of May 1, 2011.

UForest:000001


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Required Elements of Waiver Request

As set forth in the memo from Steve Larsen, Director, Office of Oversight on September 3, 2010,we would like to provide the elements required to apply for a waiver as noted below.

1. The terms of the plan or policy form(s) for which a waiver is sought.

We have attached the summary plan description for this plan. We would like to maintainthe , $ and $ maximum benefit reimbursement levels for the plan year May1, 2011 April 30, 2012.

2. The number of individuals covered by the plan or policy form(s) submitted.

As of 9/16/2010, we have total employee participants. employees are enrolledat the $ reimbursement level, employees are enrolled at the $ reimbursementlevel, and employees are enrolled at the $ reimbursement level.

3. The annual limit(s) and rates applicable to the plan or policy form(s) submitted.

Since thisexpenses.

4. A brief description of why compliance with the interim final regulations would result ina significant decrease in access to benefits for those currently covered by such plans orpolicies, or significant increase in premiums paid by those covered by such plans orpolicies, along with any supporting documentation;

If we are required to comply with the interim final regulations for this particular plan, the planwould become cost prohibitive. Complying with the interim final regulations would result in asignificant decrease in access to benefits for those currently covered because we would simply beforced to terminate the plan.

UForest:000002


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Current State

AnnualLimit Number ofEmployeesEnrolled

Accrual Rate (60%) Maximum AnnualLiability (100%)

Increase Annual Limit to $750,000

Annual

Limit

Number of

EmployeesEnrolled

Accrual Rate (60%) Maximum Annual

Liability (100%)

*Represents maximum liability of $750,000 per enrolled employee. This figure would be higher if we must offer every employee andeligible dependent up to $750,000 each.

5. An attestation, signed by the plan administrator or Chief Executive officer of the issuerof the coverage, certifying 1) that the plan was in force prior to September 23, 2010; and 2)that the application of restricted annual limits to such plans or policies would result in asignificant decrease in access to benefits for those currently covered by such plans orpolicies, or a significant increase in premiums paid by those covered by such plans orpolicies.

Please find the signed attestation below:

I attest to the following:

The Medical and Dental Reimbursement Plan of Universal Forest Products, Inc. was inforce prior to September 23, 2010.

The application of restricted annual limits to this plan would result in a significantdecrease in access to benefits for those currently covered by such plan.

Signed

Robert A. HendricksVice President, Human ResourcesPlan Administrator: Universal Forest Products, Inc.

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We appreciate your consideration of this application for a waiver, and look forward to hearingyour response. If you have any questions or need further information, please do not hesitate tocontact me, or a member of my team, as follows:

Bob Hendricks, Vice President, Human Resources 1-616-365-1570

Nancy DeGood, Director, HR Administration and Benefits 1-616-365-1572Joelle VanderVelde, Benefits Manager 1-616-365-1603

Sincerely,

Robert A. HendricksVice President, Human ResourcesUniversal Forest Products, Inc.

UForest:000004


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//T|/...rres%20-%20YELLOW/Applications%20with%20NO%2012600%20Response%20[YELLOW]/Universal%20Forest/Waiver.htm[07/11/2011 4:06:

rom: Joelle VanderVelde [[email protected]]ent: Thursday, September 23, 2010 1:43 PM

To: HHS HealthInsurance (HHS)Cc: Joelle VanderVelde; Nancy Degood; Bob Hendricks

ubject: Waiverigned By: [email protected]

ollow Up Flag: Follow up

lag Status: Red

Attachments: Waiver Application - Flex Plan _Final.pdf; Medical and Dental Reimbursement Plan SPD00110_FINAL.pdfood Afternoon

lease find attached our request for a waiver from the restricted annual limits, as well as the supplemental documentation.

hank you

oelle

oelle S. Vander Velde, CEBS

enefits Managerniversal Forest Products, Inc.

hone: 616.365.1603

ax: 616.364.1930

HI Fax: 1-866-348-8783

[email protected]

UForest:000005
mailto:[email protected]:[email protected]


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//T|/...ith%20NO%2012600%20Response%20[YELLOW]/Universal%20Forest/Request%20for%20more%20info%2010-18-2010.htm[07/11/2011 4:06:

rom: Pham, Erica (HHS/OCIIO)ent: Monday, October 18, 2010 7:30 PM

To: '[email protected]'Cc: Botwinick, Alexandra (HHS/OCIIO)

ubject: Universal Forest Products Waiver Application

ollow Up Flag: Follow uplag Status: Blueear Applicant:

We have received your application for the wavier of the medical and dental reimbursement plan. To assist us in our review of pplications, we have the following questions:

Is this reimbursement plan offered as a supplement to your core benefit plan?

Do all participants who participate in this reimbursement plan participate in the core benefit plan?

Is your assumption that your employees will utilize the plan under the same accrual rate of $750,000 accurate,especially in the scenario whereby your employees have underlying core me coverage?

n order to quickly review your application, please submit this information by COB tomorrow (October 19). Thank you for youresponse.

ind Regards,

rica Phamivision of Enforcementffice of OversightCIIO/[email protected]




ollow Up Flag: Follow uplag Status: Red



hank you

oelle


enefits Manager

UForest:000006


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//T|/...20with%20NO%2012600%20Response%20[YELLOW]/Universal%20Forest/Additional%20Info%20Response%2010.19.10.htm[07/11/2011 4:06

rom: Joelle VanderVelde [[email protected]]ent: Tuesday, October 19, 2010 9:55 AM

To: Andrews, Jane (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO); Pham, Erica (HHS/OCIIO); Joelle VanderVelde; Nancy Degood

ubject: RE: inquiry about your annual limits waiver requestigned By: [email protected] morning, Ms. Andrews:

ke an HRA, our reimbursement plan is a form of self-funded medical plan under Section 105(h) of the Internal Revenue Code

owever, the reimbursement plan does not have a roll over feature. Further, it is not integrated with the Universal Forestroducts group health plan. So, even if the reimbursement plan could be considered to be an HRA, we understand the relief o

age 37190 of the June 28 regulations from the annual limit restrictions not to apply.

hanks!

oelle


enefits Manager

niversal Forest Products, Inc.

hone: 616.365.1603

ax: 616.364.1930

HI Fax: 1-866-348-8783

[email protected]

rom: Andrews, Jane (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, October 19, 2010 9:27 AMo: Joelle VanderVeldec: Habit, Sandra (HHS/OCIIO); Pham, Erica (HHS/OCIIO)ubject: inquiry about your annual limits waiver request

Ms. Vander Velde: I have reviewed your application for a waiver from annual limits. I am not sure this stand alone reimbursem

ccount needs a waiver from annual limits since reimbursement accounts like this may not be subject to the ACA (for exampleSA, MSA or HSA), or an HRA, which is subject to ACA, if taken together with its underlying health coverage, may have limits

he underlying coverage meets the Annual Limits requirements, which is sounds like yours does. If you go to pages 37190 and

7191 of the June 28, 2010 regulation, you can read about these accounts. Could you please clarify whether your reimbursem

ccount is a FSA, MSA, HSA or an HRA? Thanks.

ane W. Andrews

CIIO

501 Wisconsin Ave

ethesda, MD 20814

01-492-4122 (desk)

02-536-6779 (Blackberry)

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.

UForest:000008


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//T|/...20NO%2012600%20Response%20[YELLOW]/Universal%20Forest/Requested%20Info%20Received%20on%2010-19-2010.htm[07/11/2011 4:06

rom: Joelle VanderVelde [[email protected]]ent: Tuesday, October 19, 2010 8:39 AM

To: Pham, Erica (HHS/OCIIO)Cc: Joelle VanderVelde; Nancy Degood; Botwinick, Alexandra (HHS/OCIIO)

ubject: Universal Forest Products Waiver Application - Response to HHS Questionsigned By: [email protected]

ollow Up Flag: Follow up

lag Status: Blueear Erica

hank you for taking the time to review our waiver application. Please find our responses to your questions in red below. Shouou have any follow up questions or if you need additional information, please do not hesitate to email me or call me at 616-36603.

ind Regards,


enefits Managerniversal Forest Products, Inc.hone: 616.365.1603

ax: 616.364.1930HI Fax: [email protected]

rom: Pham, Erica (HHS/OCIIO) [mailto:[email protected]]ent: Monday, October 18, 2010 7:30 PMo: Joelle VanderVeldec: Botwinick, Alexandra (HHS/OCIIO)ubject: Universal Forest Products Waiver Application

ear Applicant:

We have received your application for the wavier of the medical and dental reimbursement plan. To assist us in our review of pplications, we have the following questions:

Is this reimbursement plan offered as a supplement to your core benefit plan?

Yes. This reimbursement plan is offered as a supplement to our core benefit plan. While we think this plan is helpful temployees, it was never intended to be their core medical plan. In addition to reimbursing medical expenses, it alsoreimburses dental and vision expenses.

Do all participants who participate in this reimbursement plan participate in the core benefit plan?

Is your assumption that your employees will utilize the plan under the same 60% accrual rate of $750,000 accurate,especially in the scenario whereby your employees have underlying core medical coverage?

UForest:000009


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//T|/...20NO%2012600%20Response%20[YELLOW]/Universal%20Forest/Requested%20Info%20Received%20on%2010-19-2010.htm[07/11/2011 4:06

n order to quickly review your application, please submit this information by COB tomorrow (October 19). Thank you for your

esponse.

ind Regards,

rica Phamivision of Enforcementffice of OversightCIIO/[email protected]




ollow Up Flag: Follow uplag Status: Red



hank you

oelle


enefits Managerniversal Forest Products, Inc.hone: 616.365.1603ax: 616.364.1930HI Fax: [email protected]

UForest:000010
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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//T|/...sponse%20[YELLOW]/Universal%20Forest/Notification%20of%20Approval%20NO%20approval%20letter%2010-21-2010.htm[07/11/2011 4:06

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Thursday, October 21, 2010 11:24 AM

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

mportance: High

ood Morning,

hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Actection for Universal Forest Products. HHS has reviewed your application and made its determination. Pleas

ee the attached letter.

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

**In this case, your approval letter is not attached. I wanted to inform you of your approved status; howev

he signed approval letter for the effective date of May 1 stwill not be available until tomorrow or Monday. I

pologize for the inconvenience but I did not want you to have to wait to learn of your approved status.

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

incerely,

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO

[email protected]

UForest:000011


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//T|/...600%20Response%20[YELLOW]/Universal%20Forest/confirmation%20of%20notification%20not%20letter%2010-21-2010.htm[07/11/2011 4:06

rom: Joelle VanderVelde [[email protected]]ent: Thursday, October 21, 2010 11:31 AM

To: Botwinick, Alexandra (HHS/OCIIO)Cc: OCIIO Oversight; Joelle VanderVelde

ubject: RE: Waiver of the Annual Limits Requirements of PHS Act Section 2711igned By: [email protected]

Ms. Botwinick

hat is wonderful news! Our employees will be delighted! We will await receipt of the approval letter.

hanks!

oelle


enefits Manager


hone: 616.365.1603

ax: 616.364.1930

HI Fax: 1-866-348-8783

[email protected]

rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, October 21, 2010 11:24 AMo: Joelle VanderVeldeubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High

ood Morning,

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

ection for Universal Forest Products. HHS has reviewed your application and made its determination. Pleasee the attached letter.


**In this case, your approval letter is not attached. I wanted to inform you of your approved status; howev

he signed approval letter for the effective date of May 1 stwill not be available until tomorrow or Monday. I

pologize for the inconvenience but I did not want you to have to wait to learn of your approved status.


incerely,

Alexandra Botwinick

ffice of Oversight

HHS/[email protected]

UForest:000012
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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//T|/...600%20Response%20[YELLOW]/Universal%20Forest/confirmation%20of%20notification%20not%20letter%2010-21-2010.htm[07/11/2011 4:06

UForest:000013


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//T|/...%20with%20NO%2012600%20Response%20[YELLOW]/Universal%20Forest/Approval%20Letter%20Sent%2010-25-2010.htm[07/11/2011 4:06

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, October 25, 2010 11:10 AM

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

mportance: High

Attachments: May 1 .pdf

ood Morning,


ection for Universal Forest. HHS has reviewed your application and made its determination. Please see the

ttached letter.



incerely,

Alexandra Botwinick

ffice of Oversight


UForest:000014


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//T|/...00%20Response%20[YELLOW]/Universal%20Forest/Confirmation%20receipt%20of%20approval%20letter%2010-25-2010.htm[07/11/2011 4:06

rom: Joelle VanderVelde [[email protected]]ent: Monday, October 25, 2010 2:23 PM

To: Botwinick, Alexandra (HHS/OCIIO)Cc: OCIIO Oversight; Joelle VanderVelde

ubject: FW: Waiver of the Annual Limits Requirements of PHS Act Section 2711igned By: [email protected]

mportance: High

Attachments: May 1 .pdfwould like to confirm receipt of this letter.

hanks!

oelle


enefits Manager


hone: 616.365.1603

ax: 616.364.1930

HI Fax: [email protected]

rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Monday, October 25, 2010 11:10 AMo: Joelle VanderVeldeubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High

ood Morning,


ection for Universal Forest. HHS has reviewed your application and made its determination. Please see the

ttached letter.



incerely,

Alexandra Botwinick

ffice of Oversight


UForest:000015


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UForest:000017


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Pages 18 through 40 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4

Documents

Universal Forest - Combined Redacted PDF-Bates HWM