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rom: Ledford, Amanda (HHS/OCIIO)
ent: Monday, December 13, 2010 2:17 PM
o: '[email protected]'
c: Sheer, Jennifer (HHS/OCIIO)
ubject: United Benefit Fund waiver application
ttachments: Waiver Application Form.xls
Dear Applicant:
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 completthat particular cell in a separate document.
II. In addition, please provide the following information:
III.
Confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance withgrandfathering provisions, pursuant to 45 CFR 147.140?
In your application, your plan(s) or policy(ies) provide a lifetime limit. Pursuant to Section 2711 of the PHAct, you may not have any lifetime limit on your plan as of September 23, 2010, except in the case of non-essential benefits that are permitted under Federal or State law. Plans that previously had a lifetime limit madd an annual limit not less than the lifetime limit without affecting the grandfather status of the plan. Plea
confirm whether this lifetime limit will be eliminated from your plan.
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 14, 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.
manda R. Ledford, J.D.
.S. Department of Health and Human Services
ffice of Consumer Information and Insurance Oversight
301) 492-4260
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.
UBenefit:000001
http://www.hhs.gov/ociio/regulations/annual_limit_waivers.htmlhttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html -
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rom: Ledford, Amanda (HHS/OCIIO)
ent: Tuesday, December 14, 2010 12:02 PM
o: '[email protected]'; '[email protected]'
c: Sheer, Jennifer (HHS/OCIIO)
ubject: Waiver application
ello,
apologize for the trouble in emailing me. As we have discussed, please return the completed spreadsheet to me by Friday,
ecember 17.
hank you so much,
manda R. Ledford, J.D.
.S. Department of Health and Human Services
ffice of Consumer Information and Insurance Oversight
301) 492-4260
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.
UBenefit:000002
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//T|/...OW]/United%20Benefit%20Fund/Reply%20United%20Benefit%20Fund%20waiver%20application%20Dec%2017%202010.htm[07/14/2011 3:29
rom: Ledford, Amanda (HHS/OCIIO)
ent: Friday, December 17, 2010 2:36 PM
o: Sheer, Jennifer (HHS/OCIIO)
ubject: FW: United Benefit Fund waiver application
ttachments: UBF-waiver application spreadsheet.12.17.10.xls
rom: Michelle Berman [mailto:[email protected]]ent: Friday, December 17, 2010 11:30 AMo: Ledford, Amanda (HHS/OCIIO)c:[email protected]: United Benefit Fund waiver application
ear Ms. Ledford:
On behalf of the United Benefit Fund (Fund), please find attached to this email the annual limits spreadsheet fo
he Funds thirteen (13) plans. We note that the dollar amounts listed in column AC of the spreadsheet reflect
ays for In-Network providers.
n response to your additional questions, please note the following:
1) All thirteen (13) plans were in existence prior to March 23, 2010, and are in compliance with the
grandfathering provisions, pursuant to 45 CFR 147.140.
2) Any lifetime limits that do not comply with the applicable federal and/or state laws will be eliminated fro
the plans.
3) The Fund was created pursuant to the Taft-Hartley Act.
you have any questions or require additional information, please do not hesitate to contact the undersigned.
lease provide confirmation of receipt of this email and the attachment.
hank you,
bigail R. Levy
bigail R. Levy, Esq.
orlick, Kravitz & Listhaus, PC
7 State Street, 4th Floor
ew York, NY 10004212) 269-2500
UBenefit:000003
mailto:[mailto:[email protected]]mailto:[mailto:[email protected]]mailto:[email protected]:[email protected]:[mailto:[email protected]] -
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rom: Ledford, Amanda (HHS/OCIIO)
ent: Friday, December 17, 2010 11:54 AM
o: 'Michelle Berman'
c: '[email protected]'; Sheer, Jennifer (HHS/OCIIO)
ubject: RE: United Benefit Fund waiver application
bigail,
ust wanted to let you know that I have received your email with the spreadsheet attachment.
hank you,
manda Ledford
rom: Michelle Berman [mailto:[email protected]]ent: Friday, December 17, 2010 11:30 AMo: Ledford, Amanda (HHS/OCIIO)c:[email protected]: United Benefit Fund waiver application
ear Ms. Ledford:
On behalf of the United Benefit Fund (Fund), please find attached to this email the annual limits spreadsheet fo
he Funds thirteen (13) plans. We note that the dollar amounts listed in column AC of the spreadsheet reflect
ays for In-Network providers.
n response to your additional questions, please note the following:
1) All thirteen (13) plans were in existence prior to March 23, 2010, and are in compliance with the
grandfathering provisions, pursuant to 45 CFR 147.140.2) Any lifetime limits that do not comply with the applicable federal and/or state laws will be eliminated fro
the plans.
3) The Fund was created pursuant to the Taft-Hartley Act.
you have any questions or require additional information, please do not hesitate to contact the undersigned.
lease provide confirmation of receipt of this email and the attachment.
hank you,
bigail R. Levy
bigail R. Levy, Esq.
orlick, Kravitz & Listhaus, PC
7 State Street, 4th Floor
ew York, NY 10004
212) 269-2500
UBenefit:000004
mailto:[mailto:[email protected]]mailto:[mailto:[email protected]]mailto:[email protected]:[email protected]:[mailto:[email protected]] -
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rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, January 12, 2011 11:18 AM
To: '[email protected]'Cc: Habit, Sandra (HHS/OCIIO)ubject: United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
mportance: High
Attachments: Updated Jan 1 Approval Letter .pdfood Morning,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act
ection 2711 forUnited Benefit Fund. HHS has reviewed your application and made its determination. Plea
ee the attached letter.
lease confirm receipt of this letter by replying to this e-mail.
lease let me know if I can be of further assistance.
incerely,
Alexandra Botwinick
ffice of Oversight
UBenefit:000007
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rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, January 12, 2011 1:36 PM
To: Habit, Sandra (HHS/OCIIO)ubject: FW: United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
Alexandra Botwinick
ffice of OversightHHS/OCIIO
301) [email protected]
rom: David Delucia [mailto:[email protected]]ent: Wednesday, January 12, 2011 11:23 AMo: Botwinick, Alexandra (HHS/OCIIO)ubject: RE: United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
hank you for your reply
your office needs anything from ubf please send directly to my attention
hanks
AVID DELUCIA
DMINISTRATOR
NITED BENEFIT FUND
rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, January 12, 2011 11:18 AMo: David Deluciac: Habit, Sandra (HHS/OCIIO)ubject: United Benefit Fund 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 2711 forUnited Benefit Fund. HHS has reviewed your application and made its determination. Plea
ee the attached letter.
lease confirm receipt of this letter by replying to this e-mail.
lease let me know if I can be of further assistance.
UBenefit:000008
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incerely,
Alexandra Botwinick
ffice of Oversight
UBenefit:000009
mailto:[email protected]:[email protected] -
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rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, January 19, 2011 10:16 AM
To: Habit, Sandra (HHS/OCIIO)ubject: FW: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section711
Alexandra Botwinick
ffice of Oversight
HHS/OCIIO
301) [email protected]
rom: Michelle Berman [mailto:[email protected]]ent: Wednesday, January 19, 2011 9:41 AMo: Botwinick, Alexandra (HHS/OCIIO)
ubject: Re: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
Dear Ms. Botwinick,
hank you for getting back to me. Yes, I am certain that there were 13 applicationsubmitted. It looks like Cambridge E is missing from your list below. I know that it was sn initially and it is on our spreadsheet. Maybe it was an oversight?
f you could confirm that it is approved that would be great, if not please advise how wehould proceed.
hank you for your help!
Michelle
rom: "Botwinick, Alexandra (HHS/OCIIO)" o: Michelle Berman c: "Habit, Sandra (HHS/OCIIO)" ent: Wed, January 19, 2011 8:28:53 AMubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
Ms. Berman,
apologize for the confusion. The approval applies to the following plans: MB Foods #3, MB Foods #4, Building Maintenance 2
uilding Maintenance 1, Basic, Apollo, Cambridge B, Cambridge C, Cambridge , Sterling , Universal B, and Universal.
only have on a record 12 plans. Are you certain that there are 13?
Alexandra Botwinick
ffice of OversightUBenefit:000010
mailto:[email protected]:[email protected] -
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rom: Michelle Berman [mailto:[email protected]]ent: Tuesday, January 18, 2011 4:47 PMo: Botwinick, Alexandra (HHS/OCIIO)ubject: United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
Dear Ms. Botwinick,
Our firm is counsel the United Benefit Fund and we submitted the application for waiver to your office on its behaWe are writing regarding the approval letter sent to Mr. Deluccia on January 12, 2011. We would like to confirm the letter approves all thirteen applications we filed on behalf of the United Benefit Fund.
hank you in advance for your assistance in this matter.
Michelle Bermanaralegal
Michelle Berman, Paralegal
orlick, Kravitz & Listhaus, PC
7 State Street, 4th Floor
ew York, New York 10004
212) 269-2500
212) 269-2540 (fax)
OTICE: The information contained in this electronic mail and any attachments is intended for the exclusive use of the
ddressee(s) and may contain confidential, privileged, and/or proprietary information. Any other use of these materials is strictly
rohibited. If you have received these materials in error, please notify me immediately by telephone and destroy all electronic,
aper or other versions. No representation is made by the sender that any e-mails and/or attachments are virus free, and are u
t the intended recipient's sole risk. Unauthorized interception of this e-mail is a violation of federal criminal law.
UBenefit:000011
mailto:[email protected]:[email protected] -
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rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, January 19, 2011 2:55 PM
To: Habit, Sandra (HHS/OCIIO)ubject: FW: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section711
Alexandra Botwinick
ffice of Oversight
HHS/OCIIO
301) [email protected]
rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, January 19, 2011 1:47 PMo: Mercer, Joseph (HHS/OCIIO)
ubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
hanks Joe. Erica cut it off when she sent me the list.
Alexandra Botwinick
ffice of Oversight
HHS/OCIIO
301) [email protected]
rom: Mercer, Joseph (HHS/OCIIO)ent: Wednesday, January 19, 2011 1:39 PMo: Botwinick, Alexandra (HHS/OCIIO)ubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
know that the spread sheet I forwarded along had Cambridge E on it, and I believe that it should have been approved, as it w
bout a 14 % increase.
have attached the doc I sent out.
hanks!
oe
rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, January 19, 2011 10:14 AMo: Mercer, Joseph (HHS/OCIIO)ubject: FW: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
ey Joe,
UBenefit:000012
mailto:[email protected]:[email protected]:[email protected]:[email protected] -
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think the below plan is yours United Benefit Fund. I sent them an approval letter and they wanted to confirm it was for all 13
ans. I only saw 12 on the spreadsheet that Erica gave me. They are listed below. Evidently we are missing the plan called
ambridge Edo you have that plan under this application? Thanks!
Alexandra Botwinick
ffice of Oversight
HHS/OCIIO
301) [email protected]
rom: Michelle Berman [mailto:[email protected]]ent: Wednesday, January 19, 2011 9:41 AMo: Botwinick, Alexandra (HHS/OCIIO)ubject: Re: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
Dear Ms. Botwinick,
hank you for getting back to me. Yes, I am certain that there were 13 applicationsubmitted. It looks like Cambridge E is missing from your list below. I know that it was sn initially and it is on our spreadsheet. Maybe it was an oversight?
f you could confirm that it is approved that would be great, if not please advise how wehould proceed.
hank you for your help!
Michelle
rom: "Botwinick, Alexandra (HHS/OCIIO)" o: Michelle Berman c: "Habit, Sandra (HHS/OCIIO)" ent: Wed, January 19, 2011 8:28:53 AMubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
Ms. Berman,
apologize for the confusion. The approval applies to the following plans: MB Foods #3, MB Foods #4, Building Maintenance 2
uilding Maintenance 1, Basic, Apollo, Cambridge B, Cambridge C, Cambridge , Sterling , Universal B, and Universal.
only have on a record 12 plans. Are you certain that there are 13?
Alexandra Botwinick
ffice of Oversight
UBenefit:000013
mailto:[email protected]:[email protected]:[email protected]:[email protected] -
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rom: Michelle Berman [mailto:[email protected]]ent: Tuesday, January 18, 2011 4:47 PMo: Botwinick, Alexandra (HHS/OCIIO)ubject: United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
Dear Ms. Botwinick,
Our firm is counsel the United Benefit Fund and we submitted the application for waiver to your office on its behaWe are writing regarding the approval letter sent to Mr. Deluccia on January 12, 2011. We would like to confirm the letter approves all thirteen applications we filed on behalf of the United Benefit Fund.
hank you in advance for your assistance in this matter.
Michelle Bermanaralegal
Michelle Berman, Paralegal
orlick, Kravitz & Listhaus, PC
7 State Street, 4th Floor
ew York, New York 10004212) 269-2500
212) 269-2540 (fax)
OTICE: The information contained in this electronic mail and any attachments is intended for the exclusive use of the
ddressee(s) and may contain confidential, privileged, and/or proprietary information. Any other use of these materials is strictly
rohibited. If you have received these materials in error, please notify me immediately by telephone and destroy all electronic,
aper or other versions. No representation is made by the sender that any e-mails and/or attachments are virus free, and are u
t the intended recipient's sole risk. Unauthorized interception of this e-mail is a violation of federal criminal law.
UBenefit:000014
-
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rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, January 19, 2011 8:29 AM
To: 'Michelle Berman'Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section711
mportance: HighMs. Berman,
apologize for the confusion. The approval applies to the following plans: MB Foods #3, MB Foods #4, Building Maintenance 2
uilding Maintenance 1, Basic, Apollo, Cambridge B, Cambridge C, Cambridge, Sterling, Universal B, and Universal.
only have on a record 12 plans. Are you certain that there are 13?
Alexandra Botwinick
ffice of Oversight
rom: Michelle Berman [mailto:[email protected]]ent: Tuesday, January 18, 2011 4:47 PMo: Botwinick, Alexandra (HHS/OCIIO)ubject: United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
Dear Ms. Botwinick,
Our firm is counsel the United Benefit Fund and we submitted the application for waiver to your office on its behaWe are writing regarding the approval letter sent to Mr. Deluccia on January 12, 2011. We would like to confirm the letter approves all thirteen applications we filed on behalf of the United Benefit Fund.
hank you in advance for your assistance in this matter.
Michelle Bermanaralegal
Michelle Berman, Paralegal
orlick, Kravitz & Listhaus, PC
7 State Street, 4th Floorew York, New York 10004
212) 269-2500
212) 269-2540 (fax)
OTICE: The information contained in this electronic mail and any attachments is intended for the exclusive use of the
ddressee(s) and may contain confidential, privileged, and/or proprietary information. Any other use of these materials is strictly
rohibited. If you have received these materials in error, please notify me immediately by telephone and destroy all electronic,
aper or other versions. No representation is made by the sender that any e-mails and/or attachments are virus free, and are u
t the intended recipient's sole risk. Unauthorized interception of this e-mail is a violation of federal criminal law.
UBenefit:000015
mailto:[email protected]:[email protected] -
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//T|/...0%20Response%20[YELLOW]/United%20Benefit%20Fund/Question%20response%20on%20Cambridge%20E%201.19.11.htm[07/14/2011 3:29
rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, January 19, 2011 1:48 PM
To: 'Michelle Berman'Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section711
Michelle,
he approval letter applies to Cambridge E as well. Thank you for checking with us.
lease let me know if I can be of further assistance.
hanks,
Alexandra Botwinick
ffice of Oversight
rom: Michelle Berman [mailto:[email protected]]ent: Wednesday, January 19, 2011 9:41 AMo: Botwinick, Alexandra (HHS/OCIIO)ubject: Re: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
Dear Ms. Botwinick,
hank you for getting back to me. Yes, I am certain that there were 13 applicationsubmitted. It looks like Cambridge E is missing from your list below. I know that it was s
n initially and it is on our spreadsheet. Maybe it was an oversight?
f you could confirm that it is approved that would be great, if not please advise how wehould proceed.
hank you for your help!
Michelle
rom: "Botwinick, Alexandra (HHS/OCIIO)"
o: Michelle Berman c: "Habit, Sandra (HHS/OCIIO)" ent: Wed, January 19, 2011 8:28:53 AMubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
Ms. Berman,
apologize for the confusion. The approval applies to the following plans: MB Foods #3, MB Foods #4, Building Maintenance 2
uilding Maintenance 1, Basic, Apollo, Cambridge B, Cambridge C, Cambridge , Sterling , Universal B, and Universal.
only have on a record 12 plans. Are you certain that there are 13?
UBenefit:000016
mailto:[email protected]:[email protected] -
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//T|/...0%20Response%20[YELLOW]/United%20Benefit%20Fund/Question%20response%20on%20Cambridge%20E%201.19.11.htm[07/14/2011 3:29
Alexandra Botwinick
ffice of Oversight
rom: Michelle Berman [mailto:[email protected]]ent: Tuesday, January 18, 2011 4:47 PMo: Botwinick, Alexandra (HHS/OCIIO)ubject: United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711
Dear Ms. Botwinick,
Our firm is counsel the United Benefit Fund and we submitted the application for waiver to your office on its behaWe are writing regarding the approval letter sent to Mr. Deluccia on January 12, 2011. We would like to confirm the letter approves all thirteen applications we filed on behalf of the United Benefit Fund.
hank you in advance for your assistance in this matter.
Michelle Bermanaralegal
Michelle Berman, Paralegal
orlick, Kravitz & Listhaus, PC
7 State Street, 4th Floor
ew York, New York 10004
212) 269-2500
212) 269-2540 (fax)
OTICE: The information contained in this electronic mail and any attachments is intended for the exclusive use of the
ddressee(s) and may contain confidential, privileged, and/or proprietary information. Any other use of these materials is strictly
rohibited. If you have received these materials in error, please notify me immediately by telephone and destroy all electronic,
aper or other versions. No representation is made by the sender that any e-mails and/or attachments are virus free, and are u
t the intended recipient's sole risk. Unauthorized interception of this e-mail is a violation of federal criminal law.
UBenefit:000017
mailto:[email protected]:[email protected] -
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rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, January 24, 2011 8:18 AM
To: '[email protected]'Cc: Habit, Sandra (HHS/OCIIO)ubject: United Benefit Fund Plan Name Cambridge E Waiver of the Annual Limits Requirements 1-24-2011
mportance: High
Attachments: January 1 Denial Letter .pdfood MorningMr. Delucia,
know you contacted me last week concerning United Benefit Funds 13th Plan Cambridge E, which you ha
ot heard a determination on. In my haste to give you an answer concerning that plan I gave you incorrect
nformation. I do apologize for the error and any inconvenience it causes. The reason that plan had been lef
ff of the original approval list was not an oversight as I had assumed, but it was because it required furthe
onsideration. Upon further review of United Benefit Funds Plan Cambridge E, HHS has made its
etermination. Please see the attached letter.
lease confirm receipt of this letter by replying to this e-mail.
nce again, I do apologize for my error.
lease let me know if I can be of further assistance.
Alexandra Botwinick
ffice of Oversight
HHS/OCIIO
UBenefit:000018
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rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, January 24, 2011 8:29 AM
To: '[email protected]'Cc: Habit, Sandra (HHS/OCIIO)ubject: FW: United Benefit Fund Plan Names Cambridge C and Universal Waiver of the Annual Limits
Requirements 1-24-2011
mportance: High
Attachments: January 1 Denial Letter .pdfMr. Delucia,
he below e-mail and attached letter additionally applies to the following plans: Cambridge C and Universal. Once again, I do
pologize for the error. In our push to get to all of the applications with January 1st effective dates some miscommunications h
ccurred. Please be sure to let me know if I can be of any further assistance.
incerely,
Alexandra Botwinick
ffice of OversightHHS/OCIIO
rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, January 24, 2011 8:18 AMo: '[email protected]'c: Habit, Sandra (HHS/OCIIO)ubject: United Benefit Fund Plan Name Cambridge E Waiver of the Annual Limits Requirements 1-24-2011
mportance: High
ood MorningMr. Delucia,
know you contacted me last week concerning United Benefit Funds 13th Plan Cambridge E, which you ha
ot heard a determination on. In my haste to give you an answer concerning that plan I gave you incorrect
nformation. I do apologize for the error and any inconvenience it causes. The reason that plan had been lef
ff of the original approval list was not an oversight as I had assumed, but it was because it required furthe
onsideration. Upon further review of United Benefit Funds Plan Cambridge E, HHS has made its
etermination. Please see the attached letter.
lease confirm receipt of this letter by replying to this e-mail.
nce again, I do apologize for my error.
lease let me know if I can be of further assistance.
Alexandra Botwinick
UBenefit:000019
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ffice of Oversight
UBenefit:000020
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Ann ual L imit WaiverRequest Applicant
Name
Policy Name (use a newrow for each policy
application)
UnitedBenefitFund MBFoods#3
UnitedBenefitFund MBFoods#3
UnitedBenefitFund MBFoods#4
UnitedBenefitFund MBFoods#4
UnitedBenefitFund BuildingMaintenance2
UnitedBenefitFund BuildingMaintenance2
UnitedBenefitFund BuildingMaintenance1
UnitedBenefitFund BuildingMaintenance1
UnitedBenefitFund Basic
UnitedBenefitFund Basic
UnitedBenefitFund Apollo
UnitedBenefitFund Apollo
UnitedBenefitFund Apollo
UnitedBenefitFund Apollo
UnitedBenefitFund CambridgeB
UnitedBenefitFund CambridgeB
UnitedBenefitFund CambridgeC
Total Number of
Individuals Covered byPolicy (include all
dependents covered)
Current Plan Overall
Ann ual L imit (in d oll ars) Ambu lato ry Emergen cy Hospi tali zation Labo rato ry Pediat ric Materni ty/ Newb orn
-
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Ann ual L imit WaiverRequest Applicant
Name
Policy Name (use a newrow for each policy
application)
UnitedBenefitFund MBFoods#3
UnitedBenefitFund MBFoods#3
UnitedBenefitFund MBFoods#4
UnitedBenefitFund MBFoods#4
UnitedBenefitFund BuildingMaintenance2
UnitedBenefitFund BuildingMaintenance2
UnitedBenefitFund BuildingMaintenance1
UnitedBenefitFund BuildingMaintenance1
UnitedBenefitFund Basic
UnitedBenefitFund Basic
UnitedBenefitFund Apollo
UnitedBenefitFund Apollo
UnitedBenefitFund Apollo
UnitedBenefitFund Apollo
UnitedBenefitFund CambridgeB
UnitedBenefitFund CambridgeB
UnitedBenefitFund CambridgeC
Copay (if applicable)
Coinsurance (if
ap pl ic ab le ) Co pay (i f a pp li cab le)
Coinsurance (if
ap pl ic ab le ) Co pay (i f a pp li cab le)
Coinsurance (if
applicable)
Individual/ Employee
Tier*
Employee contributio
(if applicable)
-
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Ann ual L imit WaiverRequest Applicant
Name
Policy Name (use a newrow for each policy
application)
App lican t (Plan / Poli cy
Situs) City
App lican t (Plan/ Po lic y
Situs) State
Plan/ Policy Effective
Date (mm/dd/yyyy) Contact Name Street Address City State Zip Code
UnitedBenefitFund CambridgeC MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379
UnitedBenefitFund CambridgeE MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379
UnitedBenefitFund CambridgeE MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379
UnitedBenefitFund Cambridge MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379
UnitedBenefitFund Cambridge MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379
UnitedBenefitFund Sterling MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379
UnitedBenefitFund Sterling MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379
UnitedBenefitFund UniversalB MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379
UnitedBenefitFund UniversalB MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379
UnitedBenefitFund Universal MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379
UnitedBenefitFund Universal MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379
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Ann ual L imit WaiverRequest Applicant
Name
Policy Name (use a newrow for each policy
application)
UnitedBenefitFund CambridgeC
UnitedBenefitFund CambridgeE
UnitedBenefitFund CambridgeE
UnitedBenefitFund Cambridge
UnitedBenefitFund Cambridge
UnitedBenefitFund Sterling
UnitedBenefitFund Sterling
UnitedBenefitFund UniversalB
UnitedBenefitFund UniversalB
UnitedBenefitFund Universal
UnitedBenefitFund Universal
Total Number of
Individuals Covered byPolicy (include all
dependents covered)
Current Plan Overall
Ann ual L imit (in d oll ars) Ambu lato ry Emergen cy Hospi tali zation Labo rato ry Pediat ric Materni ty/ Newb orn
-
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Ann ual L imit WaiverRequest Applicant
Name
Policy Name (use a newrow for each policy
application)
UnitedBenefitFund CambridgeC
UnitedBenefitFund CambridgeE
UnitedBenefitFund CambridgeE
UnitedBenefitFund Cambridge
UnitedBenefitFund Cambridge
UnitedBenefitFund Sterling
UnitedBenefitFund Sterling
UnitedBenefitFund UniversalB
UnitedBenefitFund UniversalB
UnitedBenefitFund Universal
UnitedBenefitFund Universal
Copay (if applicable)
Coinsurance (if
ap pl ic ab le ) Co pay (i f a pp li cab le)
Coinsurance (if
ap pl ic ab le ) Co pay (i f a pp li cab le)
Coinsurance (if
applicable)
Individual/ Employee
Tier*
Employee contributio
(if applicable)
-
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Ann ual L imit WaiverRequest Applicant
Name
Policy Name (use a newrow for each policy
application)
UnitedBenefitFund CambridgeC
UnitedBenefitFund CambridgeE
UnitedBenefitFund CambridgeE
UnitedBenefitFund Cambridge
UnitedBenefitFund Cambridge
UnitedBenefitFund Sterling
UnitedBenefitFund Sterling
UnitedBenefitFund UniversalB
UnitedBenefitFund UniversalB
UnitedBenefitFund Universal
UnitedBenefitFund Universal
Employer contribution
(if applicable) Total
Employee contribution
(if applicable)
Employer contribution
(if applicable) Total
Employee contribution
(if applicable)
Employer contribution
(if applicable) Total
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PLAN NAME COLLECTIVE BARGAINING
AGREEMENT
CBA EXPIRATION DATE
MB Foods 3 & 4 MB Foods
Building Maintenance 2 Galaxy Towers Condominium
Building Maintenance Aqua Urban Renewal LLC
Basic Royal Recycling Services, Inc.
Apollo Harbor Freight Transport
Cambridge B Five Star Parking
Cambridge C Hartz Mountain Corp.
Cambridge E Connexxys, Inc.
Cambridge Crown Sanitation, Inc.
Sterling Aramark Educational Services
Universal B Muss Development LLCUniversal J & B Contracting
UBenefit:000029
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