orange county ahrc - redacted bates hw
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//T|/...0-%20YELLOW/Applications%20with%20NO%2012600%20Response%20[YELLOW]/Orange%20County-AHRC/Waiver.htm[08/24/2011 4:17:
rom: Mike Karkowski [[email protected]]ent: Thursday, November 18, 2010 11:55 AM
To: HHS HealthInsurance (HHS)Cc: 'Joe Hamilton'; Rosemarie Caputo; Tom Burgess; [email protected]: Waiver
Attachments: the Plan - Standalone HRA 7-1-10_SIGNED.pdf; the plan - Standalone HRA SMM for July 1.pdf;Waiver Application 111710.pdf
ttached please find our Waiver Application Annual Limit Requirements of PHS Act Section 2711 along with copies of oulan Documents.
Michael Karkowski
hief Financial Officer
range County AHRC
49 Broadway
ewburgh, NY 12550
845) 561-0670 ext 1154 - fax (845) 561-0892
ogo
his message contains confidential information and is intended only for the individual named. If you are not the named
ddressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if
ave received this e-mail by mistake and delete this e-mail from your system. E-mail transmission cannot be guaranteee secure or error-free as information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete, or con
iruses. The sender therefore does not accept liability for any errors or omissions in the contents of this message, which
rise as a result of e-mail transmission. If verification is required please request a hard-copy version.
PPlease consider the environment before printing this e-mail.
Orange AHRC:000001
Document obtained by CompleteColorado.com
mailto:[email protected]:[email protected] -
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Orange AHRC:000002
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Pages 3 through 17 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4
Orange AHRC:000003
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//T|/...NO%2012600%20Response%20[YELLOW]/Orange%20County-AHRC/Request%20for%20addtional%20info%2011.23.10.htm[08/24/2011 4:17
rom: Scelzo, Kathleen (HHS/OCIIO)ent: Tuesday, November 23, 2010 3:40 PM
To: '[email protected]'Cc: Habit, Sandra (HHS/OCIIO)ubject: Orange County AHRC Waiver Application
mportance: High
Attachments: Orange County AHRC Waiver Application Questions.doceff McCaskeyam sending you this e -mail in reference to the application that you submitted for Orange County AHRC application for Annua
mits Requirements of the PHS Act Section 2711. Attached above is the document that needs to be completed in order to fin
he application process. Please contact me for any questions or concerns
Many thanks for your assistance with this document.
athleen M. Scelzo, RN, MSN
ules Compliance Division
ffice of Insurance Oversight
ffice of Consumer Information and Insurance Oversight (OCIIO)
epartment of Health and Human Services501 Wisconsin Avenue
ethesda, MD
01-492-4121
Orange AHRC:000004
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November 23, 2010
Dear Applicant:
RE: Orange County AHRC
Thank you for your application for the Waiver of the Annual Limits Requirements of
the PHS Act Section 2711. In order to complete your application, please provide the
following information about Orange County AHRC
1. Indicate if there are essential benefit limits and the amount for the followingcategories :
Ambulatory: $Emergency (ER): $
Hospitalization: $Laboratory: $Pediatric: $
Maternity: $Mental Health/Substance Abuse: $
Rehabiliative: $Preventive: $Prescription (RX): $
2. (The premium amounts is the total cost to the employer and the employee)Premium(Current)
Premium(renewal)
Premium(if $750,000annual limitwas applied)
% increase if the$750,000 wasimplemented
EE
EE + Child (ifapplicable orother appropriatetier)
EE + Spouse (ifapplicable orother appropriatetier)
Family (ifapplicable or
other appropriatetier)
Orange AHRC:000005
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3. Indicate if there are any deductibles for the plan and the amount.4. Indicate if there are any copay/coinsurance for the plan for the following
categories and the amount for the following:
Office Visit Inpatient ER Prescription
5. Indicate if the plan is fully-insured plan or a self-insured plan.6. Indicate if this plan has Grandfather Status.
Please provide this information by 5:00 pm Friday November 26, 2010. We look
forward to receiving your completed application. Thank you.
Sincerely,
Kathleen M. Scelzo, RN, MSN
Rules Compliance Division
Office of Insurance Oversight
Office of Consumer Information and Insurance Oversight (OCIIO)
Department of Health and Human Services
301-492-4121
Orange AHRC:000006
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//T|/...W/Applications%20with%20NO%2012600%20Response%20[YELLOW]/Orange%20County-AHRC/Approval%2012.14.10.htm[08/24/2011 4:18
rom: Botwinick, Alexandra (HHS/OCIIO)ent: Tuesday, December 14, 2010 12:26 PM
To: '[email protected]'ubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711
mportance: High
ollow Up Flag: Follow up
lag Status: Red
Attachments: July 1 .pdf
ood Afternoon,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act
ection 2711 forOrange County AHRC. HHS has reviewed your application and made its determination. Ple
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
Orange AHRC:000007
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//T|/...W/Applications%20with%20NO%2012600%20Response%20[YELLOW]/Orange%20County-AHRC/Approval%2012.29.10.htm[08/24/2011 4:18
rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, December 29, 2010 1:41 PM
To: [email protected]: Orange County AHRC Waiver of the Annual Limits Requirements 12-29-2010
mportance: High
Attachments: July 1 .pdf
ood Afternoon,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act
ection 2711 for Orange County AHRC. HHS has reviewed your application and made its determination. Pleee 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
Orange AHRC:000008
Document obtained by CompleteColorado.com
mailto:[email protected]:[email protected] -
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//T|/...W/Applications%20with%20NO%2012600%20Response%20[YELLOW]/Orange%20County-AHRC/Approval%201.10.11.htm[08/24/2011 4:18:
rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, January 10, 2011 9:28 AM
To: Habit, Sandra (HHS/OCIIO)ubject: FW: orange county ahrc Waiver of the Annual Limits Requirements of PHS Act Section 2711
mportance: High
Attachments: July 1 .pdf
Alexandra Botwinick
ffice of Oversight
HHS/OCIIO
301) [email protected]
rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, January 10, 2011 9:27 AMo: '[email protected]'ubject: FW: Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High
Mr. Karkowski,
lease see the below e-mail and the attachment here. I apologize for the delay. I see now that the address the waiver was sen
as a .com instead of a .org
lease confirm with me that you did in fact receive this e-mail and please let me know if you have any questions.
hanks so much,
Alexandra Botwinick
ffice of Oversight
HHS/OCIIO
301) [email protected]
rom: Botwinick, Alexandra (HHS/OCIIO)ent: Thursday, December 16, 2010 11:14 AMo: '[email protected]'ubject: 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
Orange AHRC:000009
Document obtained by CompleteColorado.com
mailto:[email protected]:[email protected]:[email protected]:[email protected] -
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//T|/...W/Applications%20with%20NO%2012600%20Response%20[YELLOW]/Orange%20County-AHRC/Approval%201.10.11.htm[08/24/2011 4:18:
ection 2711 for Orange County AHRC. HHS has reviewed your application and made its determination. Ple
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
Orange AHRC:000010
Document obtained by CompleteColorado.com
mailto:[email protected]:[email protected] -
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Orange AHRC:000011
Document obtained by CompleteColorado.com
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O AHRC 000012
Document obtained by CompleteColorado.com