From: Nielsen, Mark (mcn@groom.com) [MNielsen@groom.

com] Sent: Friday, October 08, 2010 3:23 PM To: HHS HealthInsurance (HHS) Cc: Mazawey, Lou (ltm@groom.com); Killion, Tammy (TKillion@groom.com); Gogna, Anubhav (AGogna@groom.com) Subject: WAIVER--SSEU Local 371 Welfare Fund Follow Up Flag: Follow up Flag Status: Completed Attachments: Local371WFWaiverAppFinal10-8-10.pdf; Actuarial Projections--Final.pdf
Dear Mr. Mayhew, On behalf of theSocial Services Employees Union Local 371 Welfare Fund (the "SSEU Local 371 Fund" or the "Fund"), I am submitting this application for waiver of the restricted annual limit under Public Health Services Act 2711, pursuant to OCIIO SubR tory Guidance OCIIO 2010-1. TheSSEU Local 371 Fund hasa per-familyannual limit on prescription drug benefits of $Ex. 4 , and, as detailed in the attached waiver application and accompanying actuarialprojection, imposition of a $750,000 annual limitwould result in the Fund's insolvency, or drastically reduced access to benefits for those currently covered by the Fund. We appreciate your consideration of theSSEU Local 371 Fund's request. Please let Lou Mazawey or me know if you have any questions or need anything else. Lou can be reached at 202.861.6608, and I can be reached at at 202.861.5429. Best regards, Mark C. Nielsen [019470/02]

Document obtained by CompleteColorado.com

To comply with U.S. Treasury Regulations, we also inform you that, unless expressly stated otherwise, any tax advice contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code, and such advice cannot be quoted or referenced to promote or market to another party any transaction or matter addressed in this communication.

Co m

pl

Notice: This message is intended only for use by the person or entity to which it is addressed. Because it may contain confidential information intended solely for the addressee, you are notified that any disclosing, copying, downloading, distributing, or retaining of this message, and any attached files, is prohibited and may be a violation of state or federal law. If you received this message in error, please notify the sender by reply mail, and delete the message and all attached files.

et eC

Mark C. Nielsen / 1701 Pennsylvania Ave., N.W. / Washington, DC 20006 / Phone: 202-861-5429 / Fax: 202-659-4503 / www.Groom.com / MNielsen@groom.com

ol o

ra do .

file:///T|/...2012600%20Response%20[YELLOW]/SSEU%20Local%20371/WAIVER--SSEU%20Local%20371%20Welfare%20Fund.htm[08/05/2011 4:16:19 PM]

co m

SSEU L371:000001

Document obtained by CompleteColorado.com

Co m

pl

et eC

ol o
Ex. 4

ra do .
SSEU L371:000002

co m

Document obtained by CompleteColorado.com

Ex. 4

Ex. 4

pl

et eC
Ex. 4 Ex. 4

Co m

ol o
SSEU L371:000003

ra do .

co m

Document obtained by CompleteColorado.com

Ex. 4 Ex. 4

ra do . ol o
Ex. 4 Ex. 4 Ex. 4 Ex. 4 Ex. 4 Ex. 4 Ex. 4 Ex. 4 Ex. 4 Ex. 4

Ex. 4

Co m

pl

et eC

co m
Ex. 4 Ex. 4

SSEU L371:000004

Document obtained by CompleteColorado.com

Co m

pl

et eC

ol o
SSEU L371:000005

ra do .

co m

Document obtained by CompleteColorado.com

Pages 6 through 11 redacted for the following reasons: ---------------------------Exemption 4

Co m

pl

et eC

ol o
SSEU L371:000006

ra do .

co m

From: Keels, Lisa (HHS/OCIIO) Sent: Friday, October 29, 2010 4:48 PM To: mcn@groom.com Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: SSEU Local 371 Welfare Fund Waiver Application - Request for Additional Information
Dear Mr. Nielsen: Thank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. We appreciate you clarifying the information in Exhibits I and II that were included in your application. In order to complete your application, please provide the following information: What is the co-pay/coinsurance amount for prescriptions? In order to complete your application, please provide this information by 5:00 pm, Monday, November 1, 2010. We look forward to receiving your completed application. Thank you again, and have a wonderful weekend. Regards, Lisa Keels Lisa M. Keels, J.D. U.S. Department of Health & Human Services Office of Consumer Information and Insurance Oversight Office of Oversight lisa.keels@hhs.gov 301-492-4168

Document obtained by CompleteColorado.com

Co m

pl

et eC

ol o

ra do .

file:///T|/...20NO%2012600%20Response%20[YELLOW]/SSEU%20Local%20371/Requst%20for%20Additional%20Info%2010.29.10.htm[08/05/2011 4:16:21 PM]

co m

SSEU L371:000007

From: Nielsen, Mark (mcn@groom.com) [MNielsen@groom.com] Sent: Friday, October 29, 2010 5:05 PM To: Keels, Lisa (HHS/OCIIO) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: RE: SSEU Local 371 Welfare Fund Waiver Application - Request for Additional Information
Hi Lisa (and Kathleen). The cost-sharing for prescription drugs is as follows: Retail Generic: $ Ex. 4 copayment; Brand:$Ex. 4 copayment, or Ex. 4% coinsurance, whichever is greater. Mail Order Generic:$Ex. 4 opayment for for 90-day supply; Brand: $Ex. 4 copayment for 90-day supply. The copayment is prorated for less than a 90-day supply of mail order drugs. I hope this is helpful. Please let me know if you need anything else. Thanks. Best regards, Mark C. Nielsen

Document obtained by CompleteColorado.com

Dear Mr. Nielsen: Thank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. We appreciate you clarifying the information in Exhibits I and II that were included in your application. In order to complete your application, please provide the following information: What is the co-pay/coinsurance amount for prescriptions? In order to complete your application, please provide this information by 5:00 pm, Monday, November 1, 2010. We look forward to receiving your completed application. Thank you again, and have a wonderful weekend. Regards, Lisa Keels Lisa M. Keels, J.D. U.S. Department of Health & Human Services Office of Consumer Information and Insurance Oversight

Co m

pl

et eC

From: Keels, Lisa (HHS/OCIIO) [mailto:Lisa.Keels@hhs.gov] Sent: Friday, October 29, 2010 4:48 PM To: Nielsen, Mark (mcn@groom.com) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: SSEU Local 371 Welfare Fund Waiver Application - Request for Additional Information

ol o

Mark C. Nielsen / 1701 Pennsylvania Ave., N.W. / Washington, DC 20006 / Phone: 202-861-5429 / Fax: 202-659-4503 / www.Groom.com / MNielsen@groom.com

ra do .

file:///T|/...0%20Response%20[YELLOW]/SSEU%20Local%20371/Request%20for%20Additional%20Info%20Response%2010.29.10.htm[08/05/2011 4:16:21 PM]

co m
SSEU L371:000008

Office of Oversight lisa.keels@hhs.gov 301-492-4168

Document obtained by CompleteColorado.com

Notice: This message is intended only for use by the person or entity to which it is addressed. Because it may contain confidential information intended solely for the addressee, you are notified that any disclosing, copying, downloading, distributing, or retaining of this message, and any attached files, is prohibited and may be a violation of state or federal law. If you received this message in error, please notify the sender by reply mail, and delete the message and all attached files.

Co m

pl

et eC

ol o
SSEU L371:000009

file:///T|/...0%20Response%20[YELLOW]/SSEU%20Local%20371/Request%20for%20Additional%20Info%20Response%2010.29.10.htm[08/05/2011 4:16:21 PM]

ra do .

co m

To comply with U.S. Treasury Regulations, we also inform you that, unless expressly stated otherwise, any tax advice contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code, and such advice cannot be quoted or referenced to promote or market to another party any transaction or matter addressed in this communication.

From: Keels, Lisa (HHS/OCIIO) Sent: Friday, October 29, 2010 5:08 PM To: Nielsen, Mark (mcn@groom.com) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: RE: SSEU Local 371 Welfare Fund Waiver Application - Request for Additional Information
Thank you for your prompt response, Mark. I will be in touch if we need more information. All the best, Lisa
From: Nielsen, Mark (mcn@groom.com) [mailto:MNielsen@groom.com] Sent: Friday, October 29, 2010 5:05 PM To: Keels, Lisa (HHS/OCIIO) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: RE: SSEU Local 371 Welfare Fund Waiver Application - Request for Additional Information

Document obtained by CompleteColorado.com

Hi Lisa (and Kathleen). The cost-sharing for prescription drugs is as follows: Retail Generic: $ Ex. 4 copayment; copayment, or Ex. 4% coinsurance, whichever is greater. Brand:$Ex. 4 Mail Order Ex. Generic:$4 copayment for for 90-day supply; Brand: $Ex. 4 copayment for 90-day supply. The copayment is prorated for less than a 90-day supply of mail order drugs. I hope this is helpful. Please let me know if you need anything else. Thanks. Best regards, Mark C. Nielsen Groom Law Group, Chartered

From: Keels, Lisa (HHS/OCIIO) [mailto:Lisa.Keels@hhs.gov] Sent: Friday, October 29, 2010 4:48 PM To: Nielsen, Mark (mcn@groom.com) Cc: Scelzo, Kathleen (HHS/OCIIO) Subject: SSEU Local 371 Welfare Fund Waiver Application - Request for Additional Information

Dear Mr. Nielsen: Thank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. We appreciate you clarifying the information in Exhibits I and II that were included in your application. In order to complete your application, please provide the following information: What is the co-pay/coinsurance amount for prescriptions? In order to complete your application, please provide this information by 5:00 pm, Monday, November 1, 2010. We look
SSEU L371:000010

file:///T|/...2012600%20Response%20[YELLOW]/SSEU%20Local%20371/Request%20for%20Additional%20Info%20Correspondence.htm[08/05/2011 4:16:22 PM]

Co m

Mark C. Nielsen / 1701 Pennsylvania Ave., N.W. / Washington, DC 20006 / Phone: 202-861-5429 / Fax: 202-659-4503 / www.Groom.com / MNielsen@groom.com

pl

et eC

ol o

ra do .

co m

Co m

pl

et eC

ol o

To comply with U.S. Treasury Regulations, we also inform you that, unless expressly stated otherwise, any tax advice contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code, and such advice cannot be quoted or referenced to promote or market to another party any transaction or matter addressed in this communication.

ra do .

Notice: This message is intended only for use by the person or entity to which it is addressed. Because it may contain confidential information intended solely for the addressee, you are notified that any disclosing, copying, downloading, distributing, or retaining of this message, and any attached files, is prohibited and may be a violation of state or federal law. If you received this message in error, please notify the sender by reply mail, and delete the message and all attached files.

file:///T|/...2012600%20Response%20[YELLOW]/SSEU%20Local%20371/Request%20for%20Additional%20Info%20Correspondence.htm[08/05/2011 4:16:22 PM]

co m

Document obtained by CompleteColorado.com forward to receiving your completed application. Thank you again, and have a wonderful weekend. Regards, Lisa Keels Lisa M. Keels, J.D. U.S. Department of Health & Human Services Office of Consumer Information and Insurance Oversight Office of Oversight lisa.keels@hhs.gov 301-492-4168

SSEU L371:000011

From: Botwinick, Alexandra (HHS/OCIIO) Sent: Friday, November 05, 2010 2:16 PM To: 'MNielsen@groom.com' Subject: Waiver of the Annual Limits Requirements of PHS Act Section 2711 Importance: High Attachments: Updated Jan 1 Approval Letter .pdf Mr. Nielsen, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for SSEU Local 371. HHS has reviewed your application and made its determination. Please see the attached letter. Please confirm receipt of this letter by replying to this e-mail address with a copy to OCIIOOversight@hhs.gov. Please let me know if I can be of further assistance. Sincerely,

Document obtained by CompleteColorado.com

alexandra.botwinick@hhs.gov

et eC Co m pl

ol o

SSEU L371:000012

Alexandra Botwinick Office of Oversight HHS/OCIIO

file:///T|/...ations%20with%20NO%2012600%20Response%20[YELLOW]/SSEU%20Local%20371/Approval%20Letter%2011-5-2010.htm[08/05/2011 4:16:23 PM]

ra do .

co m

Document obtained by CompleteColorado.com

Co m

pl

et eC

ol o
SSEU L371:000013

ra do .

co m

Document obtained by CompleteColorado.com

Co m

pl

et eC

ol o
SSEU L371:000014

ra do .

co m

From: Nielsen, Mark (mcn@groom.com) [MNielsen@groom.com] Sent: Friday, November 05, 2010 3:35 PM To: Botwinick, Alexandra (HHS/OCIIO) Cc: OCIIO Oversight Subject: RE: Waiver of the Annual Limits Requirements of PHS Act Section 2711
Alexandra, Thank you for your email, confirming waiver of the $750,000 restricted annual limit for the SSEU Local 371 Welfare Fund. We very much appreciate the Department's consideration of our request, and its courtesies throughout this process. Best regards, Mark C. Nielsen

Document obtained by CompleteColorado.com

Mark C. Nielsen / 1701 Pennsylvania Ave., N.W. / Washington, DC 20006 / Phone: 202-861-5429 / Fax: 202-659-4503 / www.Groom.com / MNielsen@groom.com
From: Botwinick, Alexandra (HHS/OCIIO) [mailto:Alexandra.Botwinick@hhs.gov] Sent: Friday, November 05, 2010 2:16 PM To: Nielsen, Mark (mcn@groom.com) Subject: Waiver of the Annual Limits Requirements of PHS Act Section 2711 Importance: High

Alexandra Botwinick Office of Oversight HHS/OCIIO

alexandra.botwinick@hhs.gov

Co m

Mr. Nielsen, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for SSEU Local 371. HHS has reviewed your application and made its determination. Please see the attached letter. Please confirm receipt of this letter by replying to this e-mail address with a copy to OCIIOOversight@hhs.gov. Please let me know if I can be of further assistance. Sincerely,

pl

et eC

Notice: This message is intended only for use by the person or entity to which it is addressed. Because it may contain confidential information intended solely for the addressee, you are notified that any disclosing, copying, downloading, distributing, or retaining of
SSEU L371:000015

file:///T|/...2012600%20Response%20[YELLOW]/SSEU%20Local%20371/Confirmation%20of%20Approval%20Letter%2011-5-2010.htm[08/05/2011 4:16:23 PM]

ol o

ra do .

co m

Document obtained CompleteColorado.com this message, and any attached files, is prohibited and may be by a violation of state or federal law. If you received this message in error, please notify the sender by reply mail, and delete the message and all attached files.

To comply with U.S. Treasury Regulations, we also inform you that, unless expressly stated otherwise, any tax advice contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code, and such advice cannot be quoted or referenced to promote or market to another party any transaction or matter addressed in this communication.

Co m

pl

et eC

ol o
SSEU L371:000016

file:///T|/...2012600%20Response%20[YELLOW]/SSEU%20Local%20371/Confirmation%20of%20Approval%20Letter%2011-5-2010.htm[08/05/2011 4:16:23 PM]

ra do .

co m