Horizon BCBS New Jersey - Redacted HWM

7/27/2019 Horizon BCBS New Jersey - Redacted HWM

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HBCBSNJ:000001


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HBCBSNJ:000002


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HBCBSNJ:000003


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Pages 4 through 68 redacted for the following reasons:---------------------------------------------------Exemption 4

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HBCBSNJ:000005


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//T|/...20New%20Jersey/FW%20Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey%20Waiver%20Filing.htm[10/25/2011 12:45

rom: Pham, Erica (HHS/OCIIO)

ent: Wednesday, December 22, 2010 1:31 PM

o: Gary, Lapreea (HHS/OCIIO)

ubject: FW: Horizon Blue Cross Blue Shield of New Jersey Waiver Filing

ttachments: Letter and Application.pdf; EXHIBIT 1 B&E Plus Plan Waiver Filing.doc; Exhibit 1A - B&E E

Plan.doc; Exhibit 1B - IHC B&E Products 10-27-2010.xls; Exhibit 1C- Rate Information.xls;

Exhibit 2 CEO Attestation.pdf; Copy of waiver_application_form.xls

ollow Up Flag: Follow up

lag Status: Flagged

lease create a folder on the G drive for this applicant.

hey originally submitted to the wrong address ([email protected]).

rom:[email protected][mailto:[email protected]] ent: Wednesday, December 22, 2010 1:26 PMo: Pham, Erica (HHS/OCIIO)

c:[email protected]; [email protected]; [email protected];[email protected]; [email protected]; [email protected];[email protected]: Fw: Horizon Blue Cross Blue Shield of New Jersey Waiver Filing

Dear Ms. Kottenmeier,

n response to your request that Horizon Blue Cross Blue Shield of New Jersey resubmit its waiver filing

irectly to you, I have included the original email containing the filing (below). I have also attached the new

ling form that you requested. This filing pertains to an individual product.

you have any questions, please do not hesitate to contact me.

hank you very much for your assistance .

Sincerely,

ill Swyer Novak

ll Swyer Novak

ssistant General Counsel73 - 466 - 7421

73 - 466 - 7759

mail:[email protected]

his message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you

ot the named addressee, you should not disseminate, distribute or copy this e -mail. Please notify the sender immediately by

mail if you have received this e-mail by mistake and delete this e-mail from your system.-- - Forwarded by Jill Swyernovak/BCBSNJ on 12/22/2010 12:23 PM -- -- -

rom: Jill Swyernovak/BCBSNJ

o: [email protected]

Cc: Colleen Brennan/BCBSNJ@BCBSNJ, Adam Young/BCBSNJ@BCBSNJ, Edward Mailander/BCBSNJ@BCBSNJ, Robert E Meehan/BCBSNJ@BCBSNJ, PetMorey/BCBSNJ@BCBSNJ, [email protected],[email protected]

HBCBSNJ:000006
mailto:[email protected]:[email protected]:[mailto:[email protected]]mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[mailto:[email protected]]mailto:[email protected]:[email protected]


7/92

//T|/...20New%20Jersey/FW%20Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey%20Waiver%20Filing.htm[10/25/2011 12:45

ate: 11/02/2010 05:12 PM

ubject: Horizon Blue Cross Blue Shield of New Jersey Waiver Filing

Dear Mr. Mayhew:

am writing on behalf of Horizon Blue Cross Blue Shield of New Jersey to submit its application for a wai

rom restricted annual limits on the dollar value of essential benefits for Horizon BCBSNJ's Basic andEssential EPO Plus plan. Please see the attached letter and application, supporting exhibits and. CEO

ttestation.

Sincerely,

ill Swyer Novak, Esq.

ll Swyer Novak

ssistant General Counsel

73 - 466 - 7421

73 - 466 - 7759




mail if you have received this e-mail by mistake and delete this e-mail from your system.=============================================================================his message and any attachments are solely for the intended recipient. If you are not the

ntended recipient, disclosure, copying, use, or distribution of the information included in tessage is prohibited -- please immediately and permanently delete this message.=============================================================================

HBCBSNJ:000007
mailto:[email protected]:[email protected]


8/92

ANNUAL LIMIT WAIVER APPLICATION

Ann ual

Limit Waiver

Request

App licant

Name

Policy Name

(use a new

row for each

policy

application)

App licant

(Plan/ Policy

Situs) City

App licant

(Plan/

Policy

Situs)

State

Plan/ Policy

Effective Date

(mm/dd/yyyy)

Contact

Name

Street

Address City State Zip Code

Phone

Number

(including

area code)

Email

Address

C

(e.

Be

Rx o

ApplicantABC Plan 1 Washington DC 01/01/2011 J ane Doe

100 ABCDrive Washington DC 20201

1-800-ABC-1234

abc@abchea

lthplan.com Lim

HorizonHealthcare

Services, Inc.d/b/a HorizonBlue CrossBlue Shield

of NewJ ersey Basic & Essential EPO Plus NJ 09/23/2010

J ill SwyerNovak

Three PennPlaza East,

PP 16F, Newark NJ07105-2200

1-973-466-7421

jill_swyernovak@horizonb

lue.com Lim

PRA Disclosure Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The information collection is 0938-1105. The time required to complete this information collection is estimated to average ( 8 hours) or ( 240 minutes) per response, includinsearch existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.


9/92


Ambul ator y Emerg ency Hosp italizatio n Laboratory Pediat ri c

Maternity/

Newborn

Mental Health/

Substance

Abuse

Rehabilitative/

Devices

Preventive/

Wellness

Current Essential Benefits An nual Limits (Annu al Limit fo r Each Essential Benefit)


10/92


ndividual/ Employee

Tier*

Employee

contribution

(if applicable)

Employer

contribution

(if applicable) Total

Employee

contribution

(if applicable)

Employer

contribution


Employee

contribution

(if applicable)

Employer

contribution


Projected Rate Increase that woul d result

from compliance with $750,000 Annual Limit

Restriction (in d ollars) (Average Premium

by Individual)*

Current Monthly Premium Rates or

Premium Equivalent Rates (in dollars)*:

Renewal Monthly Premium Rates or

Premium Equivalent Rates if Waiver Granted

(in dollars)*

* When completing the columns requesting premium rate information, please express the premium rates as a composite rate (ifpremiums are a range based on years of service or age) and by tier (Employee, Employee +Spouse, Employee +Child, Family,etc.) as applicable. If you are an issuer, please provide the premium amount in the column titled, "Total" (Column AN, AQ and AT).


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//T|/...ng%20Team/Mike/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Correspondence%2012.22.10.htm[10/25/2011 12:45

rom: Pham, Erica (HHS/OCIIO)ent: Wednesday, December 22, 2010 3:14 PM

To: '[email protected]'Cc: '[email protected]'; '[email protected]';[email protected]'; '[email protected]'; '[email protected][email protected]'; '[email protected]'ubject: RE: Horizon Blue Cross Blue Shield of New Jersey Waiver Filingear Ms. Swyer Novak:

HS is in receipt of your application, We will review and process this application. We note that we did not receive your origina

pplication submitted on November 2 because it appears it was sent to an incorrect address, [email protected] rather t

[email protected].

hank you and happy holidays,

rica

rica Pham

ivision of Enforcement

ffice of Oversight

CIIO/HHS

01-492-4108

[email protected]

rom: [email protected] [mailto:[email protected]]ent: Wednesday, December 22, 2010 1:26 PMo: Pham, Erica (HHS/OCIIO)c: [email protected]; [email protected]; [email protected];[email protected]; [email protected]; [email protected];[email protected]: Fw: Horizon Blue Cross Blue Shield of New Jersey Waiver Filing

Dear Ms. Kottenmeier,

n response to your request that Horizon Blue Cross Blue Shield of New Jersey resubmit its waiver filing

irectly to you, I have included the original email containing the filing (below). I have also attached the new

ling form that you requested. This filing pertains to an individual product.

you have any questions, please do not hesitate to contact me.

hank you very much for your assistance .

Sincerely, ill Swyer Novak

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759

mail: [email protected]


HBCBSNJ:000011
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


12/92

//T|/...ng%20Team/Mike/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Correspondence%2012.22.10.htm[10/25/2011 12:45


mail if you have received this e-mail by mistake and delete this e-mail from your system.-- - Forwarded by Jill Swyernovak/BCBSNJ on 12/22/2010 12:23 PM -- -- -

rom: Jill Swyernovak/BCBSNJ

o: [email protected]

Cc: Colleen Brennan/BCBSNJ@BCBSNJ, Adam Young/BCBSNJ@BCBSNJ, Edward Mailander/BCBSNJ@BCBSNJ, Robert E Meehan/BCBSNJ@BCBSNJ, PetMorey/BCBSNJ@BCBSNJ, [email protected], [email protected]

ate: 11/02/2010 05:12 PM

ubject: Horizon Blue Cross Blue Shield of New Jersey Waiver Filing

Dear Mr. Mayhew:

am writing on behalf of Horizon Blue Cross Blue Shield of New Jersey to submit its application for a wai

rom restricted annual limits on the dollar value of essential benefits for Horizon BCBSNJ's Basic and

Essential EPO Plus plan. Please see the attached letter and application, supporting exhibits and. CEO

ttestation.

Sincerely,

ill Swyer Novak, Esq.

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759




mail if you have received this e-mail by mistake and delete this e-mail from your system.=============================================================================his message and any attachments are solely for the intended recipient. If you are not thentended recipient, disclosure, copying, use, or distribution of the information included in tessage is prohibited -- please immediately and permanently delete this message.=============================================================================

HBCBSNJ:000012


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//T|/...f%20New%20Jersey/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey%20Waiver%20Application.htm[10/25/2011 12:45

rom: [email protected]

ent: Tuesday, January 04, 2011 3:56 PM

o: Pham, Erica (HHS/OCIIO)

c: [email protected]; [email protected];

[email protected]; [email protected];

[email protected]; [email protected];

[email protected]

ubject: Horizon Blue Cross Blue Shield of New Jersey Waiver Application

ttachments: New Jersey Waiver Letter.pdf

Dear Ms. Pham,

am writing to inform you that the data sheet that was submitted with

he resubmission of the Horizon Blue Cross Blue Shield of New Jerse

"Horizon BCBSNJ") application for a waiver of the annual limitestrictions on essential benefits contains an incorrect number in the

column labeled "Total Number of Individuals Cove Policy (includall depend overed)." The number should be membersnstead of listed.

would also like to bring to your attention the fact that HHS has

approved the New Jersey Department of Banking and Insurance

"NJDOBI") application for a waiver of the annual limit restrictions onessential health benefits under Section 2711 of the Public Health

Services Act (See attached letter below). The coverage that is the

subject of the NJDOBI's filing is the underlying coverage supporting th

ider in the Horizon BCBSNJ application. Horizon BCBSNJ's rider

enhances the underlying NJDOBI coverage by providing increased

benefits for members.

Since the NJDOBI's filing has been approved, Horizon BCBSNJ looks

orward to hearing shortly from HHS on its approval as well.

Happy New Year and thank you very much for your assistance in this

process.

Sincerely,HBCBSNJ:000013


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//T|/...f%20New%20Jersey/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey%20Waiver%20Application.htm[10/25/2011 12:45

Jill Swyer Novak

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759mail:[email protected]



mail if you have received this e-mail by mistake and delete this e-mail from your system.=============================================================================his message and any attachments are solely for the intended recipient. If you are not thentended recipient, disclosure, copying, use, or distribution of the information included in tessage is prohibited -- please immediately and permanently delete this message.=============================================================================

HBCBSNJ:000014


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HBCBSNJ:000015


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HBCBSNJ:000016


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From: Keels, Lisa (HHS/OCIIO)Sent: Monday, January 24, 2011 2:57 PMTo: Habit, Sandra (HHS/OCIIO)Subject: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application

- Request for Additional Information

Hi Sandy,

The email didnt go through. I will try again. Thanks!

_____________________________________________

From: System Administrator

Sent: Monday, January 24, 2011 2:57 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: Undeliverable: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application -

Request for Additional Information

Your message did not reach some or all of the intended recipients.

Subject: Horizon Blue Cross Blue Shield of New Jersey Annual Limits WaiverApplication - Request for Additional Information

Sent: 1/24/2011 2:57 PM

The following recipient(s) cannot be reached:

'[email protected]' on 1/24/2011 2:57 PMNone of your e-mail accounts could send to this recipient.

HBCBSNJ:000017


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//T|/.../Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Request%20for%20info%20(2)%20%201.24.11.htm[10/25/2011 12:45

rom: Keels, Lisa (HHS/OCIIO)ent: Monday, January 24, 2011 2:59 PM

To: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additionnformation

Dear Ms. Swyer Novak:

hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. I left you a voicemail earlier this afternoon. We are processing your application and havouple of questions about the waiver application spreadsheet you submitted. In order to complete your applicationlease provide the following information:

1. On the spreadsheet, enrollees are categorized under the following tiers: Individual, Employee + Spouse,Employee + Family, and Employee + Children. Since Horizon BCBSNJ is an individual policy, please conthat, by Employee + Spouse, Employee + Family, and Employee + Children, you mean Individual +Spouse, Individual + Family, and Individual + Children.

2. The spreadsheet column entitle tal Number of Individuals Covered by Policy (include all dependent covered) contains the number . However, the application letter states that the B&E Plus Plan hadenrollees at the end of the seco arter. Please confirm the number of enrollees under each tier of cov(i.e., Individual, Employee + Child, etc.).

3. Please confirm whether the policy was in existence prior to March 23, 2010. If so, is the plan in compliancwith grandfathering provisions, pursuant to 45 CFR 147.140?

lease feel free to call me if you have any questions. I look forward to hearing from you soon.

hank you,isa

sa M. Keels, J.D..S. Department of Health & Human Services

ffice of Consumer Information and Insurance Oversight

ffice of Oversight

[email protected]

01-492-4168

HBCBSNJ:000018


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//T|/...Team/Mike/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/completion%202.3.11.htm[10/25/2011 12:45

rom: Keels, Lisa (HHS/OCIIO)Sent: Thursday, February 03, 2011 3:34 PMo: [email protected]

Cc: Habit, Sandra (HHS/OCIIO)Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request fdditional Informationear Jill,

ust wanted to let you know that your application is complete, and you should be hearing from HHS soon.

hank you,

sa

rom: [email protected] [mailto:[email protected]]ent: Thursday, February 03, 2011 2:02 PMo: Keels, Lisa (HHS/OCIIO)ubject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Informatio

hank you, Lisa.egards,ll

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759




mail if you have received this e-mail by mistake and delete this e-mail from your system.

rom: "Keels, Lisa (HHS/OCIIO)"

o: "[email protected]"

Cc: "[email protected]" , "[email protected]" , "Habit, Sandra (HHS/OCIIO)"

ate: 02/03/2011 01:43 PM

ubject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

hank you, Jill. I will let you know if we have additional questions.

est,

sa

rom: [email protected] [mailto:[email protected]]ent: Thursday, February 03, 2011 1:33 PMo: Keels, Lisa (HHS/OCIIO)c: [email protected]; [email protected]

ubject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Informatio

HBCBSNJ:000019


20/92

//T|/...Team/Mike/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/completion%202.3.11.htm[10/25/2011 12:45

Dear Lisa,

am writing to submit an answer to your question which was as follows:

The spreadsheet column entitled Total Number of Individuals Covered by Policy (include all dependent overed) contains the number . However, the application letter states that the B&E Plus Plan had

nrollees at the end of the secon arter. Please confirm the number of enrollees under each tier of cov.e., Individual, Employee + Child, etc.).

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey sen ail to Ms. Pham corr the dataheet by indicating that the total number of of individuals covered was members instead of . HorizonCBSNJ does not maintain its data in terms of members per tier. Hori BSNJ maintains its d terms ofontracts per tier.he mem esents contracts which when broken down by tier is as follows:ing wo adults

Adult/Child/renamily____________ _____otal contracts

Obviously, the above represents members in the single category and members in the two adult categoThe question is the number of m in the Adult/Child/ren and Family c ies.hope this information is helpful.

f I can be of further assistance, please contact me.

incerely,ill

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759




mail if you have received this e-mail by mistake and delete this e-mail from your system.============================================================================= his message and any attachments are solely for the intended recipient. If you are not thentended recipient, disclosure, copying, use, or distribution of the information included in t

essage is prohibited -- please immediately and permanently delete this message. =============================================================================

=============================================================================his message and any attachments are solely for the intended recipient. If you are not thentended recipient, disclosure, copying, use, or distribution of the information included in tessage is prohibited -- please immediately and permanently delete this message.=============================================================================

HBCBSNJ:000020


21/92

//T|/...rizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Scheduling%20a%20Call%202.15.11.htm[10/25/2011 12:4

rom: Keels, Lisa (HHS/OCIIO)

ent: Tuesday, February 15, 2011 3:41 PM

o: '[email protected]'

c: Kottenmeier, Erika (HHS/OCIIO)

ubject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Requ

for Additional Information

ear Jill,

ur leadership would like to schedule a call with you to discuss Horizon Blue Cross Blue Shield of New Jerseys annual limit

waiver application.

lease let me know if you would be available for a call at 10:00am next Wednesday, February 23 rd.

hank you,

sa

rom:[email protected][mailto:[email protected]] ent: Thursday, February 03, 2011 4:24 PMo: Keels, Lisa (HHS/OCIIO)c:[email protected]: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Informatio

ear Lisa,

hank you very much for the information. I appreciate your help.will look forward to hearing from you soon.

egards,ll

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759






o: "[email protected] "

Cc: "Habit, Sandra (HHS/OCIIO)"

ate: 02/03/2011 03:33 PM


HBCBSNJ:000021
mailto:[email protected]:[mailto:[email protected]]mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[mailto:[email protected]]mailto:[email protected]


22/92


ear Jill,


hank you,

sa

rom:[email protected] [mailto:[email protected]]ent: Thursday, February 03, 2011 2:02 PM

o: Keels, Lisa (HHS/OCIIO)ubject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Informatio


ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759




mail if you have received this e-mail by mistake and delete this e-mail from your system.rom: "Keels, Lisa (HHS/OCIIO)"



ate: 02/03/2011 01:43 PM



est,

sa

rom:[email protected] [mailto:[email protected]]ent: Thursday, February 03, 2011 1:33 PMo: Keels, Lisa (HHS/OCIIO)c:[email protected]; [email protected]


Dear Lisa,

am writing to submit an answer to your question which was as follows:HBCBSNJ:000022
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


23/92


The spreadsheet column entitled Total Number of Individuals Covered by Policy (include all dependent overed) contains the number . However, the application letter states that the B&E Plus Plan hadnrollees at the end of the seco arter. Please confirm the number of enrollees under each tier of cov.e., Individual, Employee + Child, etc.).

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey sen ail to Ms. Pham cor the dataheet by indicating that the total number of of individuals covered was members instead of HorizonCBSNJ does not maintain its data in terms of members per tier. Hori SNJ maintains its d terms ofontracts per tier.he mem esents contracts which when broken down by tier is as follows:inglewo adults

Adult/Child/renamily_____________ _____otal contracts

Obviously, the above represents members in the single category and members in the two adult categoThe question is the number of members in the Adult/Child/ren and Family categories.

hope this information is helpful.f I can be of further assistance, please contact me.

incerely,ill

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759





essage is prohibited -- please immediately and permanently delete this message. ============================================================================= ============================================================================= his message and any attachments are solely for the intended recipient. If you are not thentended recipient, disclosure, copying, use, or distribution of the information included in t



HBCBSNJ:000023


24/92

//T|/...20Cross%20Blue%20Shield%20of%20New%20Jersey/Scheduling%20a%20Call%20Follow-Up%202.15.11.htm[10/25/2011 12:45


ent: Tuesday, February 15, 2011 4:06 PM


c: Kottenmeier, Erika (HHS/OCIIO)

ubject: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application -


ello again, Jill,

n addition to letting me know if you are available at 10:00am next Wednesday, February 23rd, could you also please let m

now your availability for two additional dates/times? Scheduling changes often arise, and we would like to be able to

chedule this call at everyones earliest convenience.

hank you again,

sa


ent: Tuesday, February 15, 2011 3:41 PMo: '[email protected]'c: Kottenmeier, Erika (HHS/OCIIO)ubject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Informatio

ear Jill,

ur leadership would like to schedule a call with you to discuss Horizon Blue Cross Blue Shield of New Jerseys annual limit

waiver application.

lease let me know if you would be available for a call at 10:00am next Wednesday, February 23 rd.

hank you,

sa

rom:[email protected][mailto:[email protected]] ent: Thursday, February 03, 2011 4:24 PMo: Keels, Lisa (HHS/OCIIO)c:[email protected]: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Informatio

ear Lisa,


egards,ll

ll Swyer Novak


73 - 466 - 7421

HBCBSNJ:000024
mailto:[email protected]:[mailto:[email protected]]mailto:[email protected]:[email protected]:[mailto:[email protected]]mailto:[email protected]


25/92


73 - 466 - 7759








ate: 02/03/2011 03:33 PMubject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

ear Jill,


hank you,

sa

rom:[email protected] [mailto:[email protected]]ent: Thursday, February 03, 2011 2:02 PMo: Keels, Lisa (HHS/OCIIO)



ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759







ate: 02/03/2011 01:43 PM


HBCBSNJ:000025
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


26/92



est,

sa


c:[email protected]; [email protected]: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Informatio

Dear Lisa,


The spreadsheet column entitled Total Number of Individuals Covered by Policy (include all dependent overed) contains the number However, the application letter states that the B&E Plus Plan had

nrollees at the end of the second quarter. Please confirm the number of enrollees under each tier of cov.e., Individual, Employee + Child, etc.).

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey sent an email to Ms. Pham cor the dataheet by indicating that the total number of of individuals covered was members instead of . HorizonCBSNJ does not maintain its data in terms of members per tier. Hori BSNJ maintains its d terms ofont r tier.he mem sents contracts which when broken down by tier is as follows:ing wo adults




incerely,ill

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759





HBCBSNJ:000026
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


27/92




=============================================================================his message and any attachments are solely for the intended recipient. If you are not thentended recipient, disclosure, copying, use, or distribution of the information included in t

essage is prohibited -- please immediately and permanently delete this message.=============================================================================

HBCBSNJ:000027


28/92

//T|/...Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Correspondence%20about%20call%202.16.11.htm[10/25/2011 12:4


ent: Wednesday, February 16, 2011 4:33 PM


c: [email protected]; Kottenmeier, Erika (HHS/OCIIO)

ubject: RE: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application -



lag Status: Flagged

hank you, Jill. I will work on scheduling the call and will confirm with you as soon as possible.

ll the best,

sa

rom:[email protected][mailto:[email protected]] ent: Wednesday, February 16, 2011 4:30 PM

o: Keels, Lisa (HHS/OCIIO)c:[email protected]: Re: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additionalnformation

ello Lisa.

Wednesday, February 23, 2011 at 10 am is fine. As alternative dates and times, I would like to suggest Thursday, February 24

011 at 11 am and Friday, February 25, 2011 at 10 am.

egards,

ll

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759







Cc: "Kottenmeier, Erika (HHS/OCIIO)"

ate: 02/15/2011 04:06 PM

ubject: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

HBCBSNJ:000028
mailto:[email protected]:[mailto:[email protected]]mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[mailto:[email protected]]mailto:[email protected]


29/92


ello again, Jill,

addition to letting me know if you are available at 10:00am next Wednesday, February 23 rd, could you also please let me know your

vailability for two additional dates/times? Scheduling changes often arise, and we would like to be able to schedule this call at everyone

arliest convenience.

hank you again,

sa

rom: Keels, Lisa (HHS/OCIIO)ent: Tuesday, February 15, 2011 3:41 PMo: '[email protected]'c: Kottenmeier, Erika (HHS/OCIIO)


ear Jill,

ur leadership would like to schedule a call with you to discuss Horizon Blue Cross Blue Shield of New Jerseys annual limits waiver applicat

ease let me know if you would be available for a call at 10:00am next Wednesday, February 23 rd.

hank you,

sa

rom:[email protected] [mailto:[email protected]]ent: Thursday, February 03, 2011 4:24 PMo: Keels, Lisa (HHS/OCIIO)c:[email protected]


ear Lisa,


egards,ll

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759







ate: 02/03/2011 03:33 PM


HBCBSNJ:000029
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


30/92


ear Jill,


hank you,

sa




ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759







ate: 02/03/2011 01:43 PM



est,

sa

HBCBSNJ:000030
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


31/92




Dear Lisa,


The spreadsheet column entitled Total Number of Individuals Covered by Policy (include all dependents

overed) contains the number . However, the application letter states that the B&E Plus Plan hadnrollees at the end of the seco arter. Please confirm the number of enrollees under each tier of cov.e., Individual, Employee + Child, etc.).

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey sen ail to Ms. Pham correcting the dataheet by indicating that the total number of of individuals covered was members instead of HorizonCBSNJ does not maintain its data in terms of members per tier. Hori BSNJ maintains its d terms ofontracts per tier.he members represents contracts which when broken down by tier is as follows:ing wo adults


Obviously, the above represents members in the single category and members in the two adult categoThe question is the number of m in the Adult/Child/ren and Family c es.hope this information is helpful.


incerely,ill

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759







HBCBSNJ:000031


32/92


============================================================================= his message and any attachments are solely for the intended recipient. If you are not thentended recipient, disclosure, copying, use, or distribution of the information included in t



HBCBSNJ:000032


33/92

//T|/...ue%20Shield%20of%20New%20Jersey/Correspondence%20about%20scheduling%20a%20call%202.16.11.htm[10/25/2011 12:4



o: Keels, Lisa (HHS/OCIIO)




lag Status: Flagged

hank you very much, Lisa.

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759







Cc: "[email protected]" , "Kottenmeier, Erika (HHS/OCIIO)"

ate: 02/16/2011 04:33 PM

ubject: RE: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information


l the best,

sa

rom:[email protected] [mailto:[email protected]]ent: Wednesday, February 16, 2011 4:30 PMo: Keels, Lisa (HHS/OCIIO)c:[email protected]

ubject: Re: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additionalnformation

ello Lisa.



egards,ll

HBCBSNJ:000033
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


34/92


ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759



ot the named addressee, you should not disseminate, distribute or copy this e -mail. Please notify the sender immediately by mail if you have received this e-mail by mistake and delete this e-mail from your system.




ate: 02/15/2011 04:06 PM


ello again, Jill,




hank you again,sa



ear Jill,



hank you,

sa



HBCBSNJ:000034


35/92


ear Lisa,


egards,ll

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759






Cc: "Habit, Sandra (HHS/OCIIO)" ate: 02/03/2011 03:33 PM


ear Jill,


hank you,

sa




ll Swyer Novak


73 - 466 - 7421

HBCBSNJ:000035
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


36/92


73 - 466 - 7759







ate: 02/03/2011 01:43 PM



est,

sa


c:[email protected]; [email protected]: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Informatio

Dear Lisa,


The spreadsheet column entitle tal Number of Individuals Covered by Policy (include all dependent overed) contains the number . However, the application letter states that the B&E Plus Plan hadnrollees at the end of the secon arter. Please confirm the number of enrollees under each tier of cov.e., Individual, Employee + Child, etc.).

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey sent an email to Ms. Pham corr the dataheet by indicating that the total number of of individuals covered was members instead of HorizonCBSNJ does not maintain its data in terms of members per tier. Hori BSNJ maintains its d terms ofont er tier.he mem sents contracts which when broken down by tier is as follows:ing wo adults

Adult/Child/renamily

HBCBSNJ:000036
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


37/92


____________ _______otal contracts



incerely,ill

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759










HBCBSNJ:000037


38/92

//T|/...%20Cross%20Blue%20Shield%20of%20New%20Jersey/Scheduling%20a%20Call%20response%202.16.11.htm[10/25/2011 12:4




c: [email protected]

ubject: Re: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application -



lag Status: Flagged

ello Lisa.



egards,ll

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759








ate: 02/15/2011 04:06 PM


ello again, Jill,




hank you again,

sa

rom: Keels, Lisa (HHS/OCIIO)ent: Tuesday, February 15, 2011 3:41 PM

HBCBSNJ:000038


39/92


o: '[email protected]'c: Kottenmeier, Erika (HHS/OCIIO)


ear Jill,



hank you,

sa



ear Lisa,


egards,ll

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759







ate: 02/03/2011 03:33 PM


ear Jill,


HBCBSNJ:000039


40/92


hank you,

sa




ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759







ate: 02/03/2011 01:43 PM



est,

sa



Dear Lisa,


HBCBSNJ:000040
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


41/92


The spreadsheet column entitled Total Number of Individuals Covered by Policy (include all dependent overed) contains the number . However, the application letter states that the B&E Plus Plan hadnrollees at the end of the second quarter. Please confirm the number of enrollees under each tier of covera

.e., Individual, Employee + Child, etc.).

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey se ail to Ms. Pham correcting the dataheet by indicating that the total number of of individuals covered was members instead of HorizonCBSNJ does not maintain its data in terms of members per tier. Hori BSNJ maintains its d terms ofont r tier.he members represents contracts which when broken down by tier is as follows:in wo adults


Obviously, the above represents members in the single category and members in the two adult categoThe question is the number of in the Adult/Child/ren and Family c ies.hope this information is helpful.


incerely,ill

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759






essage is prohibited -- please immediately and permanently delete this message.

============================================================================= ============================================================================= his message and any attachments are solely for the intended recipient. If you are not thentended recipient, disclosure, copying, use, or distribution of the information included in t



HBCBSNJ:000041


42/92

//T|/...lue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Question%20re%20Call%20Agenda%202.17.11.htm[10/25/2011 12:4


ent: Thursday, February 17, 2011 10:56 AM


c: [email protected]




lag Status: Flagged

i Lisa.Would it be possible to provide me with an agenda for the call? We would like to be able to have the appropriate people on t

all to respond to your questions.

hanks very much for your help. ll

ll Swyer Novakssistant General Counsel

73 - 466 - 7421

73 - 466 - 7759







Cc: "[email protected]" , "Kottenmeier, Erika (HHS/OCIIO)"

ate: 02/16/2011 04:33 PM

ubject: RE: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information


l the best,

sa

rom:[email protected] [mailto:[email protected]]ent: Wednesday, February 16, 2011 4:30 PMo: Keels, Lisa (HHS/OCIIO)c:[email protected]: Re: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional

nformation

ello Lisa.

HBCBSNJ:000042
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


43/92

//T|/...lue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Question%20re%20Call%20Agenda%202.17.11.htm[10/25/2011 12:4



egards,ll

ll Swyer Novak


73 - 466 - 7421

73 - 466 - 7759







ate: 02/15/2011 04:06 PM


ello again, Jill,




hank you again,

sa



ear Jill,



hank you,

sa

HBCBSNJ:000043


44/92

//T|/...lue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Question%20re%20Call%20Agenda%202.17.11.htm[10/25/2011

Documents

Horizon BCBS New Jersey - Redacted HWM