IBEW Local 1249 - Redacted HWM

7/27/2019 IBEW Local 1249 - Redacted HWM

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//T|/...0-%20Torres/DFOI%20Processing%20Team/Mike/IBEW%20Local%201249%20Insurance%20Fund/waiver%20application.htm[10/28/2011 5:16:

rom: D Dafoe [[email protected]]ent: Friday, November 05, 2010 11:12 AM

To: HHS HealthInsurance (HHS)ubject: waiver application

Attachments: WAIVER APP 2010.pdfo Whom It May Concern,

lease find attached, an application for a waiver from the restricted annual limits relating to the Patient Protection and Affordab

are Act from the IBEW Local 1249 Insurance Fund, Federal ID # 15-6025162.

lease feel free to contact us at your convenience should any more information be required.incerely,

aniel R Dafoe

dministrator

IBEW L1249:000001


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IBEW L1249:000002


3/32

IBEW L1249:000003


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//T|/...essing%20Team/Mike/IBEW%20Local%201249%20Insurance%20Fund/Request%20for%20additional%20info%2011.22.10.htm[10/28/2011 5:16

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, November 22, 2010 9:06 AM

To: '[email protected]'Cc: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for I.B.E.W. Local 1249 Insurance Fund

mportance: High

ood Morning,

am in the process of reviewing the application for I.B.E.W. Local 1249 Insurance Fund for a Waiver of theAnnual Limits Requirements of PHS Act Section 2711, and I have a few questions before I am able to compl

my review.

lease provide me with the following information:

1. Current Premium Amount (Rate) Monthly

2. Renewal Premium Amount (Rate) Monthly

3. Projected Premium Amount if the plan had to comply with the $750,000 annual limit

4. Was the plan in effect prior to March 23, 2010?

hank you in advance for your prompt attention to this matter. We are working to get all applications

eviewed as soon as possible.

lease let me know if you have any questions.

incerely,

Alexandra Botwinick

ffice of Oversight

HHS/[email protected]

IBEW L1249:000004
mailto:[email protected]:[email protected]


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//T|/...%20Insurance%20Fund/FW%20Waiver%20Application%20for%20I.B.E.W.%20Local%201249%20Insurance%20Fund%20.htm[10/28/2011 5:16

rom: Daniel E. Kornfeld [[email protected]]ent: Monday, November 29, 2010 3:53 PM

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

ubject: FW: Waiver Application for I.B.E.W. Local 1249 Insurance Fund

ollow Up Flag: Follow uplag Status: Red

ear Alexandra Botwinick:

his e-mail message follows the voice mail message that I left for you last week in response to your e-mail messa

opied below. This firm represents the I.B.E.W. Local 1249 Insurance Fund. In response to your questions, the

nformation that you are seeking is as follows:

1. Current Premium Amount (Rate) Monthly:

The Fund has no premiums because it is self-funded. However, the 2010 hourly contribution rates are

2. Renewal Premium Amount (Rate) Monthly:

The Fund has no renewal premiums because it is self-funded.

3. Projected Premium Amount if the plan had to comply with the $750,000 annual limit:

The Fund has not conducted an actuarial report concerning the costs of compliance with the $750,000

annual limit. However, one estimate for stop loss coverage based on a recent survey published by Aegis

for 2010 involved annual premiums between $ and $ . Based on these estimates, the hocontribution rate would be significantly increased.


Yes.

you have any additional questions, please contact me or Daniel R. Dafoe, Fund Administrator.

Daniel Kornfeld

litman & King LLP

ranklin Center, Suite 300| 443 North Franklin Street| Syracuse New York 13204-5412

315.422.7111 | F: 315.471.2623 | E: [email protected] | www.bklawyers.com

onfidentiality Notice: This electronic mail transmission is intended solely for the use of the individual or entity to which it is addressed and may contain confidential and/or privileg

formation which is protected by the attorney- client or other privileges. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or

king of any action in reliance on the contents of this information is strictly prohibited. If you have received this transmission in error, Please notify the sender immediately by e- ma

lete the original message.

S Circular 230 Disclosure: To comply with recent IRS rules, we must inform you that this message, and any attachments, if they contain advice relating to federal taxes, are not int

written to be used, and they cannot be used for (1) the purpose of avoiding penalties that may be imposed under federal tax law; or (2) promoting, marketing or recommending t

other party any tax- related matter addressed herein. Under these IRS rules, a taxpayer may rely on professional advice to avoid federal tax penalties only if that advice is reflecte

mprehensive tax opinion that conforms to stringent requirements under federal law.

IBEW L1249:000005
http://www.bklawyers.com/http://www.bklawyers.com/


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//T|/...%20Insurance%20Fund/FW%20Waiver%20Application%20for%20I.B.E.W.%20Local%201249%20Insurance%20Fund%20.htm[10/28/2011 5:16

rom: D Dafoe [mailto:[email protected]]ent: Monday, November 22, 2010 12:01 PMo: Daniel E. Kornfeldubject: FW: Waiver Application for I.B.E.W. Local 1249 Insurance Fundmportance: High

---Original Message-----rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]

ent: Monday, November 22, 2010 9:06 AMo: D Dafoec: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for I.B.E.W. Local 1249 Insurance Fundmportance: High

ood Morning,

am in the process of reviewing the application for I.B.E.W. Local 1249 Insurance Fund for a Waiver of theAnnual Limits Requirements of PHS Act Section 2711, and I have a few questions before I am able to compl

my review.









incerely,

Alexandra Botwinick

ffice of Oversight


IBEW L1249:000006


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//T|/...Processing%20Team/Mike/IBEW%20Local%201249%20Insurance%20Fund/Additional%20Info%20Received%2012-2-2010.txt[10/28/2011 5:16

rom: dan dafoe [[email protected]]ent: Thursday, December 02, 2010 3:54 PMo: Botwinick, Alexandra (HHS/OCIIO)ubject: IBEW Local 1249 Insurance Waiver


Dear Alexandra Botwinick,

he information requested in your e-mail of November 22, 2010 is as follows:

Current Premium Amount (Rate) Monthly?

he Fund has no premiums because it is self-funded and is paid for by negotiated hourly contribution rates.

hese rates are $ an hour.

Renewal Premium Amount (Rate) Monthly?

he Fund has no renewal premiums because it is self-funded.

rojected Premium Amount if the Plan had to comply with the $750,000 annual limit?

he Fund has not conducted an actuarial report concerning costs of compliance with the $750,000 annual limit.However, one estimate for s cover on a recent survey published by Aegis Risk for 2010 involvednnual premiums between $ and $ . Bases on these estimates, the hourly contribution rate would bignificantly increased.

Was the Plan in effect prior to March 23, 2010?

Yes.

Very truly yours,

Daniel R. Dafoe

und Administrator

IBEW L1249:000007


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//T|/...Processing%20Team/Mike/IBEW%20Local%201249%20Insurance%20Fund/Additional%20Info%20Received%2012-2-2010.txt[10/28/2011 5:16

IBEW L1249:000008


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//T|/...orres/DFOI%20Processing%20Team/Mike/IBEW%20Local%201249%20Insurance%20Fund/Additional%20info%2012.21.10.txt[10/28/2011 5:16

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Tuesday, December 21, 2010 9:13 AMo: 'Daniel E. Kornfeld'ubject: FW: IBEW Local 1249 Insurance Waiver

mportance: High

Daniel,

Here is the 8:32 message. If this still doesnt go through I will fax you. I think attaching the spreadsheet was the issYou can find the spreadsheet and download it at the below e-mail address.

hanks,Alex

Alexandra Botwinick

Office of OversightHHS/OCIIO301) 492-4177

[email protected]

----Original Message-----rom: Botwinick, Alexandra (HHS/OCIIO)ent: Tuesday, December 21, 2010 8:32 AMo: 'Daniel E. Kornfeld'

Cc: Habit, Sandra (HHS/OCIIO)

ubject: FW: IBEW Local 1249 Insurance Waivermportance: High

Mr. Kornfeld,

elow is the message that I sent to Mr. Dafoe on the 7th. I never received a response from him.

Attached here is the spreadsheet we are now asking applicants to fill out. Filling out the attached will answer theuestions asked in the below e-mail that was sent to Mr. Dafoe. Thank you again for your continued patience andooperation in this process.

Here are the instructions that accompany the spreadsheet:

I. Please complete the entire annual limits spreadsheet, [available at:ttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html]. Please return the completed spreadsheet to thmail address as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., eveell should contain the information requested). If a cell on the spreadsheet does not pertain to your plan,lease write None, and/or provide an explanation regarding why you are unable to complete that particular cell ineparate document.

II. In addition, please provide the following information: Confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance wi

IBEW L1249:000009


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randfathering 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 thHS Act, you may not have any lifetime limit on your plan as of September 23, 2010, except in the case of non-ssential benefits that are permitted under Federal or State law. Plans that previously had a lifetime limit may addnnual limit not less than the lifetime limit without affecting the grandfather status of the plan. Please confirm

whether this lifetime limit will be eliminated from your plan.

If applicable please confirm whether the plan was created pursuant to the Taft-Hartley Act. If yes:

o Please confirm the Collective Bargaining Agreement was ratified prior to October 3, 200

o Please provide the date for which the Collective Bargaining Agreement will expi


hanks!

Alexandra Botwinick

Office of OversightHHS/OCIIO301) 492-4177

[email protected]

----Original Message-----rom: Botwinick, Alexandra (HHS/OCIIO)ent: Tuesday, December 07, 2010 8:32 AMo: 'dan dafoe'

Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: IBEW Local 1249 Insurance Waiver

Mr. Dafoe,

hank you very much for your timely response. While I understand your inability to give me the numbers I requestdo need a bit more information in order to understand how the increase to your hourly contributions would beignificant.

understand that the Fund has not conducted an actuarial report concerning costs of compliance with the $750,000

nnual limit. However, that is precisely the information I need in order to make a determination concerning yourpplication. If one estimate for stop loss coverage based on a recent survey published by Aegis Risk for 2010 invonnual premiums between $ and $ can you please use those numbers to provide me with a figurestimating what the hourly ion w ase to?need to see if there would be a "significant increase" between the current $ -$ an hour contribution and w

he contribution would be if you all had to comply with the $750,000 annual limit.

Once again, I appreciate your continued patience and cooperation with our process. Please get back to me at yourarliest convenience.

IBEW L1249:000010


11/32


incerely,

Alexandra Botwinick

Office of OversightHHS/OCIIO

[email protected]

----Original Message-----rom: dan dafoe [mailto:[email protected]]ent: Thursday, December 02, 2010 3:54 PMo: Botwinick, Alexandra (HHS/OCIIO)ubject: IBEW Local 1249 Insurance Waiver





hese rates are $ -$ an hour.




he Fund has not conducted an actuarial report concerning costs of compliance with the $750,000 annual limit.However, one estimate for s cover on a recent survey published by Aegis Risk for 2010 involvednnual premiums between $ and $ . Bases on these estimates, the hourly contribution rate would bignificantly increased.


Yes.

IBEW L1249:000011


12/32


Very truly yours,

Daniel R. Dafoe

und Administrator

IBEW L1249:000012


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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

Typ

Cov

(e.g

Ben

Rx o

HHS Plan 1 Washington DC 01/01/2011 J ane Doe endence Ave Washington DC 20201 -877-696-677 Oversight@h Lim

HHS Plan 2 Washington DC 01/01/2011 J ane Doe endence Ave Washington DC 20202 -877-696-677 Oversight@h Lim

PRA Disclosure Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless itdisplays 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.


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

Maternity/

Newborn

Mental Health/

Substance

Abuse

Rehabilitative/

Devices

Preventive/

Wellness Pr

Current Essential Benefits Annual Limits (Annual Limit f or Each Essential Benefit)


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Employee

contribution

Employer

con tr ibut ion To tal

Employee

contribution

Employer

con tr ibut ion To tal

Employee

contribution

Employer

contribution Total

Projectthat wo

complia

Annua

(in doll

Premiu

(Differe

and AP

AP)

Current Monthly Premium Rates or

Premium Equivalent Rates (in dollars)*:

Renewal Monthly Premium Rates or

Premium Equivalent Rates if Waiver Granted

(in dollars)*

Projected Rate Increase that would r esult from c ompliance

with $750,000 Annual Limi t Restriction (in dollars) (Average

Premium by Individual)*

*When completing the columns requesting premium rate information, please express the premium rates by tier, if applicable.


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//T|/...FOI%20Processing%20Team/Mike/IBEW%20Local%201249%20Insurance%20Fund/Request%20for%20info%2012.21.10.htm[10/28/2011 5:16:

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Tuesday, December 21, 2010 8:51 AM

To: 'Daniel E. Kornfeld'Cc: '[email protected]'; Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fund

mportance: HighMr. Kornfeld,

id you receive the e-mail that I sent you at 8:32 this morning?

included the Dec. 7th e-mail, the spreadsheet, and instructions for filling out the spreadsheet.

hanks!

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO

301) 492-4177

[email protected]

rom: Daniel E. Kornfeld [mailto:[email protected]]ent: Tuesday, December 21, 2010 8:48 AMo: Botwinick, Alexandra (HHS/OCIIO)c: '[email protected]'ubject: RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fund

lex:

This e-mail message follows our telephone conversation this morning.

Notwithstanding the e-mail message copied below you stated that the Department still requires additional

nformation from the Fund concerning its waiver application. To expedite this process, please note that the Fund

was in existence prior to March 23, 2010, the Fund is in compliance with grandfathering provisions, pursuant to

.F.R. 147.140, and the Fund was created pursuant to the Taft-Hartley Act, 29 U.S.C. 186(c).

If you need any additional information, please contact me as quickly as possible. I look forward to hearing fr

ou this week about this application. Thank you.

aniel

rom: Daniel E. Kornfeldent: Monday, November 29, 2010 3:53 PMo: '[email protected]'c: [email protected]: FW: Waiver Application for I.B.E.W. Local 1249 Insurance Fund

IBEW L1249:000016


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$ -$ .








Yes.


Daniel Kornfeld

litman & King LLP


315.422.7111 | F: 315.471.2623 | E: [email protected]| www.bklawyers.com










---Original Message-----

IBEW L1249:000017
mailto:[email protected]://www.bklawyers.com/http://www.bklawyers.com/mailto:[email protected]


18/32


rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Monday, November 22, 2010 9:06 AMo: D Dafoec: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for I.B.E.W. Local 1249 Insurance Fundmportance: High

ood Morning,

am in the process of reviewing the application for I.B.E.W. Local 1249 Insurance Fundfor a Waiver of theAnnual Limits Requirements of PHS Act Section 2711, and I have a few questions before I am able to compl

my review.









incerely,

Alexandra Botwinick

ffice of Oversight


IBEW L1249:000018


19/32

//T|/...cessing%20Team/Mike/IBEW%20Local%201249%20Insurance%20Fund/Request%20for%20info%20response%2012.21.10.htm[10/28/2011 5:16

rom: Daniel E. Kornfeld [[email protected]]ent: Tuesday, December 21, 2010 8:53 AM

To: Botwinick, Alexandra (HHS/OCIIO)Cc: '[email protected]'; Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fund

lex:

o. I did not receive the 8:32 e-mail message. Maybe you could fax it to 315.471.2623?

aniel

rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, December 21, 2010 8:51 AMo: Daniel E. Kornfeldc: '[email protected]'; Habit, Sandra (HHS/OCIIO)ubject: [POSSIBLE SPAM] RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fundmportance: Low

Mr. Kornfeld,



hanks!

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO

301) [email protected]


lex:






IBEW L1249:000019


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aniel

rom: Daniel E. Kornfeldent: Monday, November 29, 2010 3:53 PMo: '[email protected]'

c: [email protected]: FW: Waiver Application for I.B.E.W. Local 1249 Insurance Fund







$ -$ 2. Renewal Premium Amount (Rate) Monthly:







Yes.


Daniel Kornfeld

litman & King LLP







IBEW L1249:000020


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---Original Message-----rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Monday, November 22, 2010 9:06 AMo: D Dafoec: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for I.B.E.W. Local 1249 Insurance Fundmportance: High

ood Morning,

am in the process of reviewing the application for I.B.E.W. Local 1249 Insurance Fundfor a Waiver of theAnnual Limits Requirements of PHS Act Section 2711, and I have a few questions before I am able to compl

my review.









incerely,

Alexandra Botwinick

ffice of Oversight


IBEW L1249:000021


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//T|/...rocessing%20Team/Mike/IBEW%20Local%201249%20Insurance%20Fund/Request%20for%20info%20response%2012.7.10.txt[10/28/2011 5:16

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Tuesday, December 07, 2010 8:32 AMo: 'dan dafoe'

Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: IBEW Local 1249 Insurance Waiver

Mr. Dafoe,

hank you very much for your timely response. While I understand your inability to give me the numbers I requestdo need a bit more information in order to understand how the increase to your hourly contributions would beignificant.

understand that the Fund has not conducted an actuarial report concerning costs of compliance with the $750,000nnual limit. However, that is precisely the information I need in order to make a determination concerning yourpplication. If one estimate loss coverage based on a recent survey published by Aegis Risk for 2010 invonnual premiums between $ and $ can you please use those numbers to provide me with a figurestimating what the hourly c ion w ase to?need to see if there would be a "significant increase" between the current $ -$ an hour contribution and w

he contribution would be if you all had to comply with the $750,000 annual t.Once again, I appreciate your continued patience and cooperation with our process. Please get back to me at yourarliest convenience.

incerely,

Alexandra Botwinick

Office of OversightHHS/OCIIO

[email protected]

----Original Message-----rom: dan dafoe [mailto:[email protected]]ent: Thursday, December 02, 2010 3:54 PMo: Botwinick, Alexandra (HHS/OCIIO)ubject: IBEW Local 1249 Insurance Waiver





hese rates are $ -$ an hour.IBEW L1249:000022


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//T|/...rocessing%20Team/Mike/IBEW%20Local%201249%20Insurance%20Fund/Request%20for%20info%20response%2012.7.10.txt[10/28/2011 5:16




he Fund has not conducted an actuarial report concerning costs of compliance with the $750,000 annual limit.However, one estimate for stop loss coverage based on a recent survey published by Aegis Risk for 2010 involvednnual premiums between $ and $ . Bases on these estimates, the hourly contribution rate would bignificantly increased.


Yes.

Very truly yours,

Daniel R. Dafoe

und Administrator

IBEW L1249:000023


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//T|/...20Torres/DFOI%20Processing%20Team/Mike/IBEW%20Local%201249%20Insurance%20Fund/Confirmation%2012.29.10.htm[10/28/2011 5:16

rom: Daniel E. Kornfeld [[email protected]]ent: Wednesday, December 29, 2010 1:37 PM

To: Botwinick, Alexandra (HHS/OCIIO)Cc: '[email protected]'; Sara M. Kelly

ubject: RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fund


lex:

hank you for assisting with the approval of the annual limit waiver application mentioned in the e-mail message

opied below. I will contact Administrator Dafoe about sending the notice as quickly as we can. If you have any

uestions, please contact me.

Daniel Kornfeld

litman & King LLP


315.422.7111 | F: 315.471.2623 | E: [email protected] | www.bklawyers.com









rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, December 29, 2010 1:18 PMo: Daniel E. Kornfeldc: '[email protected]'; Sara M. Kellyubject: RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fund

mportance: High

ear Mr. Kornfeld,

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

ection 2711 for I.B.E.W Local 1249 Insurance Fund . HHS has reviewed your application and made its

etermination. Please see the attached letter.

lease confirm receipt of this letter by replying to this e-mail.

With regard to providing notice, you may do so now that you have received the waiver.

apologize for the late turn around and my inaccessibility. Many plans have January 1st effective dates so w

ave lots of applications to get through. Additionally, the holiday season has made it particularly difficult to

o everyone, but we are trying our best.

am out of the office until January 3, 2011, so the best way to reach me is by e-mail.

lease do not hesitate to e-mail me if you have any further questions.

IBEW L1249:000024
http://www.bklawyers.com/http://www.bklawyers.com/


25/32


incerely,

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO

[email protected]

rom: Daniel E. Kornfeld [[email protected]]ent: Wednesday, December 29, 2010 12:33 PMo: Botwinick, Alexandra (HHS/OCIIO)c: '[email protected]'; Sara M. Kellyubject: RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fund

lex:

I did not receive a response to the e-mail message copied below. In addition, I tried to reach you by pho

oday to discuss this waiver request, but your phone would not accept any further messages. Please contact me

uickly as possible concerning the status of the annual limits waiver application for the I.B.E.W. Local 1249 Insura

und (Fund). As we discussed last week, the Funds Plan Year starts on Saturday, January 1, 2011, and the Fun

rustees would like to have the application approved before then.

Additionally, according to the Insurance Standards Guidance Series issued by Director Steven Larsen on

ecember 9, 2010, the Fund has until February 7, 2011 to provide a notice to current and eligible participants th

he Fund does not meet the minimum annual limits for essential benefits and has received a waiver of the

equirement. Please confirm that this deadline is correct. We would prefer not to wait until February 7, 2011 to

end the notice, and the Fund is ready to distribute the notice as soon as we receive the approval of the applicat

If you have any questions, please contact me about them as well. Thank you.

aniel

rom: Daniel E. Kornfeldent: Tuesday, December 21, 2010 12:54 PMo: 'Botwinick, Alexandra (HHS/OCIIO)'c: [email protected]; Sara M. Kellyubject: RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fund

lex:

In response to your e-mail messages copied below, attached is the spreadsheet supporting the application fo

he waiver of the annual limits for the above referenced multiemployer plan.

Additionally, the Fund has not conducted an actuarial report concerning the costs of compliance with the ann

mits, so we cannot complete a few of the columns in the attachment. As stated in my e-mail message to you f

ovember 29, 2010, one estimate for stop loss coverage based on a recent survey published by Aegis Risk for 20

nvolved annual premiums between $ and $ . Based on these estimates, the hourly contributionIBEW L1249:000025


26/32


ate would be significantly increased if the Fund had to comply with the annual limits. If you need more informa

bout these estimates, please contact me.

Further, this e-mail message confirms that Fund was in existence prior to March 23, 2010, the Fund is in

ompliance with grandfathering provisions, pursuant to 45 C.F.R. 147.140, and the Fund was created pursuant t

he Taft-Hartley Act, 29 U.S.C. 186(c). Effective January 1, 2011, the Fund eliminated any lifetime limits on

enefits. Also, this e-mail message confirms that the collective bargaining agreement you inquired about was

dopted on May 7, 2007 and expired on May 2, 2010.

If you have any questions, or if you need any additional information, please contact me.

aniel

rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, December 21, 2010 11:09 AMo: Daniel E. Kornfeldubject: [POSSIBLE SPAM] RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fundmportance: Low

aniel,

reat I am glad you received it. Please fill in what you can (some cells may not apply), I am going to go ahead and put your

pplication on the list for review for this afternoon just so it is sure to be looked at asap.

lex

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO


rom: Daniel E. Kornfeld [mailto:[email protected]]ent: Tuesday, December 21, 2010 11:03 AMo: Botwinick, Alexandra (HHS/OCIIO)c: [email protected]; Sara M. Kellyubject: RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fund

lex:

just returned to the office, and I received the e-mail message copied below. There is no need to fax the messag

will work with Administrator Dafoe on the response. If you have any questions in the meantime, please contact

me.

aniel

rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, December 21, 2010 9:24 AM

IBEW L1249:000026


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o: Daniel E. Kornfeldubject: [POSSIBLE SPAM] RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fundmportance: Low

ani el ,

er e i s t he 8: 32 message. I f t hi s st i l l doesn t go t hr ough I wi l l f ax you. I t hi nk at t achi ng tpreadsheet was t he i ssue. You can f i nd t he spr eadsheet and downl oad i t at t he bel ow e- mai lddress.

hanks,

l ex

l exandr a Botwi ni ck

f f i ce of Over si ghtHS/ OCI I O301) 492- 4177

l exandr a. botwi ni ck@hhs. gov

- - - - Or i gi nal Message- - - - -r om: Botwi ni ck, Al exandr a ( HHS/ OCI I O)ent : Tuesday, December 21, 2010 8: 32 AMo: ' Dani el E. Kornf el d'c: Habi t , Sandra ( HHS/ OCI I O)ubj ect : FW: I BEW Local 1249 I nsur ance Wai vermport ance: Hi gh

Mr . Kor nf el d,

el ow i s t he message that I sent t o Mr . Daf oe on t he 7t h. I never r ecei ved a r esponse f r om hi m

t t ached her e i s t he spr eadsheet we ar e now aski ng appl i cant s t o f i l l out . Fi l l i ng out t het t ached wi l l answer t he quest i ons asked i n t he bel ow e- mai l t hat was sent t o Mr . Daf oe. Thankou agai n f or your cont i nued pat i ence and cooper at i on i n t hi s pr ocess.

ere are t he i nst r uct i ons t hat accompany t he spreadsheet :

I . Pl ease compl et e t he ent i r e annual l i mi t s spr eadsheet , [ avai l abl e at :ht t p: / / www. hhs. gov/ oci i o/ r egul at i ons/ annual _l i mi t _wai ver s. ht ml ] . Pl ease r et ur n t hecompl eted spr eadsheet t o thi s emai l addr ess as an at t achment . We wi l l onl y be ablt o pr ocess spr eadsheet s t hat ar e f ul l y compl et e (i . e. , ever y cel l shoul d cont ai n ti nf or mat i on r equest ed) . I f a cel l on t he spr eadsheet does not per t ai n t o your pl apl ease wr i t e None, and/ or pr ovi de an expl anat i on r egardi ng why you ar e unabl e t ocompl et e t hat par t i cul ar cel l i n a separ at e document .

I I . I n addi t i on, pl ease pr ovi de t he f ol l owi ng i nf or mat i on: Conf i r m whet her the pl an was i n exi st ence pr i or t o Mar ch 23, 2010. I f so, i s t hepl an i n compl i ance wi t h gr andf atheri ng pr ovi si ons, pur suant t o 45 CFR 147. 140?

I n your appl i cat i on, your pl an( s) or pol i cy( i es) pr ovi de a l i f et i me l i mi t . Pur sua

t o Sect i on 2711 of t he PHS Act , you may not have any l i f et i me l i mi t on your pl an as ofSept ember 23, 2010, except i n the case of non- essent i al benef i t s t hat are per mi t t ed undeFeder al or St at e l aw. Pl ans t hat pr evi ousl y had a l i f et i me l i mi t may add an annual l i minot l ess t han the l i f et i me l i mi t wi t hout af f ecti ng the gr andf at her st at us of t he pl an.Pl ease conf i r m whet her t hi s l i f et i me l i mi t wi l l be el i mi nat ed f r om your pl an.

I f appl i cabl e pl ease conf i r m whet her t he pl an was cr eat ed pur suant t o t he Taf t -art l ey Act. I f yes:

o Pl ease conf i r m t he Col l ect i ve Bar gai ni ng Agr eement was r at i f i ed pr i or t oct ober 3, 2008.

o Pl ease pr ovi de t he dat e f or whi ch t he Col l ect i ve Bar gai ni ng Agr eement wi l lxpi r e.

IBEW L1249:000027
mailto:[email protected]://www.hhs.gov/ociio/regulations/annual_limit_waivers.htmlhttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.htmlmailto:[email protected]


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l ease l et me know i f you have any quest i ons.

hanks!


f f i ce of Over si ghtHS/ OCI I O301) 492- 4177


- - - - Or i gi nal Message- - - - -r om: Botwi ni ck, Al exandr a ( HHS/ OCI I O)ent : Tuesday, December 07, 2010 8: 32 AMo: ' dan daf oe'c: Habi t , Sandra ( HHS/ OCI I O)ubj ect : RE: I BEW Local 1249 I nsur ance Wai ver

Mr . Daf oe,

hank you ver y much f or your t i mel y r esponse. Whi l e I underst and your i nabi l i t y t o gi ve me t heumbers I r equest ed, I do need a bi t more i nf ormat i on i n or der t o unders t and how t he i ncr ease our hour l y cont r i but i ons woul d be si gni f i cant .

underst and t hat t he Fund has not conduct ed an actuari al r eport concerni ng cost s of compl i ancwi t h t he $750, 000 annual l i mi t . However , t hat i s preci sel y t he i nf or mat i on I need i n or der t omake a det er mi nat i on concer ni ng your appl i cat i on. I f one est i mat e f or st op l oss cover e t survey publ i shed by Aegi s Ri sk f or 2010 i nvol ved annual pr emi ums bet ween $ can you pl ease use t hose numbers t o provi de me wi t h a f i gur e est i mat i ng wha t r i but i on woul d i ncrease to?

need to see i f t her e woul d be a " si gni f i cant i ncr ease" bet ween t he cur r ent $ - $ an hoont r i but i on and what t he cont r i but i on woul d be i f you al l had t o compl y wi t h $7 00 anni mi t .

nce agai n, I appr eci ate your cont i nued pat i ence and cooperat i on wi t h our pr ocess. Pl ease getack t o me at your ear l i est conveni ence.

i ncer el y,


f f i ce of Over si ghtHS/ OCI I O


- - - - Or i gi nal Message- - - - -r om: dan daf oe [ mai l t o: ddaf oe@yahoo. com]ent : Thursday, December 02, 2010 3: 54 PMo: Bot wi ni ck, Al exandr a ( HHS/ OCI I O)ubj ect : I BEW Local 1249 I nsurance Wai ver

ear Al exandr a Botwi ni ck,

he i nf or mat i on r equest ed i n your e- mai l of November 22, 2010 i s as f ol l ows:

ur r ent Premi um Amount ( Rate) Mont hl y?

IBEW L1249:000028
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


29/32


he Fund has no premi ums because i t i s sel f - f unded and i s pai d f or by negot i at ed hour l yont r i but i on rates.

hese r at es ar e $ an hour .

enewal Premi um Amount ( Rat e) Mont hl y?

he Fund has no r enewal premi ums because i t i s sel f - f unded.

roj ect ed Premi um Amount i f t he Pl an had t o compl y wi t h t he $750, 000 annual l i mi t ?

he Fund has not conduct ed an act uar i al r eport concer ni ng cost s of compl i ance wi t h t he $750, 00nnual l i mi t . However , one est i mat e f or st op l oss cove sed on survey publ i shed egi s Ri sk f or 2010 i nvol ved annual premi ums bet ween $ and $ . Bases on t hesesti mat es, t he hour l y cont r i but i on r at e woul d be si gni y i ncr

Was t he Pl an i n ef f ect pr i or t o Mar ch 23, 2010?

es.

er y t r ul y your s,

ani el R. Daf oe

und Admi ni st r at or

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO


rom: Daniel E. Kornfeld [mailto:[email protected]]ent: Tuesday, December 21, 2010 8:53 AMo: Botwinick, Alexandra (HHS/OCIIO)c: '[email protected]'; Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fund

lex:

o. I did not receive the 8:32 e-mail message. Maybe you could fax it to 315.471.2623?

IBEW L1249:000029


30/32


aniel

rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, December 21, 2010 8:51 AMo: Daniel E. Kornfeldc: '[email protected]'; Habit, Sandra (HHS/OCIIO)ubject: [POSSIBLE SPAM] RE: Waiver Application for I.B.E.W. Local 1249 Insurance Fundmportance: Low

Mr. Kornfeld,



hanks!

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO



lex:








aniel

rom: Daniel E. Kornfeldent: Monday, November 29, 2010 3:53 PMo: '[email protected]'c: [email protected]: FW: Waiver Application for I.B.E.W. Local 1249 Insurance Fund

IBEW L1249:000030


31/32








$ .




The Fund has not conducted an actuarial report concerning the costs of compliance with the $750,000annual limit. However, one estimate for stop loss coverage based on a recent survey published by Aegis



Yes.


Daniel Kornfeld

litman & King LLP









other party any tax- related matter addressed herein. Under these IRS rules, a taxpayer may rely on professional advice to avoid federal tax penalties only if that advice is reflectemprehensive tax opinion that conforms to stringent requirements under federal law.


---Original Message-----rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]

IBEW L1249:000031


32/32

ent: Monday, November 22, 2010 9:06 AMo: D Dafoec: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for I.B.E.W. Local 1249 Insurance Fundmportance: High

ood Morning,

am in the process of reviewing the application for I.B.E.W. Local 1249 Insurance Fund for a Waiver of the

Annual Limits Requirements of PHS Act Section 2711, and I have a few questions before I am able to complmy review.






hank you in advance for your prompt attention to this matter. We are working to get all applicationseviewed as soon as possible.


incerely,

Alexandra Botwinick

ffice of OversightHHS/OCIIO

[email protected]

Documents

IBEW Local 1249 - Redacted HWM