From: Gregory A. Storm [gstorm@reinhartlaw.

com] Sent: Tuesday, October 12, 2010 5:02 PM To: HHS HealthInsurance (HHS) Subject: Waiver Attachments: waiver.PDF
Dear Mr. Mayhew -

On behalf of the United Food and Commercial Workers Union Local 1995 and Employers Health and Welfare Fund ("Fund"), we attach a request for a waiver of the restricted annual benefit limit requirement with respect to the benefit programs described in the attachment.

Greg Storm Gregory A. Storm

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file:////co-adshare/...orce/CCIIO%20Waivers%20-%20Torres/DFOI%20Processing%20Team/Mike/UFCW%20Local%201995/Waiver.htm[11/15/2011 10:37:09 AM]

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Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

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If you have any questions regarding the waiver application, please do not hesitate to contact the Fund's legal counsel,Tom Funk, Bill Tobin or the undersigned, at 414-298-1000.

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From: Gregory A. Storm [gstorm@reinhartlaw.com] Sent: Wednesday, October 13, 2010 2:24 PM To: HHS HealthInsurance (HHS) Subject: FW: Waiver Attachments: waiver.PDF
Dear Sir or Madam --

Yesterday, we submitted the attached waiver application on behalf of the plan referenced below. Although we provided our firm's contact information, we inadvertently omitted the contact information for the plan itself. That information follows: United Food and Commercial Workers Union Local 1995 and Employers Health and Welfare Fund c/o Dennis Nast, Administrator 1800 Phoenix Boulevard, Suite 310 Atlanta, Georgia 30349-9834

Again, we would ask that any inquiries regarding the application be directed to our office, as legal counsel for the Fund. Please contact any of the following individuals with questions: Tom Funk (direct line - 414-298-8109), Bill Tobin (414-298-8279) or Greg Storm (414-298-8147). We apologize for any confusion, and thank you for incorporating this information into the Fund's submission.

Greg Storm Gregory A. Storm

Dear Mr. Mayhew -

On behalf of the United Food and Commercial Workers Union Local 1995 and Employers Health and Welfare Fund ("Fund"), we attach a request for a waiver of the restricted annual benefit limit requirement with respect to the benefit programs described in the attachment.

If you have any questions regarding the waiver application, please do not hesitate to contact the Fund's legal counsel,Tom Funk, Bill Tobin or the undersigned, at 414-298-1000. Greg Storm Gregory A. Storm

Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com
UFCW L1995:000013

file:////co-adshare/...IIO%20Waivers%20-%20Torres/DFOI%20Processing%20Team/Mike/UFCW%20Local%201995/FW%20Waiver.htm[11/15/2011 10:37:11 AM]

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From: Gregory A. Storm Sent: Tuesday, October 12, 2010 4:02 PM To: 'healthinsurance@hhs.gov' Subject: Waiver

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Reinhart Boerner Van Deuren s.c. 1000 North Water Street, Suite 1700 | Milwaukee, WI 53202 Office: 414-298-8147 | Fax: 414-298-8097 gstorm@reinhartlaw.com | bio | vCard | reinhartlaw.com

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file:////co-adshare/...IIO%20Waivers%20-%20Torres/DFOI%20Processing%20Team/Mike/UFCW%20Local%201995/FW%20Waiver.htm[11/15/2011 10:37:11 AM]

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From: Pham, Erica (HHS/OCIIO) Sent: Wednesday, October 27, 2010 3:05 PM To: 'Gregory A. Storm' Cc: Habit, Sandra (HHS/OCIIO) Subject: UFCW Local 1995 Application for a Waiver Dear Applicant: Thank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section 2711. In order to complete your application, please provide the following information: Please provide the current monthly premium rates and the projected monthly premium rates applicable to the3 plans if the plans were to comply with the restricted annual benefits. In other words, we would like a chart that reflects the following information: 2009 November 2010 November 2010 November Premium (current Premium (renewal) Premium (if $750,000 level) annual limit was applied) EE EE + Child (if applicable or other appropriate tier) EE + Spouse (if applicable or other appropriate tier) Family (if applicable or other appropriate tier) Please confirm that the retiree plan has less than two active participants enrolled onto the plan. In order to complete your application, please provide this information as soon as possible. We look forward to receiving your completed application. Thank you.
Erica Pham Division of Enforcement Office of Oversight OCIIO/HHS 301-492-4108 erica.pham@hhs.gov

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From: Botwinick, Alexandra (HHS/OCIIO) Sent: Friday, October 29, 2010 3:07 PM To: 'gstorm@reinhartlaw.com' Subject: Waiver of the Annual Limits Requirements of PHS Act Section 2711 Importance: High Attachments: November Approval Letter .pdf Mr. Storm, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for UFCW Local 1995. 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,

alexandra.botwinick@hhs.gov

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Alexandra Botwinick Office of Oversight HHS/OCIIO

file:////co-adshare/...res/DFOI%20Processing%20Team/Mike/UFCW%20Local%201995/Approval%20Letter%20Sent%2010-29-2010.htm[11/15/2011 10:37:12 AM]

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From: Gregory A. Storm [gstorm@reinhartlaw.com] Sent: Wednesday, November 03, 2010 9:46 AM To: Botwinick, Alexandra (HHS/OCIIO) Cc: OCIIO Oversight Subject: RE: Waiver of the Annual Limits Requirements of PHS Act Section 2711 Follow Up Flag: Follow up Flag Status: Red

I am writing to confirm receipt of this email. Thank you for your help and prompt review.

alexandra.botwinick@hhs.gov

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Mr. Storm, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for UFCW Local 1995. 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,

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From: Botwinick, Alexandra (HHS/OCIIO) [mailto:Alexandra.Botwinick@hhs.gov] Sent: Friday, October 29, 2010 2:07 PM To: Gregory A. Storm Subject: Waiver of the Annual Limits Requirements of PHS Act Section 2711 Importance: High

UFCW L1995:000019