southeastern carpenters & millwrights - redacted bates hw
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7/27/2019 Southeastern Carpenters & Millwrights - Redacted Bates HW
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//C|/...IA%20-%20Second%20Round/Disc%203/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Waiver.htm[08/09/2011 2:22:3
rom: Donny Dowlen [donny.dowlen@southernbenefit.com]
ent: Monday, January 03, 2011 3:59 PM
o: HHS HealthInsurance (HHS)
ubject: Waiver
ttachments: 13114.pdf
ncl osed i s document at i on f or t he Sout heast ern Carpent ers and Mi l l wr i ght s Heal t h Trust .
onny Dowl enout her n Benef i t Admi ni st r at or s00- 831- 4914
r i v a cy a n d Co n f i d e n t i a l i t y N o t i c e : This message is being sent via secure SSL encryption to protect the priv
f our clients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attac
r embedded documents) is intended for the exclusive and confidential use of the individual or entity to which
as been addressed, and unless otherwise expressly indicated, is confidential and privileged information of
outhern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is
rohibited. If you receive this transmission in error, please notify us immediately by e-mail at
buse@southernbenefit.com, and delete the original message. Your cooperation is appreciated.
SE Carpenters:000001
Document obtained by CompleteColorado.com
mailto:abuse@southernbenefit.commailto:abuse@southernbenefit.com -
7/27/2019 Southeastern Carpenters & Millwrights - Redacted Bates HW
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SE Carpenters:000002
Document obtained by CompleteColorado.com
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SE Carpenters:000003
Document obtained by CompleteColorado.com
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Document obtained by CompleteColorado.com
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Pages 5 through 8 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4
SE Carpenters:000005
Document obtained by CompleteColorado.com
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//C|/...nd/Disc%203/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Request%20for%20info%201.31.11.htm[08/09/2011 2:22
rom: Moultrie, Cam (HHS/OCIIO)ent: Monday, January 31, 2011 12:32 PM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Southeastern Carpenters & Millwrights Health Trusthank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act
PHS Act) Section 2711. Please provide the following information:
I.
Please complete the entire annual limits spreadsheet available at:http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheto this email address as an attachment. We will only be able to process spreadsheets that are fully comp(i.e., every cell should contain the information requested). If a cell on the spreadsheet does not pertain tyour plan, please write None, and/or provide an explanation regarding why you are unable to completethat particular cell in a separate 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 with
grandfathering provisions, pursuant to 45 CFR 147.140?
Confirm whether your plan provides any lifetime limits.
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective and
expiration dates of the collective bargaining agreement.
n order to complete your application, please provide this information by 5:00 pm, February 3, 2011. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
his information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu
copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Monday, January 03, 2011 3:59 PMo: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeastern Carpenters and Millwrights Health Trust.
onny Dowlenouthern Benefit Administrators00-831-4914
r i v a cy a n d Co n f i d e n t i a l i t y N o t i c e : This message is being sent via secure SSL encryption to protect the priv
f our clients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attac
r embedded documents) is intended for the exclusive and confidential use of the individual or entity to which
SE Carpenters:000006
Document obtained by CompleteColorado.com
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//C|/...nd/Disc%203/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Request%20for%20info%201.31.11.htm[08/09/2011 2:22
as been addressed, and unless otherwise expressly indicated, is confidential and privileged information of
outhern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is
rohibited. If you receive this transmission in error, please notify us immediately by e-mail at
buse@southernbenefit.com, and delete the original message. Your cooperation is appreciated.
SE Carpenters:000007
Document obtained by CompleteColorado.com
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//C|/...03/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Request%20for%20info%20response%202.1.11.htm[08/09/2011 2:22
rom: Donny Dowlen [donny.dowlen@southernbenefit.com]ent: Tuesday, February 01, 2011 4:03 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
Attachments: 21117.xlsnclosed is the completed spreadsheet. Note that there is only one tier of employees covered ll employees pay the same amount for their coverage. It is therefore not necessary that we k
overage by employee, employee/child, employee/family, etc. An employee who is single pays thame as the employee with a wife and 3 children. Its the way these types of union fundsypically operate. There are no separate rates.
e have responded to your questions below. Let us know if you need anything else.
onny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]ent: Monday, January 31, 2011 11:32 AMo: Donny Dowlenc: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. Please provide the following information:
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 this eddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None,nd/or provide an explanation regarding why you are unable to complete that particular cell in a separate document
I. 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 withrandfathering provisions, pursuant to 45 CFR 147.140?
Yes as noted in the initial submission
Confirm whether your plan provides any lifetime limits.
$ as noted in the initial submission
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective andxpiration dates of the collective bargaining agreement.
Yes, expiration date 9/30/2012 as noted in the initial submissionn order to complete your application, please provide this information by 5:00 pm, February 3, 2011. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humaervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
SE Carpenters:000008
Document obtained by CompleteColorado.com
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//C|/...03/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Request%20for%20info%20response%202.1.11.htm[08/09/2011 2:22
hank you.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governm
use only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatioUnauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Monday, January 03, 2011 3:59 PM
To: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeastern Carpenters and Millwrights Health Trust.
Donny Dowlen
outhern Benefit Administrators00-831-4914
rivacy and Confidentiality Notice: This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete theriginal message. Your cooperation is appreciated.
rivacy and Confidentiality Notice: This message is being sent via secure SSL encryption to protect the privacy of our clients and to ensure compliance with HIPAA regulations.urthermore, this message (including any attached or embedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has been addresnd unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosaterial is prohibited. If you receive this transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete the original message. Your cooperappreciated.
SE Carpenters:000009
Document obtained by CompleteColorado.com
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Annual L imit
Waiver
Request
Appl icant
Name
Policy Name
(use a new
row for each
policy
application)
Appl icant
(Plan/ Policy
Situs) City
Appl icant
(Plan/
Policy
Situs) State
Plan/ Policy
Effective Date
(mm/dd/yyyy)
Contact
Name
Street
Address City
Southeastern
Carpenters
and
Millwrights
Health Trust
Southeastern
Carpenters
and
Millwrights
Health Trust Goodlettsville TN 04/01/2001
Donny
Dowlen
2001
Caldwell
Drive Goodlettsvil
Southeastern
Carpenters
and
Millwrights
Health Trust
Southeastern
Carpenters
and
Millwrights
Health Trust Goodlettsville TN 04/01/2011
Donny
Dowlen
2001
Caldwell
Drive Goodlettsvil
Southeastern
Carpenters
and
MillwrightsHealth Trust
Southeastern
Carpenters
and
MillwrightsHealth Trust Goodlettsville TN 04/01/2011
DonnyDowlen
2001
CaldwellDrive Goodlettsvil
Southeastern
Carpenters
and
Millwrights
Health Trust
Southeastern
Carpenters
and
Millwrights
Health Trust Goodlettsville TN 04/01/2011
Donny
Dowlen
2001
Caldwell
Drive Goodlettsvil
Document obtained by CompleteColorado.com
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Email
Address
Type of
Coverage (e.g.,
Limited
Benefit, HRA,
Rx only, Other)
Self-
Insured
Individual or
Group Policy
Total Number
of
Individuals
Covered by
Policy
(include all
dependents
covered)
Current Plan
Annual L imit
(in dollars) Ambulatory Emerge
donny.dowlen
@southernbe
nefit.com Limited Benefit yes Group none n
donny.dowlen
@southernbe
nefit.com Limited Benefit yes Group none n
donny.dowlen
@southernbenefit.com Limited Benefit yes Group none n
donny.dowlen
@southernbe
nefit.com Limited Benefit yes Group none n
Document obtained by CompleteColorado.com
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Laboratory Pediatric
Maternity/
Newborn
Mental Health/
Substance
Abuse
Rehabilitative/
Devices
Preventive/
Wellness Pres
none
none
none
none
nt Essential Benefits Annual Limits (Annual Limit for Each Essential Benefit)
Document obtained by CompleteColorado.com
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Copay (if
applicable
)
Coinsuranc
e (if
applicable)
Copay (if
applicable
)
Coinsura
nce (if
applicable
)
Copay (if
applicable
)
Coinsura
nce (if
applicable
)
Copay (if
applicable
)
Coinsurance
(if applicable)
Individual/
Employee
Tier*
employee
employee +
child
employee +spouse
employee +
family
Office Visit
Copays/Coinsurance
Hospital Inpatient
Copay/Coinsurance
Emergency Room
Copay/Coinsurance Rx Copay/Coninsurance
Document obtained by CompleteColorado.com
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Total
Employee
contribution
Employer
contribution Total
Employee
contribution
Employer
contribution Total
s or Premium
Renewal Monthly Premium Rates or Premium
Equivalent Rates if Waiver Granted (in
dollars)*
Projected Rate Increase that would result from c
with $750,000 Annual Limit Restric tion (in doll ars
Premium by Individual)*
Document obtained by CompleteColorado.com
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Projected Rate Increase
that would result from
compliance with $750,000
Annual L imit Restrict ion (in
dollars)(Average Premium
by Individual) (Difference
of Column AV and AS
divided by Column AS)
Decrease in
Access to
Benefits thatwould result
from
compliance
with $750,000
Annual L imit
Restriction
(describe
briefly)
Plan
Administ r
ator/ CEO
of Health
Insurance
Issuer
Name
Title of
Individual
Providing
At tes tat ion
Taft-Hartley
Plan
If Yes Taft-
Hartley then
Date
Collective
Bargaining
Agreement
Expires
Complianc
with
Grandfathe
Regulation
be forced to
eliminate the
non esential
benefits and
increase
Donny
Dowlen
Plan
Administrator yes 09/30/2012 yes
be forced to
eliminate the
non esential
benefits and
increase
Donny
Dowlen
Plan
Administrator yes 09/30/2012 yes
be forced to
eliminate the
non esential
benefits andincrease DonnyDowlen PlanAdministrator yes 09/30/2012 yes
be forced to
eliminate the
non esential
benefits and
increase
eligibility
Donny
Dowlen
Plan
Administrator yes 09/30/2012 yes
OCIIO Review
Document obtained by CompleteColorado.com
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//C|/...03/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Request%20for%20info%20response%202.3.11.htm[08/09/2011 2:22
rom: Donny Dowlen [donny.dowlen@southernbenefit.com]ent: Thursday, February 03, 2011 12:26 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trustam, please note my response to you on 2/1/11. There is only one tier of employees since theyll pay the same regardless of how many are covered in the family. Its the typical way Taftartley union plans work. It is not necessary for us to keep records broken down by tier andhis is not something we have. Please let me know if you need anything else.
onny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]ent: Thursday, February 03, 2011 10:55 AMo: Donny Dowlenc: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
lease breakdown the number of employees in each employee tier.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Wednesday, February 02, 2011 3:30 PM
To: Moultrie, Cam (HHS/OCIIO)
Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
Cam, thank you for the email. As you know, the lifetime limit must be removed before the beginning of the plan yn or after September 23, 2010. For this plan, the first plan year after September 23, 2010 is April 1, 2011. Thefetime limit will be removed by April 1, 2011 and the trustees intend to maintain the plans grandfather status. Le
me know if you need anything else regarding this application. Thank you.
Donny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]ent: Wednesday, February 02, 2011 9:48 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
ursuant to Section 2711 of the PHS Act, you may not have any lifetime limit on your plan as of September 23, 20xcept in the case of non-essential benefits that are permitted under Federal or State law. Plans that previously hadfetime limit may add an annual limit not less than the lifetime limit without affecting the grandfather status of thelan. Please confirm whether this lifetime limit will be eliminated from your plan.
SE Carpenters:000016
Document obtained by CompleteColorado.com
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//C|/...03/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Request%20for%20info%20response%202.3.11.htm[08/09/2011 2:22
hank you.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governm
use only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatioUnauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Tuesday, February 01, 2011 4:03 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
nclosed is the completed spreadsheet. Note that there is only one tier of employees covered as all employees pay ame amount for their coverage. It is therefore not necessary that we keep coverage by employee, employee/child,
mployee/family, etc. An employee who is single pays the same as the employee with a wife and 3 children. Its way these types of union funds typically operate. There are no separate rates.
We have responded to your questions below. Let us know if you need anything else.
Donny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]ent: Monday, January 31, 2011 11:32 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. Please provide the following information:
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 this eddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None,nd/or provide an explanation regarding why you are unable to complete that particular cell in a separate document
I. 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 withrandfathering provisions, pursuant to 45 CFR 147.140?
Yes as noted in the initial submission
SE Carpenters:000017
Document obtained by CompleteColorado.com
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18/37
//C|/...03/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Request%20for%20info%20response%202.3.11.htm[08/09/2011 2:22
Confirm whether your plan provides any lifetime limits.
$ as noted in the initial submission
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective andxpiration dates of the collective bargaining agreement.
Yes, expiration date 9/30/2012 as noted in the initial submissionn order to complete your application, please provide this information by 5:00 pm, February 3, 2011. Once this
nformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Monday, January 03, 2011 3:59 PM
To: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeastern Carpenters and Millwrights Health Trust.
Donny Dowlenouthern Benefit Administrators00-831-4914
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete the
riginal message. Your cooperation is appreciated.
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete theriginal message. Your cooperation is appreciated.
SE Carpenters:000018
Document obtained by CompleteColorado.com
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//C|/...03/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Request%20for%20info%20response%202.3.11.htm[08/09/2011 2:22
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete theriginal message. Your cooperation is appreciated.
rivacy and Confidentiality Notice:This message is being sent via secure SSL encryption to protect the privacy of our clients and to ensure compliance with HIPAA regulations.urthermore, this message (including any attached or embedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has been addred unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclos
aterial is prohibited. If you receive this transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete the original message. Your cooperappreciated.
SE Carpenters:000019
Document obtained by CompleteColorado.com
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//C|/...sc%203/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/LIfetime%20limits%20question%202.2.11.htm[08/09/2011 2:22
rom: Moultrie, Cam (HHS/OCIIO)ent: Wednesday, February 02, 2011 10:48 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
ursuant to Section 2711 of the PHS Act, you may not have any lifetime limit on your plan as of September 23, 20xcept in the case of non-essential benefits that are permitted under Federal or State law. Plans that previously had
fetime limit may add an annual limit not less than the lifetime limit without affecting the grandfather status of thelan. Please confirm whether this lifetime limit will be eliminated from your plan.
hank you.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
his information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu
copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Tuesday, February 01, 2011 4:03 PMo: Moultrie, Cam (HHS/OCIIO)c: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
nclosed is the completed spreadsheet. Note that there is only one tier of employees covered ll employees pay the same amount for their coverage. It is therefore not necessary that we koverage by employee, employee/child, employee/family, etc. An employee who is single pays thame as the employee with a wife and 3 children. Its the way these types of union fundsypically operate. There are no separate rates.
e have responded to your questions below. Let us know if you need anything else.
onny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]ent: Monday, January 31, 2011 11:32 AMo: Donny Dowlenc: Habit, Sandra (HHS/OCIIO)ubject: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. Please provide the following information:
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 this eddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None,nd/or provide an explanation regarding why you are unable to complete that particular cell in a separate document
I. In addition, please provide the following information:
SE Carpenters:000020
Document obtained by CompleteColorado.com
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21/37
//C|/...sc%203/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/LIfetime%20limits%20question%202.2.11.htm[08/09/2011 2:22
Confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance withrandfathering provisions, pursuant to 45 CFR 147.140?
Yes as noted in the initial submission
Confirm whether your plan provides any lifetime limits.
$ as noted in the initial submission
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective andxpiration dates of the collective bargaining agreement.
Yes, expiration date 9/30/2012 as noted in the initial submissionn order to complete your application, please provide this information by 5:00 pm, February 3, 2011. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Monday, January 03, 2011 3:59 PM
To: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeastern Carpenters and Millwrights Health Trust.
Donny Dowlenouthern Benefit Administrators00-831-4914
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy of
lients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete theriginal message. Your cooperation is appreciated.
ri vacy and Confi dentiali ty Notice:This message is being sent via secure SSL encryption to protect the privacy of our clients and to ensure
ompliance with HIPAA regulations. Furthermore, this message (including any attached or embedded documents) is intended for the exclusive
SE Carpenters:000021
Document obtained by CompleteColorado.com
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7/27/2019 Southeastern Carpenters & Millwrights - Redacted Bates HW
22/37
//C|/...sc%203/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/LIfetime%20limits%20question%202.2.11.htm[08/09/2011 2:22
onfidential use of the individual or entity to which it has been addressed, and unless otherwise expressly indicated, is confidential and privile
formation of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you
eceive this transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete the original message. You
ooperation is appreciated.
SE Carpenters:000022
Document obtained by CompleteColorado.com
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7/27/2019 Southeastern Carpenters & Millwrights - Redacted Bates HW
23/37
//C|/...theastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Lifetime%20limit%20question%20response%202.2.11.htm[08/09/2011 2:22
rom: Donny Dowlen [donny.dowlen@southernbenefit.com]ent: Wednesday, February 02, 2011 3:30 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trustam, thank you for the email. As you know, the lifetime limit must be removed before theeginning of the plan year on or after September 23, 2010. For this plan, the first plan yeafter September 23, 2010 is April 1, 2011. The lifetime limit will be removed by April 1, 20nd the trustees intend to maintain the plans grandfather status. Let me know if you neednything else regarding this application. Thank you.
onny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]ent: Wednesday, February 02, 2011 9:48 AMo: Donny Dowlenc: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
ursuant to Section 2711 of the PHS Act, you may not have any lifetime limit on your plan as of September 23, 20xcept in the case of non-essential benefits that are permitted under Federal or State law. Plans that previously had
fetime limit may add an annual limit not less than the lifetime limit without affecting the grandfather status of thelan. Please confirm whether this lifetime limit will be eliminated from your plan.
hank you.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Tuesday, February 01, 2011 4:03 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
nclosed is the completed spreadsheet. Note that there is only one tier of employees covered as all employees pay ame amount for their coverage. It is therefore not necessary that we keep coverage by employee, employee/child,mployee/family, etc. An employee who is single pays the same as the employee with a wife and 3 children. Its
way these types of union funds typically operate. There are no separate rates.
We have responded to your questions below. Let us know if you need anything else.
Donny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]ent: Monday, January 31, 2011 11:32 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
SE Carpenters:000023
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24/37
//C|/...theastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Lifetime%20limit%20question%20response%202.2.11.htm[08/09/2011 2:22
ubject: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. Please provide the following information:
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 this eddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shou
ontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None,nd/or provide an explanation regarding why you are unable to complete that particular cell in a separate document
I. 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 withrandfathering provisions, pursuant to 45 CFR 147.140?
Yes as noted in the initial submission
Confirm whether your plan provides any lifetime limits.
$ as noted in the initial submission
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective andxpiration dates of the collective bargaining agreement.
Yes, expiration date 9/30/2012 as noted in the initial submissionn order to complete your application, please provide this information by 5:00 pm, February 3, 2011. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humaervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Monday, January 03, 2011 3:59 PM
To: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeastern Carpenters and Millwrights Health Trust.
SE Carpenters:000024
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25/37
//C|/...theastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Lifetime%20limit%20question%20response%202.2.11.htm[08/09/2011 2:22
Donny Dowlenouthern Benefit Administrators00-831-4914
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete theriginal message. Your cooperation is appreciated.
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete theriginal message. Your cooperation is appreciated.
rivacy and Confidentiality Notice:This message is being sent via secure SSL encryption to protect the privacy of our clients and to ensure compliance with HIPAA regulations.urthermore, this message (including any attached or embedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has been addred unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclos
aterial is prohibited. If you receive this transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete the original message. Your cooperappreciated.
SE Carpenters:000025
Document obtained by CompleteColorado.com
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26/37
//C|/...und/Disc%203/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Request%20for%20info%202.3.11.htm[08/09/2011 2:22:
rom: Moultrie, Cam (HHS/OCIIO)ent: Thursday, February 03, 2011 11:55 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
lease breakdown the number of employees in each employee tier.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
his information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu
copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Wednesday, February 02, 2011 3:30 PMo: Moultrie, Cam (HHS/OCIIO)c: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
am, thank you for the email. As you know, the lifetime limit must be removed before theeginning of the plan year on or after September 23, 2010. For this plan, the first plan yeafter September 23, 2010 is April 1, 2011. The lifetime limit will be removed by April 1, 20nd the trustees intend to maintain the plans grandfather status. Let me know if you neednything else regarding this application. Thank you.
onny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]ent: Wednesday, February 02, 2011 9:48 AMo: Donny Dowlenc: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
ursuant to Section 2711 of the PHS Act, you may not have any lifetime limit on your plan as of September 23, 20xcept in the case of non-essential benefits that are permitted under Federal or State law. Plans that previously hadfetime limit may add an annual limit not less than the lifetime limit without affecting the grandfather status of thelan. Please confirm whether this lifetime limit will be eliminated from your plan.
hank you.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Tuesday, February 01, 2011 4:03 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
SE Carpenters:000026
Document obtained by CompleteColorado.com
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27/37
//C|/...und/Disc%203/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Request%20for%20info%202.3.11.htm[08/09/2011 2:22:
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
nclosed is the completed spreadsheet. Note that there is only one tier of employees covered as all employees pay ame amount for their coverage. It is therefore not necessary that we keep coverage by employee, employee/child,mployee/family, etc. An employee who is single pays the same as the employee with a wife and 3 children. Its
way these types of union funds typically operate. There are no separate rates.
We have responded to your questions below. Let us know if you need anything else.
Donny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]ent: Monday, January 31, 2011 11:32 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. Please provide the following information:
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 this eddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None,nd/or provide an explanation regarding why you are unable to complete that particular cell in a separate document
I. 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 withrandfathering provisions, pursuant to 45 CFR 147.140?
Yes as noted in the initial submission
Confirm whether your plan provides any lifetime limits.
$ as noted in the initial submission
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective and
xpiration dates of the collective bargaining agreement.
Yes, expiration date 9/30/2012 as noted in the initial submissionn order to complete your application, please provide this information by 5:00 pm, February 3, 2011. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humaervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you.
SE Carpenters:000027
Document obtained by CompleteColorado.com
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28/37
//C|/...und/Disc%203/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Request%20for%20info%202.3.11.htm[08/09/2011 2:22:
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Monday, January 03, 2011 3:59 PM
To: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeastern Carpenters and Millwrights Health Trust.
Donny Dowlenouthern Benefit Administrators00-831-4914
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete theriginal message. Your cooperation is appreciated.
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy of
lients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete theriginal message. Your cooperation is appreciated.
ri vacy and Confi dentiali ty Notice:This message is being sent via secure SSL encryption to protect the privacy of our clients and to ensure
ompliance with HIPAA regulations. Furthermore, this message (including any attached or embedded documents) is intended for the exclusive
onfidential use of the individual or entity to which it has been addressed, and unless otherwise expressly indicated, is confidential and privile
formation of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you
eceive this transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete the original message. You
ooperation is appreciated.
SE Carpenters:000028
Document obtained by CompleteColorado.com
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29/37
//C|/...cond%20Round/Disc%203/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Completion%202.3.11.htm[08/09/2011 2:22:
rom: Moultrie, Cam (HHS/OCIIO)ent: Thursday, February 03, 2011 1:12 PM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
hank you for your information. Your application is now complete and you will receive a determination of yourpplication within 30 days.
hank you.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
his information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu
copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Thursday, February 03, 2011 12:26 PMo: Moultrie, Cam (HHS/OCIIO)c: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
am, please note my response to you on 2/1/11. There is only one tier of employees since theyll pay the same regardless of how many are covered in the family. Its the typical way Taftartley union plans work. It is not necessary for us to keep records broken down by tier andhis is not something we have. Please let me know if you need anything else.
onny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]
ent: Thursday, February 03, 2011 10:55 AMo: Donny Dowlenc: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
lease breakdown the number of employees in each employee tier.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:This information has not been publicly disclosed and may be privileged and confidential. It is for internal governm
use only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatioUnauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Wednesday, February 02, 2011 3:30 PM
To: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
SE Carpenters:000029
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30/37
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Cam, thank you for the email. As you know, the lifetime limit must be removed before the beginning of the plan yn or after September 23, 2010. For this plan, the first plan year after September 23, 2010 is April 1, 2011. Thefetime limit will be removed by April 1, 2011 and the trustees intend to maintain the plans grandfather status. Le
me know if you need anything else regarding this application. Thank you.
Donny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]
ent: Wednesday, February 02, 2011 9:48 AMTo: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
ursuant to Section 2711 of the PHS Act, you may not have any lifetime limit on your plan as of September 23, 20xcept in the case of non-essential benefits that are permitted under Federal or State law. Plans that previously hadfetime limit may add an annual limit not less than the lifetime limit without affecting the grandfather status of thelan. Please confirm whether this lifetime limit will be eliminated from your plan.
hank you.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Tuesday, February 01, 2011 4:03 PMTo: Moultrie, Cam (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
nclosed is the completed spreadsheet. Note that there is only one tier of employees covered as all employees pay ame amount for their coverage. It is therefore not necessary that we keep coverage by employee, employee/child,mployee/family, etc. An employee who is single pays the same as the employee with a wife and 3 children. Its
way these types of union funds typically operate. There are no separate rates.
We have responded to your questions below. Let us know if you need anything else.
Donny Dowlen
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]ent: Monday, January 31, 2011 11:32 AM
To: Donny DowlenCc: Habit, Sandra (HHS/OCIIO)
ubject: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act
SE Carpenters:000030
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31/37
//C|/...cond%20Round/Disc%203/Southeastern%20Carpenters%20and%20Millwrights%20Health%20Trust/Completion%202.3.11.htm[08/09/2011 2:22:
PHS Act) Section 2711. Please provide the following information:
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 this eddress as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell shouontain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None,nd/or provide an explanation regarding why you are unable to complete that particular cell in a separate document
I. 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 withrandfathering provisions, pursuant to 45 CFR 147.140?
Yes as noted in the initial submission
Confirm whether your plan provides any lifetime limits.
$ as noted in the initial submission
Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective andxpiration dates of the collective bargaining agreement.
Yes, expiration date 9/30/2012 as noted in the initial submissionn order to complete your application, please provide this information by 5:00 pm, February 3, 2011. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humaervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi
hank you.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
rom: Donny Dowlen [mailto:donny.dowlen@southernbenefit.com]ent: Monday, January 03, 2011 3:59 PM
To: HHS HealthInsurance (HHS)ubject: Waiver
nclosed is documentation for the Southeastern Carpenters and Millwrights Health Trust.
Donny Dowlenouthern Benefit Administrators00-831-4914
SE Carpenters:000031
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32/37
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Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete theriginal message. Your cooperation is appreciated.
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete theriginal message. Your cooperation is appreciated.
Privacy and Confidential ity Notice:This message is being sent via secure SSL encryption to protect the privacy oflients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attached ormbedded documents) is intended for the exclusive and confidential use of the individual or entity to which it has bddressed, and unless otherwise expressly indicated, is confidential and privileged information of Southern Benefit
Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you receivhis transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete theriginal message. Your cooperation is appreciated.
ri vacy and Confi dentiali ty Notice:This message is being sent via secure SSL encryption to protect the privacy of our clients and to ensureompliance with HIPAA regulations. Furthermore, this message (including any attached or embedded documents) is intended for the exclusive
onfidential use of the individual or entity to which it has been addressed, and unless otherwise expressly indicated, is confidential and privile
formation of Southern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is prohibited. If you
eceive this transmission in error, please notify us immediately by e-mail at abuse@southernbenefit.com, and delete the original message. You
ooperation is appreciated.
SE Carpenters:000032
Document obtained by CompleteColorado.com
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//C|/...20Health%20Trust/Waiver%20Application%20for%20Southeastern%20Carpenters%20%20Millwrights%20Health%20Trust.htm[08/09/2011 2:22
rom: Moultrie, Cam (HHS/OCIIO)
ent: Monday, February 14, 2011 11:17 AM
o: 'Donny Dowlen'
ubject: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
ttachments: April 1 Approval .pdf
ood Morning,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711
outheastern Carpenters & Millwrights Health Trust. HHS has reviewed your application and made its determination.
lease see the attached letter.
he attached letter refers to the following plans:
Southeastern Carpenters & Millwrights Health Trust
lease confirm receipt of this letter by replying to this e-mail.
lease let me know if I can be of further assistance.
am Lynne Moultrie
ivision of Oversight
enter for Consumer Information and Insurance Oversight
.S. Department of Health & Human Services
01.492.4174
am.moultrie@hhs.gov
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
his information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu
copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
SE Carpenters:000033
Document obtained by CompleteColorado.com
mailto:cam.moultrie@hhs.govmailto:cam.moultrie@hhs.gov -
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//C|/...h%20Trust/RE%20Waiver%20Application%20for%20Southeastern%20Carpenters%20%20Millwrights%20Health%20Trust.htm[08/09/2011 2:22
rom: Donny Dowlen [donny.dowlen@southernbenefit.com]
ent: Monday, February 14, 2011 3:39 PM
o: Moultrie, Cam (HHS/OCIIO)
ubject: RE: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
eceipt confirmed.
rom: Moultrie, Cam (HHS/OCIIO) [mailto:Cam.Moultrie@hhs.gov]ent: Monday, February 14, 2011 10:17 AMo: Donny Dowlenubject: Waiver Application for Southeastern Carpenters & Millwrights Health Trust
Good Morning,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2orSoutheastern Carpenters & Millwrights Health Trust. HHS has reviewed your application and made itsetermination. Please see the attached letter.
he attached letter refers to the following plans:
Southeastern Carpenters & Millwrights Health Trust
lease confirm receipt of this letter by replying to this e-mail.
lease let me know if I can be of further assistance.
Cam Lynne Moultrie
Division of OversightCenter for Consumer Information and Insurance OversightU.S. Department of Health & Human Services01.492.4174am.moultrie@hhs.gov
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:
This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the informatio
Unauthorized disclosure may result in prosecution to the full extent of the law.
r i v a cy a n d Co n f i d e n t i a l i t y N o t i c e : This message is being sent via secure SSL encryption to protect the priv
f our clients and to ensure compliance with HIPAA regulations. Furthermore, this message (including any attac
r embedded documents) is intended for the exclusive and confidential use of the individual or entity to which
as been addressed, and unless otherwise expressly indicated, is confidential and privileged information of
outhern Benefit Administrators, Inc. Any dissemination, distribution or copying of the enclosed material is
rohibited. If you receive this transmission in error, please notify us immediately by e-mail at
SE Carpenters:000034
Document obtained by CompleteColorado.com
mailto:[mailto:Cam.Moultrie@hhs.gov]mailto:cam.moultrie@hhs.govmailto:cam.moultrie@hhs.govmailto:[mailto:Cam.Moultrie@hhs.gov] -
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//C|/...h%20Trust/RE%20Waiver%20Application%20for%20Southeastern%20Carpenters%20%20Millwrights%20Health%20Trust.htm[08/09/2011 2:22
buse@southernbenefit.com, and delete the original message. Your cooperation is appreciated.
SE Carpenters:000035
Document obtained by CompleteColorado.com
mailto:abuse@southernbenefit.commailto:abuse@southernbenefit.com -
7/27/2019 Southeastern Carpenters & Millwrights - Redacted Bates HW
36/37
SE Carpenters:000036
Document obtained by CompleteColorado.com
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Document obtained by CompleteColorado.com
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