essex nysarc - redacted hwm
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//T|/...ng%20Team/Jean/Essex%20County%20Chapter%20NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Waiver.htm[12/21/2011 12:58:
rom: Kristie Watrous [[email protected]]ent: Wednesday, November 17, 2010 4:03 PM
To: HHS HealthInsurance (HHS)ubject: Waiver
ollow Up Flag: Follow uplag Status: Red
Attachments: Mntn Lake Srvc Standalone HRA 1-1-10_SIGNED.pdf; SMM - Standalone HRA.pdf;CAN5003_000.pdfAttached is Mountain Lake Services Waiver Application Letter with attachments. Please contact office with any questions. Thank you.
Kristie WatrousHuman Resources Specialist546-7721
ESSEX NYSARC:000001
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Pages 3 through 18 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4
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//T|/...pter%20NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Request%20for%20additional%20info%2011.24.10.htm[12/21/2011 12:58
rom: Habit, Sandra (HHS/OCIIO)ent: Wednesday, November 24, 2010 11:21 AM
To: '[email protected]'ubject: Waiver Application - Mountain Lake Services
Mr. Nephew,
hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section
711. In order to complete your application, please provide the following information regarding Mountain
ake Services:
1. Indicate the annual limit of the HRA.
2. Is this a self or fully insured policy?
3. Is this a group or individual policy?
4. Can you provide COBRA equivalent rates for the following chart:
(The premium amounts is the total cost to the employer and the employee)
Premium(current level)
Premium(renewal)
Premium(if $750,000
annual limit wasapplied)
% increase if the$750,000 was
implemented
EE
EE + Child (ifapplicable or otherappropriate tier)
EE + Spouse (ifapplicable or otherappropriate tier)
Family (ifapplicable or otherappropriate tier)
If you have any questions, please feel free to contact me. Have a good holiday!
Thank you,
Sandy
andra Habit
uality Analyst
ffice of Consumer Information and Insurance Oversight
01-492-4175
NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly
sclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu
r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full eESSEX NYSARC:000004
mailto:[email protected]:[email protected] -
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//T|/...pter%20NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Request%20for%20additional%20info%2011.24.10.htm[12/21/2011 12:58
f the law.
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//T|/...hapter%20NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Request%20for%20info%20response%2012.1.10.htm[12/21/2011 12:58:
rom: Marty Nephew [[email protected]]ent: Wednesday, December 01, 2010 2:11 PM
To: Habit, Sandra (HHS/OCIIO)Cc: Patricia Allen
ubject: RE: Waiver Application - Mountain Lake ServicesMs. Habit,
lease see responses below and let me know should you have any questions.
hank you,
Martin J. Nephewxecutive Director
Mountain Lake Services0 St. Patrick's Place
ort Henry, NY 12974
hone: (518)546-3381 x51ax: (518)546-7138
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, November 24, 2010 11:21 AMo: Marty Nephewubject: Waiver Application - Mountain Lake Services
Mr. Nephew,
hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section711. In order to complete your application, please provide the following information regarding Mountain
ake Services:
1. Indicate the annual limit of the HRA. B n SPD for 2011 Annual Contributi punused funds rolled from prior years. mum projected account rollover is $ emaximum projected benefit would be $ .
2. Is this a self or fully insured policy? Se 3. Is this a group or individual policy? Gr 4. Can you provide COBRA equivalent rates for the following chart:
(The premium amounts is the total cost to the employer and the employee)
Premium(current level)
Premium(renewal)
Premium(if $750,000annual limit was
% increase if the$750,000 wasimplemented
EE
ESSEX NYSARC:000006
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//T|/...hapter%20NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Request%20for%20info%20response%2012.1.10.htm[12/21/2011 12:58:
EE + Child (ifapplicable or otherappropriate tier)
EE + Spouse (ifapplicable or otherappropriate tier)
Family (ifapplicable or other
appropriate tier)
If you have any questions, please feel free to contact me. Have a good holiday!
Thank you,
Sandy
andra Habit
uality Analyst
ffice of Consumer Information and Insurance Oversight01-492-4175
NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly
sclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu
r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full e
f the law.
ESSEX NYSARC:000007
mailto:[email protected]:[email protected] -
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//T|/...hapter%20NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Request%20for%20info%20response%2012.3.10.htm[12/21/2011 12:58:
rom: Marty Nephew [[email protected]]ent: Friday, December 03, 2010 7:17 AM
To: Habit, Sandra (HHS/OCIIO)ubject: RE: Waiver Application - Mountain Lake Servicesandy,
This plan does comply with grandfathered regulations.
hanks,
Martin J. Nephewxecutive Director
Mountain Lake Services0 St. Patrick's Place
ort Henry, NY 12974
hone: (518)546-3381 x51ax: (518)546-7138
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, December 01, 2010 2:17 PMo: Marty Nephewc: Patricia Allenubject: RE: Waiver Application - Mountain Lake Services
Mr. Nephew,
hank you for your response. I have one last question for you and then I should be finished reviewing your application. Is this
an complying with grandfathered regulations or in effect prior to March 23, 2010?
andy
rom: Marty Nephew [mailto:[email protected]]ent: Wednesday, December 01, 2010 2:11 PMo: Habit, Sandra (HHS/OCIIO)c: Patricia Allenubject: RE: Waiver Application - Mountain Lake Services
Ms. Habit,
lease see responses below and let me know should you have any questions.
hank you,
Martin J. Nephewxecutive Director
ESSEX NYSARC:000008
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//T|/...hapter%20NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Request%20for%20info%20response%2012.3.10.htm[12/21/2011 12:58:
Mountain Lake Services
0 St. Patrick's Placeort Henry, NY 12974
hone: (518)546-3381 x51ax: (518)546-7138
rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, November 24, 2010 11:21 AM
o: Marty Nephewubject: Waiver Application - Mountain Lake Services
Mr. Nephew,
hank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section
711. In order to complete your application, please provide the following information regarding Mountain
ake Services:
1. Indicate the annual limit of the HRA. B n SPD for 2011 Annual Contributi punused funds rolled from prior years. mum projected account rollover is $ emaximum projected benefit would be $ .
2. Is this a self or fully insured policy? Se 3. Is this a group or individual policy? Gr 4. Can you provide COBRA equivalent rates for the following chart:
(The premium amounts is the total cost to the employer and the employee)
Premium(current level)
Premium(renewal)
Premium(if $750,000annual limit was
% increase if the$750,000 wasimplemented
EE
EE + Child (ifapplicable or otherappropriate tier)
EE + Spouse (ifapplicable or otherappropriate tier)
Family (ifapplicable or otherappropriate tier)
If you have any questions, please feel free to contact me. Have a good holiday!
Thank you,
Sandy
ESSEX NYSARC:000009
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//T|/...hapter%20NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Request%20for%20info%20response%2012.3.10.htm[12/21/2011 12:58:
andra Habit
uality Analyst
ffice of Consumer Information and Insurance Oversight
01-492-4175
NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publiclysclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu
r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full e
f the law.
ESSEX NYSARC:000010
mailto:[email protected]:[email protected] -
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//T|/...NYSARC,%20Inc.%20dba%20Moutain%20Lake%20Services/Mountain%20Lake%20Services%20approval%2012_14_10.htm[12/21/2011 12:58
rom: Botwinick, Alexandra (HHS/OCIIO)ent: Tuesday, December 14, 2010 12:14 PM
To: '[email protected]'ubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711
mportance: High
ollow Up Flag: Follow up
lag Status: Red
Attachments: Updated Jan 1 Approval Letter .pdf
ood Afternoon,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act
ection 2711 forMountain Lake Services. HHS has reviewed your application and made its determinationlease see the attached letter.
lease confirm receipt of this letter by replying to this e-mail.
lease let me know if I can be of further assistance.
incerely,
Alexandra Botwinick
ffice of Oversight
ESSEX NYSARC:000011
mailto:[email protected]:[email protected] -
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rom: Marty Nephew [[email protected]]ent: Tuesday, December 14, 2010 1:13 PM
To: Botwinick, Alexandra (HHS/OCIIO)ubject: RE: Waiver of the Annual Limits Requirements of PHS Act Section 2711eceived on 12/12/2010.
hank you,
Martin J. Nephewxecutive Director
Mountain Lake Services
0 St. Patrick's Placeort Henry, NY 12974
hone: (518)546-3381 x51
ax: (518)546-7138
rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, December 14, 2010 12:14 PMo: Marty Nephewubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High
ood Afternoon,
hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act
ection 2711 forMountain Lake Services.
HHS has reviewed your application and made its determinationlease see the attached letter.
lease confirm receipt of this letter by replying to this e-mail.
lease let me know if I can be of further assistance.
incerely,
Alexandra Botwinick
ffice of Oversight
ESSEX NYSARC:000012
mailto:[email protected]:[email protected]