united benefit fund - combined redacted-bates hwm

7/27/2019 United Benefit Fund - Combined Redacted-Bates HWM

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//T|/...20[YELLOW]/United%20Benefit%20Fund/United%20Benefit%20Fund%20waiver%20application%20Dec%2013%202010.htm[07/14/2011 3:29:2

rom: Ledford, Amanda (HHS/OCIIO)

ent: Monday, December 13, 2010 2:17 PM

o: '[email protected]'

c: Sheer, Jennifer (HHS/OCIIO)

ubject: United Benefit Fund waiver application

ttachments: Waiver Application Form.xls

Dear Applicant:

hank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service ActPHS Act) Section 2711. In order to expedite your application, please provide the following information:

I. Please complete the entire annual limits spreadsheet, [attached to the email] [and available at:http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html]. Please return the completed spreadshto 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 completthat particular cell in a separate document.

II. In addition, please provide the following information:

III.

Confirm whether the plan was in existence prior to March 23, 2010. If so, is the plan in compliance withgrandfathering 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 the PHAct, you may not have any lifetime limit on your plan as of September 23, 2010, except in the case of non-essential benefits that are permitted under Federal or State law. Plans that previously had a lifetime limit madd an annual limit not less than the lifetime limit without affecting the grandfather status of the plan. Plea

confirm whether this lifetime limit will be eliminated from your plan.

Confirm whether the plan was created pursuant to the Taft-Hartley Act.

n order to complete your application, please provide this information by 5:00 pm, December 14, 2010. 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.

manda R. Ledford, J.D.

.S. Department of Health and Human Services

ffice of Consumer Information and Insurance Oversight

301) 492-4260

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, distrib

or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

UBenefit:000001
http://www.hhs.gov/ociio/regulations/annual_limit_waivers.htmlhttp://www.hhs.gov/ociio/regulations/annual_limit_waivers.html


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//T|/...nefit%20Fund/Spreadsheet%20deadline%20United%20Benefit%20Fund%20waiver%20application%20Dec%2014%202010.htm[07/14/2011 3:29


ent: Tuesday, December 14, 2010 12:02 PM

o: '[email protected]'; '[email protected]'

c: Sheer, Jennifer (HHS/OCIIO)

ubject: Waiver application

ello,

apologize for the trouble in emailing me. As we have discussed, please return the completed spreadsheet to me by Friday,

ecember 17.

hank you so much,

manda R. Ledford, J.D.

.S. Department of Health and Human Services

ffice of Consumer Information and Insurance Oversight

301) 492-4260

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, distrib

or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

UBenefit:000002


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//T|/...OW]/United%20Benefit%20Fund/Reply%20United%20Benefit%20Fund%20waiver%20application%20Dec%2017%202010.htm[07/14/2011 3:29


ent: Friday, December 17, 2010 2:36 PM

o: Sheer, Jennifer (HHS/OCIIO)

ubject: FW: United Benefit Fund waiver application

ttachments: UBF-waiver application spreadsheet.12.17.10.xls

rom: Michelle Berman [mailto:[email protected]]ent: Friday, December 17, 2010 11:30 AMo: Ledford, Amanda (HHS/OCIIO)c:[email protected]: United Benefit Fund waiver application

ear Ms. Ledford:

On behalf of the United Benefit Fund (Fund), please find attached to this email the annual limits spreadsheet fo

he Funds thirteen (13) plans. We note that the dollar amounts listed in column AC of the spreadsheet reflect

ays for In-Network providers.

n response to your additional questions, please note the following:

1) All thirteen (13) plans were in existence prior to March 23, 2010, and are in compliance with the

grandfathering provisions, pursuant to 45 CFR 147.140.

2) Any lifetime limits that do not comply with the applicable federal and/or state laws will be eliminated fro

the plans.

3) The Fund was created pursuant to the Taft-Hartley Act.

you have any questions or require additional information, please do not hesitate to contact the undersigned.

lease provide confirmation of receipt of this email and the attachment.

hank you,

bigail R. Levy

bigail R. Levy, Esq.

orlick, Kravitz & Listhaus, PC

7 State Street, 4th Floor

ew York, NY 10004212) 269-2500

UBenefit:000003
mailto:[mailto:[email protected]]mailto:[mailto:[email protected]]mailto:[email protected]:[email protected]:[mailto:[email protected]]


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//T|/...firm%20Receipt%20of%20Reply%20to%20United%20Benefit%20Fund%20waiver%20application%20Dec%2017%202010.htm[07/14/2011 3:29


ent: Friday, December 17, 2010 11:54 AM

o: 'Michelle Berman'

c: '[email protected]'; Sheer, Jennifer (HHS/OCIIO)

ubject: RE: United Benefit Fund waiver application

bigail,

ust wanted to let you know that I have received your email with the spreadsheet attachment.

hank you,

manda Ledford

rom: Michelle Berman [mailto:[email protected]]ent: Friday, December 17, 2010 11:30 AMo: Ledford, Amanda (HHS/OCIIO)c:[email protected]: United Benefit Fund waiver application

ear Ms. Ledford:

On behalf of the United Benefit Fund (Fund), please find attached to this email the annual limits spreadsheet fo

he Funds thirteen (13) plans. We note that the dollar amounts listed in column AC of the spreadsheet reflect

ays for In-Network providers.

n response to your additional questions, please note the following:

1) All thirteen (13) plans were in existence prior to March 23, 2010, and are in compliance with the

grandfathering provisions, pursuant to 45 CFR 147.140.2) Any lifetime limits that do not comply with the applicable federal and/or state laws will be eliminated fro

the plans.

3) The Fund was created pursuant to the Taft-Hartley Act.

you have any questions or require additional information, please do not hesitate to contact the undersigned.

lease provide confirmation of receipt of this email and the attachment.

hank you,

bigail R. Levy

bigail R. Levy, Esq.



ew York, NY 10004

212) 269-2500

UBenefit:000004
mailto:[mailto:[email protected]]mailto:[mailto:[email protected]]mailto:[email protected]:[email protected]:[mailto:[email protected]]


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//T|/...W/Applications%20with%20NO%2012600%20Response%20[YELLOW]/United%20Benefit%20Fund/Approval%201.12.11.htm[07/14/2011 3:29

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, January 12, 2011 11:18 AM

To: '[email protected]'Cc: Habit, Sandra (HHS/OCIIO)ubject: United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

mportance: High

Attachments: Updated Jan 1 Approval Letter .pdfood Morning,

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

ection 2711 forUnited Benefit Fund. HHS has reviewed your application and made its determination. Plea

ee 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

HHS/[email protected]

UBenefit:000007
mailto:[email protected]:[email protected]


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//T|/...ions%20with%20NO%2012600%20Response%20[YELLOW]/United%20Benefit%20Fund/Approval%20receipt%201.12.11.htm[07/14/2011 3:29

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, January 12, 2011 1:36 PM

To: Habit, Sandra (HHS/OCIIO)ubject: FW: United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

Alexandra Botwinick

ffice of OversightHHS/OCIIO

301) [email protected]

rom: David Delucia [mailto:[email protected]]ent: Wednesday, January 12, 2011 11:23 AMo: Botwinick, Alexandra (HHS/OCIIO)ubject: RE: United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

hank you for your reply

your office needs anything from ubf please send directly to my attention

hanks

AVID DELUCIA

DMINISTRATOR

NITED BENEFIT FUND

[email protected]

rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, January 12, 2011 11:18 AMo: David Deluciac: Habit, Sandra (HHS/OCIIO)ubject: United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High

ood Morning,

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

ection 2711 forUnited Benefit Fund. HHS has reviewed your application and made its determination. Plea

ee the attached letter.



UBenefit:000008


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//T|/...ions%20with%20NO%2012600%20Response%20[YELLOW]/United%20Benefit%20Fund/Approval%20receipt%201.12.11.htm[07/14/2011 3:29

incerely,

Alexandra Botwinick

ffice of Oversight


UBenefit:000009


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//T|/...ns%20with%20NO%2012600%20Response%20[YELLOW]/United%20Benefit%20Fund/Possible%20oversight%201.19.11.htm[07/14/2011 3:29


To: Habit, Sandra (HHS/OCIIO)ubject: FW: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section711

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO


rom: Michelle Berman [mailto:[email protected]]ent: Wednesday, January 19, 2011 9:41 AMo: Botwinick, Alexandra (HHS/OCIIO)

ubject: Re: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

Dear Ms. Botwinick,

hank you for getting back to me. Yes, I am certain that there were 13 applicationsubmitted. It looks like Cambridge E is missing from your list below. I know that it was sn initially and it is on our spreadsheet. Maybe it was an oversight?

f you could confirm that it is approved that would be great, if not please advise how wehould proceed.

hank you for your help!

Michelle

rom: "Botwinick, Alexandra (HHS/OCIIO)" o: Michelle Berman c: "Habit, Sandra (HHS/OCIIO)" ent: Wed, January 19, 2011 8:28:53 AMubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

Ms. Berman,

apologize for the confusion. The approval applies to the following plans: MB Foods #3, MB Foods #4, Building Maintenance 2

uilding Maintenance 1, Basic, Apollo, Cambridge B, Cambridge C, Cambridge , Sterling , Universal B, and Universal.

only have on a record 12 plans. Are you certain that there are 13?

Alexandra Botwinick

ffice of OversightUBenefit:000010


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//T|/...ns%20with%20NO%2012600%20Response%20[YELLOW]/United%20Benefit%20Fund/Possible%20oversight%201.19.11.htm[07/14/2011 3:29


rom: Michelle Berman [mailto:[email protected]]ent: Tuesday, January 18, 2011 4:47 PMo: Botwinick, Alexandra (HHS/OCIIO)ubject: United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

Dear Ms. Botwinick,

Our firm is counsel the United Benefit Fund and we submitted the application for waiver to your office on its behaWe are writing regarding the approval letter sent to Mr. Deluccia on January 12, 2011. We would like to confirm the letter approves all thirteen applications we filed on behalf of the United Benefit Fund.

hank you in advance for your assistance in this matter.

Michelle Bermanaralegal

Michelle Berman, Paralegal



ew York, New York 10004

212) 269-2500

212) 269-2540 (fax)

OTICE: The information contained in this electronic mail and any attachments is intended for the exclusive use of the

ddressee(s) and may contain confidential, privileged, and/or proprietary information. Any other use of these materials is strictly

rohibited. If you have received these materials in error, please notify me immediately by telephone and destroy all electronic,

aper or other versions. No representation is made by the sender that any e-mails and/or attachments are virus free, and are u

t the intended recipient's sole risk. Unauthorized interception of this e-mail is a violation of federal criminal law.

UBenefit:000011


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//T|/...s%20with%20NO%2012600%20Response%20[YELLOW]/United%20Benefit%20Fund/Request%20for%20info%201.19.11.htm[07/14/2011 3:29


To: Habit, Sandra (HHS/OCIIO)ubject: FW: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section711

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO


rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, January 19, 2011 1:47 PMo: Mercer, Joseph (HHS/OCIIO)

ubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

hanks Joe. Erica cut it off when she sent me the list.

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO


rom: Mercer, Joseph (HHS/OCIIO)ent: Wednesday, January 19, 2011 1:39 PMo: Botwinick, Alexandra (HHS/OCIIO)ubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

know that the spread sheet I forwarded along had Cambridge E on it, and I believe that it should have been approved, as it w

bout a 14 % increase.

have attached the doc I sent out.

hanks!

oe

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Wednesday, January 19, 2011 10:14 AMo: Mercer, Joseph (HHS/OCIIO)ubject: FW: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

ey Joe,

UBenefit:000012
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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think the below plan is yours United Benefit Fund. I sent them an approval letter and they wanted to confirm it was for all 13

ans. I only saw 12 on the spreadsheet that Erica gave me. They are listed below. Evidently we are missing the plan called

ambridge Edo you have that plan under this application? Thanks!

Alexandra Botwinick

ffice of Oversight

HHS/OCIIO


rom: Michelle Berman [mailto:[email protected]]ent: Wednesday, January 19, 2011 9:41 AMo: Botwinick, Alexandra (HHS/OCIIO)ubject: Re: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

Dear Ms. Botwinick,

hank you for getting back to me. Yes, I am certain that there were 13 applicationsubmitted. It looks like Cambridge E is missing from your list below. I know that it was sn initially and it is on our spreadsheet. Maybe it was an oversight?



Michelle

rom: "Botwinick, Alexandra (HHS/OCIIO)" o: Michelle Berman c: "Habit, Sandra (HHS/OCIIO)" ent: Wed, January 19, 2011 8:28:53 AMubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

Ms. Berman,




Alexandra Botwinick

ffice of Oversight


UBenefit:000013
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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Dear Ms. Botwinick,







ew York, New York 10004212) 269-2500

212) 269-2540 (fax)






UBenefit:000014


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//T|/...ns%20with%20NO%2012600%20Response%20[YELLOW]/United%20Benefit%20Fund/Question%20response%201.19.11.htm[07/14/2011 3:29


To: 'Michelle Berman'Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section711

mportance: HighMs. Berman,


uilding Maintenance 1, Basic, Apollo, Cambridge B, Cambridge C, Cambridge, Sterling, Universal B, and Universal.


Alexandra Botwinick

ffice of Oversight



Dear Ms. Botwinick,






7 State Street, 4th Floorew York, New York 10004

212) 269-2500

212) 269-2540 (fax)






UBenefit:000015


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//T|/...0%20Response%20[YELLOW]/United%20Benefit%20Fund/Question%20response%20on%20Cambridge%20E%201.19.11.htm[07/14/2011 3:29


To: 'Michelle Berman'Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section711

Michelle,

he approval letter applies to Cambridge E as well. Thank you for checking with us.


hanks,

Alexandra Botwinick

ffice of Oversight


rom: Michelle Berman [mailto:[email protected]]ent: Wednesday, January 19, 2011 9:41 AMo: Botwinick, Alexandra (HHS/OCIIO)ubject: Re: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

Dear Ms. Botwinick,

hank you for getting back to me. Yes, I am certain that there were 13 applicationsubmitted. It looks like Cambridge E is missing from your list below. I know that it was s

n initially and it is on our spreadsheet. Maybe it was an oversight?



Michelle

rom: "Botwinick, Alexandra (HHS/OCIIO)"

o: Michelle Berman c: "Habit, Sandra (HHS/OCIIO)" ent: Wed, January 19, 2011 8:28:53 AMubject: RE: Correspondence United Benefit Fund Waiver of the Annual Limits Requirements of PHS Act Section 2711

Ms. Berman,




UBenefit:000016


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//T|/...0%20Response%20[YELLOW]/United%20Benefit%20Fund/Question%20response%20on%20Cambridge%20E%201.19.11.htm[07/14/2011 3:29

Alexandra Botwinick

ffice of Oversight



Dear Ms. Botwinick,







ew York, New York 10004

212) 269-2500

212) 269-2540 (fax)






UBenefit:000017


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//T|/...OW/Applications%20with%20NO%2012600%20Response%20[YELLOW]/United%20Benefit%20Fund/Denial%201.24.11.htm[07/14/2011 3:29

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, January 24, 2011 8:18 AM

To: '[email protected]'Cc: Habit, Sandra (HHS/OCIIO)ubject: United Benefit Fund Plan Name Cambridge E Waiver of the Annual Limits Requirements 1-24-2011

mportance: High

Attachments: January 1 Denial Letter .pdfood MorningMr. Delucia,

know you contacted me last week concerning United Benefit Funds 13th Plan Cambridge E, which you ha

ot heard a determination on. In my haste to give you an answer concerning that plan I gave you incorrect

nformation. I do apologize for the error and any inconvenience it causes. The reason that plan had been lef

ff of the original approval list was not an oversight as I had assumed, but it was because it required furthe

onsideration. Upon further review of United Benefit Funds Plan Cambridge E, HHS has made its

etermination. Please see the attached letter.


nce again, I do apologize for my error.


Alexandra Botwinick

ffice of Oversight

HHS/OCIIO

[email protected]

UBenefit:000018


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//T|/...20with%20NO%2012600%20Response%20[YELLOW]/United%20Benefit%20Fund/Denial%20correspondence%201.24.11.htm[07/14/2011 3:29

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, January 24, 2011 8:29 AM

To: '[email protected]'Cc: Habit, Sandra (HHS/OCIIO)ubject: FW: United Benefit Fund Plan Names Cambridge C and Universal Waiver of the Annual Limits

Requirements 1-24-2011

mportance: High

Attachments: January 1 Denial Letter .pdfMr. Delucia,

he below e-mail and attached letter additionally applies to the following plans: Cambridge C and Universal. Once again, I do

pologize for the error. In our push to get to all of the applications with January 1st effective dates some miscommunications h

ccurred. Please be sure to let me know if I can be of any further assistance.

incerely,

Alexandra Botwinick

ffice of OversightHHS/OCIIO

[email protected]

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, January 24, 2011 8:18 AMo: '[email protected]'c: Habit, Sandra (HHS/OCIIO)ubject: United Benefit Fund Plan Name Cambridge E Waiver of the Annual Limits Requirements 1-24-2011

mportance: High

ood MorningMr. Delucia,

know you contacted me last week concerning United Benefit Funds 13th Plan Cambridge E, which you ha

ot heard a determination on. In my haste to give you an answer concerning that plan I gave you incorrect

nformation. I do apologize for the error and any inconvenience it causes. The reason that plan had been lef

ff of the original approval list was not an oversight as I had assumed, but it was because it required furthe

onsideration. Upon further review of United Benefit Funds Plan Cambridge E, HHS has made its

etermination. Please see the attached letter.


nce again, I do apologize for my error.


Alexandra Botwinick

UBenefit:000019


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ffice of Oversight


UBenefit:000020


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Ann ual L imit WaiverRequest Applicant

Name

Policy Name (use a newrow for each policy

application)

UnitedBenefitFund MBFoods#3




UnitedBenefitFund BuildingMaintenance2




UnitedBenefitFund Basic


UnitedBenefitFund Apollo




UnitedBenefitFund CambridgeB


UnitedBenefitFund CambridgeC

Total Number of

Individuals Covered byPolicy (include all

dependents covered)

Current Plan Overall

Ann ual L imit (in d oll ars) Ambu lato ry Emergen cy Hospi tali zation Labo rato ry Pediat ric Materni ty/ Newb orn


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Name


application)


















Copay (if applicable)

Coinsurance (if

ap pl ic ab le ) Co pay (i f a pp li cab le)

Coinsurance (if


Coinsurance (if

applicable)

Individual/ Employee

Tier*

Employee contributio

(if applicable)


24/69


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Name


application)

App lican t (Plan / Poli cy

Situs) City

App lican t (Plan/ Po lic y

Situs) State

Plan/ Policy Effective

Date (mm/dd/yyyy) Contact Name Street Address City State Zip Code

UnitedBenefitFund CambridgeC MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379

UnitedBenefitFund CambridgeE MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379

UnitedBenefitFund CambridgeE MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379

UnitedBenefitFund Cambridge MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379

UnitedBenefitFund Cambridge MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379

UnitedBenefitFund Sterling MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379

UnitedBenefitFund Sterling MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379

UnitedBenefitFund UniversalB MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379

UnitedBenefitFund UniversalB MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379

UnitedBenefitFund Universal MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379

UnitedBenefitFund Universal MiddleVillage NY 01/01/2010 DavidDelucia 7415Metropolitan Ave MiddleVillage NY 11379


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Name


application)


UnitedBenefitFund CambridgeE


UnitedBenefitFund Cambridge


UnitedBenefitFund Sterling


UnitedBenefitFund UniversalB


UnitedBenefitFund Universal


Total Number of

Individuals Covered byPolicy (include all

dependents covered)

Current Plan Overall

Ann ual L imit (in d oll ars) Ambu lato ry Emergen cy Hospi tali zation Labo rato ry Pediat ric Materni ty/ Newb orn


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Name


application)












Copay (if applicable)

Coinsurance (if


Coinsurance (if


Coinsurance (if

applicable)

Individual/ Employee

Tier*

Employee contributio

(if applicable)


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Name


application)












Employer contribution

(if applicable) Total

Employee contribution

(if applicable)



Employee contribution

(if applicable)




29/69

PLAN NAME COLLECTIVE BARGAINING

AGREEMENT

CBA EXPIRATION DATE

MB Foods 3 & 4 MB Foods

Building Maintenance 2 Galaxy Towers Condominium

Building Maintenance Aqua Urban Renewal LLC

Basic Royal Recycling Services, Inc.

Apollo Harbor Freight Transport

Cambridge B Five Star Parking

Cambridge C Hartz Mountain Corp.

Cambridge E Connexxys, Inc.

Cambridge Crown Sanitation, Inc.

Sterling Aramark Educational Services

Universal B Muss Development LLCUniversal J & B Contracting

UBenefit:000029


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united benefit fund - combined redacted-bates hwm

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