From: ADAM JENSEN [ajensen@cottinghambutler.

com] Sent: Friday, November 05, 2010 4:53 PM To: HHS HealthInsurance (HHS) Cc: ceasterday@westernexp.com; KIM BECK; ROB HOHMANN Subject: Waiver Attachments: Health Insurance Wavier 110510.pdf; Health Insurance Attestation 110510.pdf; Western Express 2011 sugg fund rates.pdf; Plan D as of 02-24-09.pdf; Plan C as of 02-24-09.pdf
Attached please find a request for waiver of the restricted annual limit requirements on behalf of our client, Western Express, Inc. Please advise if there are any questions. Thank you for your assistance in this matter.

Cottingham & Butler Consulting Services

recipient(s) and may contain confidential and privileged information or Protected Health Information (PHI). Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender and destroy all original copies.

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10 Terrace Court | Suite 204 Madison, WI 53718 An Assurex Global Partner National Underwriter 2007 Agency of the Year CONFIDENTIALITY NOTICE: This correspondence, including any attachments, is for the sole use of the intended

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Director of Compliance Services ph: 608.467.5030 877.288.0622 ext: 2030 fax: 608.249.2630 ajensen@cottinghambutler.com

file:///T|/CCIIO%20Waivers%20-%20Torres/DFOI%20Processing%20Team/Mike/Western%20Express/Waiver.htm[11/16/2011 5:01:46 PM]

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WESTEXP:000001

Adam P. Jensen, JD, CEBS, GBA, FLMI

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Western Express Inc.

2011 Rates Based on Claims Experience Separately for Plan C&D

C&D Rates Without 2011 Rate Annual Maximums * Plan C&D: w/Vision Individual 2-Person Family Plan C&D: no Vision Individual 2-Person Family
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* Following annual maximums would be eliminated: - $Ex. 4 inpatient - $Ex. 4 Rx - $Ex. 4 all other expenses

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Pages 6 through 24 redacted for the following reasons: ---------------------------Exemption 4

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From: Botwinick, Alexandra (HHS/OCIIO) Sent: Tuesday, November 23, 2010 1:39 PM To: 'ajensen@cottinghambutler.com' Subject: Waiver of the Annual Limits Requirements of PHS Act Section 2711 Importance: High Attachments: Updated Jan 1 Approval Letter .pdf Good Afternoon, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for Western Express. HHS has reviewed your application and made its determination. Please see the attached letter. Please confirm receipt of this letter by replying to this e-mail address with a copy to OCIIOOversight@hhs.gov. Please let me know if I can be of further assistance. Sincerely,

alexandra.botwinick@hhs.gov

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Alexandra Botwinick Office of Oversight HHS/OCIIO

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file:///T|/...ivers%20-%20Torres/DFOI%20Processing%20Team/Mike/Western%20Express/Approval%20letter%20sent%2011-23-2010.htm[11/16/2011 5:01:48 PM]

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From: ADAM JENSEN [ajensen@cottinghambutler.com] Sent: Tuesday, November 23, 2010 3:31 PM To: Botwinick, Alexandra (HHS/OCIIO) Cc: OCIIO Oversight Subject: RE: Waiver of the Annual Limits Requirements of PHS Act Section 2711 Follow Up Flag: Follow up Flag Status: Red

Confirming receipt of Waiver approval letter.

Adam P. Jensen, JD, CEBS, GBA, FLMI

Cottingham & Butler Consulting Services

recipient(s) and may contain confidential and privileged information or Protected Health Information (PHI). Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender and destroy all original copies.

Good Afternoon, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section for Western Express. HHS has reviewed your application and made its determination. Please see the attached letter. Please confirm receipt of this letter by replying to this e-mail address with a copy to OCIIOOversight@hhs.gov. Please let me know if I can be of further assistance. Sincerely,

Alexandra Botwinick Office of Oversight HHS/OCIIO

alexandra.botwinick@hhs.gov
WESTEXP:000010

file:///T|/...orres/DFOI%20Processing%20Team/Mike/Western%20Express/Confirmation%20of%20Approval%20letter%2011-23-2010.htm[11/16/2011 5:01:49 PM]

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From: Botwinick, Alexandra (HHS/OCIIO) [mailto:Alexandra.Botwinick@hhs.gov] Sent: Tuesday, November 23, 2010 12:39 PM To: ADAM JENSEN Subject: Waiver of the Annual Limits Requirements of PHS Act Section 2711 Importance: High

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10 Terrace Court | Suite 204 Madison, WI 53718 An Assurex Global Partner National Underwriter 2007 Agency of the Year CONFIDENTIALITY NOTICE: This correspondence, including any attachments, is for the sole use of the intended

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Director of Compliance Services ph: 608.467.5030 877.288.0622 ext: 2030 fax: 608.249.2630 ajensen@cottinghambutler.com

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WESTEXP:000011

file:///T|/...orres/DFOI%20Processing%20Team/Mike/Western%20Express/Confirmation%20of%20Approval%20letter%2011-23-2010.htm[11/16/2011 5:01:49 PM]

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