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HBCBSNJ:000001

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HBCBSNJ:000002

Ex. 4 Ex. 4 Ex. 4 Ex. 4 Ex. 4 Ex. 4 Ex. 4 Ex.
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4
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Ex. 4

HBCBSNJ:000003

Pages 4 through 68 redacted for the following reasons:

---------------------------------------------------

Exemption 4

HBCBSNJ:000004

HBCBSNJ:000005

From:

Pham, Erica (HHS/OCIIO)

Sent:

Wednesday, December 22, 2010 1:31 PM

To:

Gary, Lapreea (HHS/OCIIO)

Subject:

FW: Horizon Blue Cross Blue Shield of New Jersey Waiver Filing

Attachments:

Letter and Application.pdf; EXHIBIT 1 B&E Plus Plan Waiver Filing.doc; Exhibit 1A - B&E EPO Plan.doc; Exhibit 1B - IHC B&E Products 10-27-2010.xls; Exhibit 1C- Rate Information.xls; Exhibit 2 CEO Attestation.pdf; Copy of waiver_application_form.xls

Follow Up Flag:

Follow up

Flag Status:

Flagged

Please create a folder on the G drive for this applicant.

They originally submitted to the wrong address (heathinsurance@hhs.gov).

Sent: Wednesday, December 22, 2010 1:26 PM

To: Pham, Erica (HHS/OCIIO)

Subject: Fw: Horizon Blue Cross Blue Shield of New Jersey Waiver Filing

Dear Ms. Kottenmeier,

In response to your request that Horizon Blue Cross Blue Shield of New Jersey resubmit its waiver filing

directly to you, I have included the original email containing the filing (below). I have also attached the new

filing form that you requested. This filing pertains to an individual product.

If you have any questions, please do not hesitate to contact me.

Thank you very much for your assistance .

Sincerely, Jill Swyer Novak

Jill Swyer Novak

Assistant General Counsel

973 - 466 - 7421

973 - 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are not the named addressee, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e- mail if you have received this e-mail by mistake and delete this e-mail from your system.

----- Forwarded by Jill Swyernovak/BCBSNJ on 12/22/2010 12:23 PM -----

From:

Jill Swyernovak/BCBSNJ

To:

Cc:

Colleen Brennan/BCBSNJ@BCBSNJ, Adam Young/BCBSNJ@BCBSNJ, Edward Mailander/BCBSNJ@BCBSNJ, Robert E Meehan/BCBSNJ@BCBSNJ, Peter Morey/BCBSNJ@BCBSNJ, Ellen.DeRosa@dobi.state.nj.us, neil.sullivan@dobi.state.nj.us

HBCBSNJ:000006

Date:

Subject: Horizon Blue Cross Blue Shield of New Jersey Waiver Filing

11/02/2010 05:12 PM

Dear Mr. Mayhew:

I am writing on behalf of Horizon Blue Cross Blue Shield of New Jersey to submit its application for a waiver from restricted annual limits on the dollar value of essential benefits for Horizon BCBSNJ's Basic and Essential EPO Plus plan. Please see the attached letter and application, supporting exhibits and. CEO attestation.

Sincerely,

Jill Swyer Novak, Esq.

Jill Swyer Novak

Assistant General Counsel

973 - 466 - 7421

973 - 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

==============================================================================

This message and any attachments are solely for the intended recipient. If you are not the

intended recipient, disclosure, copying, use, or distribution of the information included in this

message is prohibited -- please immediately and permanently delete this message.

==============================================================================

Please notify the sender immediately by e-

HBCBSNJ:000007

ANNUAL LIMIT WAIVER APPLICATION 2010

Ex. 4 Total Number of Individuals Annual Limit Waiver Request Applicant Policy Name (use a
Ex. 4
Total
Number of
Individuals
Annual
Limit Waiver
Request
Applicant
Policy Name
(use a new
row for each
policy
application)
Applicant
Type of
Covered by
Current
(Plan/
Phone
Coverage
Policy
Plan Overall
Applicant
Policy
Plan/ Policy
Number
(e.g., Limited
Self-
(include all
Annual
(Plan/ Policy
Situs)
Effective Date
Contact
Street
(including
Email
Benefit, HRA,
Insured
Individual or
dependents
Limit (in
Name
Situs) City
State
(mm/dd/yyyy)
Name
Address
City
State
Zip Code
area code)
Address
Rx only, Other)
(Yes/No)
Group Policy
covered)
dollars)
Applicant
100 ABC
1-800-ABC-
abc@abchea
ABC
Plan 1
Washington
DC
01/01/2011
Jane Doe
Drive
Washington
DC
20201
1234
lthplan.com
Limited Benefit
Yes
Group
Horizon
Healthcare
Services, Inc.
d/b/a Horizon
Blue Cross
Blue Shield
Three Penn
jill_swyernov
of New
Jill Swyer
Plaza East,
07105-
1-973-466-
ak@horizonb
Jersey
Basic & Essential EPO Plus
NJ
09/23/2010
Novak
PP 16F,
Newark
NJ
2200
7421
lue.com
Limited Benefit
No
Individual
PRA Disclosure Statement
According to
the Paperwork
Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.
The valid OMB control number for this
information collection is 0938-1105. The time required to complete this
information collection is estimated to average ( 8 hours) or ( 240 minutes) per
response, including the time to
review instructions,
search existing data resources, gather the data needed, and complete and review the
information collection. If you
have comments concerning the accuracy of the time estimate(s) or suggestions for
improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

HBCBSNJ:000008

ANNUAL LIMIT WAIVER APPLICATION 2010

   

Office Visit

Hospital Inpatient

Emergency Room

 

Rx

 

Current Essential Benefits Annual Limits (Annual Limit for Each Essential Benefit)

 

Copays/Coinsurance

Copay/Coinsurance

Copay/Coinsurance

Copay/Coninsurance

                       

Coinsura

Coinsura

 

Mental Health/

 

Copay (if

Coinsuranc

Copay (if

nce (if

Copay (if

nce (if

Copay (if

Coinsuran

Maternity/

Substance

Rehabilitative/

Preventive/

Plan

applicabl

e (if

applicabl

applicabl

applicabl

applicabl

applicabl

ce (if

Ambulatory

Emergency

Hospitalization

Laboratory

Pediatric

Newborn

Abuse

Devices

Wellness

Prescription

Deductible

e)

applicable)

e)

e)

e)

e)

e)

applicable)

Ex. 4

HBCBSNJ:000009

ANNUAL LIMIT WAIVER APPLICATION 2010

Ex. 4 Projected Rate Increase that would result Renewal Monthly Premium Rates or from compliance
Ex. 4
Projected Rate Increase that would result
Renewal Monthly Premium Rates or
from compliance with $750,000 Annual Limit
Current Monthly Premium Rates or
Premium Equivalent Rates (in dollars)*:
Premium Equivalent Rates if Waiver Granted
Restriction (in dollars) (Average Premium
(in dollars)*
by Individual)*
Decrease in
Access to
Benefits that
Projected Rate Increase
would result
that would result from
from
compliance with $750,000
compliance
Plan
Annual Limit Restriction
with $750,000
Administr
(in dollars)(Average
Annual Limit
ator/ CEO
Premium by Individual)
Restriction
of
Health
Employee
Employer
Employee
Employer
Employee
Employer
(Difference of Column AT
(describe
Insuranc
Title of Individual
Individual/ Employee
contribution
contribution
contribution
contribution
contribution
contribution
and AQ divided by
briefly in cell
e
Issuer
Tier*
(if applicable)
(if applicable)
Total
(if applicable)
(if applicable)
Total
(if applicable)
(if applicable)
Total
Column AQ)
or in a
Name
Providing
Attestation
Jane Doe
Plan Administrator
William J.
Marino
CEO
* When completing the columns requesting premium rate information, please express the premium rates as a composite rate (if
premiums are a range based on years of service or age) and by tier (Employee, Employee + Spouse, Employee + Child, Family,
etc.) as applicable. If you are an issuer,
please provide the premium amount in the column titled, "Total" (Column AN, AQ and AT).

HBCBSNJ:000010

From: Pham, Erica (HHS/OCIIO) Sent: Wednesday, December 22, 2010 3:14 PM To: 'Jill_Swyernovak@Horizon-BCBSNJ.com' Cc: 'Adam_Young@horizonblue.com'; 'Colleen_Brennan@Horizon-BCBSNJ.COM'; 'Edward_Mailander@horizonblue.com'; 'Robert_E_Meehan@horizon-bcbsnj.com'; 'Peter_Morey@horizonblue.com'; 'Sandi_L_Kelly@horizon-bcbsnj.com'; 'Kristen_A_Jarosz@horizon-bcbsnj.com' Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Waiver Filing

Dear Ms. Swyer Novak:

HHS is in receipt of your application, We will review and process this application. We note that we did not receive your original application submitted on November 2 because it appears it was sent to an incorrect address, heathinsurance@hhs.gov rather than healthinsurance@hhs.gov.

Thank you and happy holidays,

Erica

Erica Pham

Division of Enforcement

Office of Oversight OCIIO/HHS

301-492-4108

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com]

Sent: Wednesday, December 22, 2010 1:26 PM

To: Pham, Erica (HHS/OCIIO)

Cc: Adam_Young@horizonblue.com; Colleen_Brennan@Horizon-BCBSNJ.COM; Edward_Mailander@horizonblue.com;

Robert_E_Meehan@horizon-bcbsnj.com; Peter_Morey@horizonblue.com; Sandi_L_Kelly@horizon-bcbsnj.com;

Kristen_A_Jarosz@horizon-bcbsnj.com

Subject: Fw: Horizon Blue Cross Blue Shield of New Jersey Waiver Filing

Dear Ms. Kottenmeier,

In response to your request that Horizon Blue Cross Blue Shield of New Jersey resubmit its waiver filing

directly to you, I have included the original email containing the filing (below). I have also attached the new

filing form that you requested. This filing pertains to an individual product.

If you have any questions, please do not hesitate to contact me.

Thank you very much for your assistance .

Sincerely, Jill Swyer Novak

Jill Swyer Novak

Assistant General Counsel

973 - 466 - 7421

973 - 466 - 7759

email: jill_swyernovak@horizonblue.com

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

file:///T|/

HBCBSNJ:000011

ng%20Team/Mike/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Correspondence%2012.22.10.htm[10/25/2011

12:45:17 PM]

not the named addressee, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e- mail if you have received this e-mail by mistake and delete this e-mail from your system.

----- Forwarded by Jill Swyernovak/BCBSNJ on 12/22/2010 12:23 PM -----

From:

To: heathinsurance@hhs.gov

Jill Swyernovak/BCBSNJ

Cc:

Colleen Brennan/BCBSNJ@BCBSNJ, Adam Young/BCBSNJ@BCBSNJ, Edward Mailander/BCBSNJ@BCBSNJ, Robert E Meehan/BCBSNJ@BCBSNJ, Peter

Date:

Morey/BCBSNJ@BCBSNJ, Ellen.DeRosa@dobi.state.nj.us, neil.sullivan@dobi.state.nj.us 11/02/2010 05:12 PM

Subject: Horizon Blue Cross Blue Shield of New Jersey Waiver Filing

Dear Mr. Mayhew:

I am writing on behalf of Horizon Blue Cross Blue Shield of New Jersey to submit its application for a waiver

from restricted annual limits on the dollar value of essential benefits for Horizon BCBSNJ's Basic and

Essential EPO Plus plan.

attestation.

Please see the attached letter and application, supporting exhibits and. CEO

Sincerely,

Jill Swyer Novak, Esq.

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

email: jill_swyernovak@horizonblue.com

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

==============================================================================

This message and any attachments are solely for the intended recipient. If you are not the

intended recipient, disclosure, copying, use, or distribution of the information included in this

message is prohibited -- please immediately and permanently delete this message.

==============================================================================

Please notify the sender immediately by e-

file:///T|/

HBCBSNJ:000012

ng%20Team/Mike/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Correspondence%2012.22.10.htm[10/25/2011

12:45:17 PM]

From:

Jill_Swyernovak@Horizon-BCBSNJ.com

Sent:

Tuesday, January 04, 2011 3:56 PM

To:

Pham, Erica (HHS/OCIIO)

Cc:

Adam_Young@horizonblue.com; Colleen_Brennan@Horizon-BCBSNJ.COM;

Subject:

Edward_Mailander@horizonblue.com; Robert_E_Meehan@horizon-bcbsnj.com; Peter_Morey@horizonblue.com; Sandi_L_Kelly@horizon-bcbsnj.com; Kristen_A_Jarosz@horizon-bcbsnj.com Horizon Blue Cross Blue Shield of New Jersey Waiver Application

Attachments:

New Jersey Waiver Letter.pdf

Dear Ms. Pham,

I am writing to inform you that the data sheet that was submitted with

the resubmission of the Horizon Blue Cross Blue Shield of New Jersey

("Horizon BCBSNJ") application for a waiver of the annual limit

restrictions on essential benefits contains an incorrect number in the

column labeled "Total Number of Individuals Cove

all depend

instead of

Policy (include

members

Ex. 4

overed)." The number should be

listed.

Ex. 4

I would also like to bring to your attention the fact that HHS has

approved the New Jersey Department of Banking and Insurance

("NJDOBI") application for a waiver of the annual limit restrictions on

essential health benefits under Section 2711 of the Public Health

Services Act (See attached letter below).

subject of the NJDOBI's filing is the underlying coverage supporting the

rider in the Horizon BCBSNJ application. Horizon BCBSNJ's rider

enhances the underlying NJDOBI coverage by providing increased

benefits for members.

The coverage that is the

Since the NJDOBI's filing has been approved, Horizon BCBSNJ looks forward to hearing shortly from HHS on its approval as well.

Happy New Year and thank you very much for your assistance in this process.

Sincerely,

file:///T|/

HBCBSNJ:000013

f%20New%20Jersey/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey%20Waiver%20Application.htm[10/25/2011

12:45:18 PM]

Jill Swyer Novak

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

==============================================================================

This message and any attachments are solely for the intended recipient. If you are not the

intended recipient, disclosure, copying, use, or distribution of the information included in this

message is prohibited -- please immediately and permanently delete this message.

==============================================================================

Please notify the sender immediately by e-

file:///T|/

HBCBSNJ:000014

f%20New%20Jersey/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey%20Waiver%20Application.htm[10/25/2011

12:45:18 PM]

HBCBSNJ:000015

HBCBSNJ:000016

From:

Keels, Lisa (HHS/OCIIO)

Sent:

Monday, January 24, 2011 2:57 PM

To:

Habit, Sandra (HHS/OCIIO)

Subject:

FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Hi Sandy,

The email didn’t go through.

I will try again.

Thanks!

From: System Administrator

Sent: Monday, January 24, 2011 2:57 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: Undeliverable: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application -

Request for Additional Information

Your message did not reach some or all of the intended recipients.

Subject: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver

Application - Request for Additional Information

Sent: 1/24/2011 2:57 PM

The following recipient(s) cannot be reached:

'Jill_Swyernovak@Horizon-BCBSNJ.com' on 1/24/2011 2:57 PM

None of your e-mail accounts could send to this recipient.

HBCBSNJ:000017

From: Keels, Lisa (HHS/OCIIO) Sent: Monday, January 24, 2011 2:59 PM To: jill_swyernovak@horizonblue.com Cc: Habit, Sandra (HHS/OCIIO) Subject: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information Dear Ms. Swyer Novak:

Thank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (PHS Act) Section 2711. I left you a voicemail earlier this afternoon. We are processing your application and have a couple of questions about the waiver application spreadsheet you submitted. In order to complete your application, please provide the following information:

1. On the spreadsheet, enrollees are categorized under the following tiers: Individual, Employee + Spouse,

Employee + Family, and Employee + Children. Since Horizon BCBSNJ is an individual policy, please confirm

that, by “Employee + Spouse,” “Employee + Family,” and “Employee + Children,” you mean “Individual +

Spouse,” “Individual + Family,” and “Individual + Children.”

2. The spreadsheet column entitle

tal Number of Individuals Covered by Policy (include all dependent

. However, the application letter states that the B&E Plus Plan had

covered)” contains the number

Ex. 4
Ex. 4
Ex. 4
Ex. 4

enrollees at the end of the seco

(i.e., Individual, Employee + Child, etc.).

arter. Please confirm the number of enrollees under each tier of cov

3. Please confirm whether the policy was in existence prior to March 23, 2010. If so, is the plan in compliance

with grandfathering provisions, pursuant to 45 CFR 147.140?

Please feel free to call me if you have any questions. I look forward to hearing from you soon.

Thank you,

Lisa

Lisa M. Keels, J.D.

U.S. Department of Health & Human Services

Office of Consumer Information and Insurance Oversight

Office of Oversight lisa.keels@hhs.gov

301-492-4168

file:///T|/

HBCBSNJ:000018

/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Request%20for%20info%20(2)%20%201.24.11.htm[10/25/2011

12:45:28 PM]

From: Keels, Lisa (HHS/OCIIO) Sent: Thursday, February 03, 2011 3:34 PM To: Jill_Swyernovak@Horizon-BCBSNJ.com Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Jill,

I just wanted to let you know that your application is complete, and you should be hearing from HHS soon.

Thank you,

Lisa

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com]

Sent: Thursday, February 03, 2011 2:02 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Lisa. Regards, Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

email: jill_swyernovak@horizonblue.com

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

"Jill_Swyernovak@Horizon-BCBSNJ.com" <Jill_Swyernovak@Horizon-BCBSNJ.com>

Cc:

"Adam_Young@horizonblue.com" <Adam_Young@horizonblue.com>, "Colleen_Brennan@Horizon-BCBSNJ.COM" <Colleen_Brennan@Horizon-

BCBSNJ.COM>, "Habit, Sandra (HHS/OCIIO)" <Sandra.Habit@hhs.gov>

Date:

02/03/2011 01:43 PM

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Jill. I will let you know if we have additional questions.

Best,

Lisa

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com] Sent: Thursday, February 03, 2011 1:33 PM To: Keels, Lisa (HHS/OCIIO) Cc: Adam_Young@horizonblue.com; Colleen_Brennan@Horizon-BCBSNJ.COM Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

file:///T|/

HBCBSNJ:000019

Team/Mike/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/completion%202.3.11.htm[10/25/2011

12:45:41 PM]

Dear Lisa,

I am writing to submit an answer to your question which was as follows:

The spreadsheet column entitled “Total Number of Individuals Covered by Policy (include all dependent

covered)” contains the number

arter. Please confirm the number of enrollees under each tier of cov

(i.e., Individual, Employee + Child, etc.).

enrollees at the end of the secon

. However, the application letter states that the B&E Plus Plan hadEmployee + Child, etc.). enrollees at the end of the secon Ex. 4 On January 4,

Ex. 4
Ex. 4

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey sen

sheet by indicating that the total number of of individuals covered was

BCBSNJ does not maintain its data in terms of members per tier. Hori

contracts per tier.

ail to Ms. Pham corr

members instead of

the data

. Horizon

terms of

Ex. 4
Ex. 4
Ex. 4
Ex. 4

BSNJ maintains its d

The Ex. 4 Sing
The
Ex. 4
Sing
Ex. 4
Ex. 4

mem

esents

contracts which when broken down by tier is as follows:

Ex. 4

Two adults

Adult/Child/ren

Family

Total

contractsis as follows: Ex. 4 Two adults Adult/Child/ren Family Total Obviously, the above represents Ex. 4

Obviously, the above represents

Ex. 4
Ex. 4

The question is the number of m

members in the single category and

Ex. 4
Ex. 4

in the Adult/Child/ren and Family c

members in the two adult category.

ies.

I hope this information is helpful.

If I can be of further assistance, please contact me.

Sincerely,

Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

email: jill_swyernovak@horizonblue.com

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

==============================================================================

This message and any attachments are solely for the intended recipient. If you are not the

intended recipient, disclosure, copying, use, or distribution of the information included in this

message is prohibited -- please immediately and permanently delete this message.

==============================================================================

Please notify the sender immediately by e-

============================================================================== This message and any attachments are solely for the intended recipient. If you are not the intended recipient, disclosure, copying, use, or distribution of the information included in this message is prohibited -- please immediately and permanently delete this message. ==============================================================================

file:///T|/

HBCBSNJ:000020

Team/Mike/Horizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/completion%202.3.11.htm[10/25/2011

12:45:41 PM]

From:

Keels, Lisa (HHS/OCIIO)

Sent:

Tuesday, February 15, 2011 3:41 PM

To:

'Jill_Swyernovak@Horizon-BCBSNJ.com'

Cc:

Kottenmeier, Erika (HHS/OCIIO)

Subject:

RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Jill,

Our leadership would like to schedule a call with you to discuss Horizon Blue Cross Blue Shield of New Jersey’s annual limits

waiver application.

Please let me know if you would be available for a call at 10:00am next Wednesday, February 23

Thank you,

Lisa

rd

.

Sent: Thursday, February 03, 2011 4:24 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Lisa,

Thank you very much for the information. I appreciate your help.

I will look forward to hearing from you soon.

Regards,

Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

Cc:

"Habit, Sandra (HHS/OCIIO)" <Sandra.Habit@hhs.gov>

Date:

02/03/2011 03:33 PM

Subject:

RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

file:///T|/

HBCBSNJ:000021

rizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Scheduling%20a%20Call%202.15.11.htm[10/25/2011

12:45:41 PM]

Dear Jill,

I just wanted to let you know that your application is complete, and you should be hearing from HHS soon.

Thank you,

Lisa

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com] Sent: Thursday, February 03, 2011 2:02 PM To: Keels, Lisa (HHS/OCIIO) Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Lisa. Regards, Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Jill. I will let you know if we have additional questions.

Best,

Lisa

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com] Sent: Thursday, February 03, 2011 1:33 PM To: Keels, Lisa (HHS/OCIIO) Cc: Adam_Young@horizonblue.com; Colleen_Brennan@Horizon-BCBSNJ.COM Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Lisa,

I am writing to submit an answer to your question which was as follows:

file:///T|/

HBCBSNJ:000022

rizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Scheduling%20a%20Call%202.15.11.htm[10/25/2011

12:45:41 PM]

The spreadsheet column entitled “Total Number of Individuals Covered by Policy (include all dependent

covered)” contains the number enrollees at the end of the seco

arter. Please confirm the number of enrollees under each tier of cov

(i.e., Individual, Employee + Child, etc.).

. However, the application letter states that the B&E Plus Plan hadtier of cov (i.e., Individual, Employee + Child, etc.). Ex. 4 On January 4, 2011, Horizon

Ex. 4
Ex. 4

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey sen

sheet by indicating that the total number of of individuals covered was BCBSNJ does not maintain its data in terms of members per tier. Hori contracts per tier.

ail to Ms. Pham cor

the data

Horizon

terms of

Ex. 4
Ex. 4

members instead of

SNJ maintains its d

Ex. 4
Ex. 4
The Ex. 4 mem esents contracts which when broken down by tier is as follows:
The
Ex. 4
mem
esents
contracts which when broken down by tier is as follows:
Single
Ex. 4
Two adults
Adult/Child/ren
Family
Total
Ex. 4
contracts

Obviously, the above represents

Ex. 4
Ex. 4

members in the single category and

Ex. 4
Ex. 4

members in the two adult category.

The question is the number of members in the Adult/Child/ren and Family categories.

I hope this information is helpful.

If I can be of further assistance, please contact me.

Sincerely,

Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

==============================================================================

This message and any attachments are solely for the intended recipient. If you are not the

intended recipient, disclosure, copying, use, or distribution of the information included in this

message is prohibited -- please immediately and permanently delete this message.

==============================================================================

==============================================================================

This message and any attachments are solely for the intended recipient. If you are not the

intended recipient, disclosure, copying, use, or distribution of the information included in this

message is prohibited -- please immediately and permanently delete this message.

==============================================================================

Please notify the sender immediately by e-

============================================================================== This message and any attachments are solely for the intended recipient. If you are not the intended recipient, disclosure, copying, use, or distribution of the information included in this message is prohibited -- please immediately and permanently delete this message. ==============================================================================

file:///T|/

HBCBSNJ:000023

rizon%20Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Scheduling%20a%20Call%202.15.11.htm[10/25/2011

12:45:41 PM]

From:

Keels, Lisa (HHS/OCIIO)

Sent:

Tuesday, February 15, 2011 4:06 PM

To:

'Jill_Swyernovak@Horizon-BCBSNJ.com'

Cc:

Kottenmeier, Erika (HHS/OCIIO)

Subject:

FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Hello again, Jill,

In addition to letting me know if you are available at 10:00am next Wednesday, February 23 rd , could you also please let me

know your availability for two additional dates/times?

schedule this call at everyone’s earliest convenience.

Scheduling changes often arise, and we would like to be able to

Thank you again, Lisa

From: Keels, Lisa (HHS/OCIIO)

Sent: Tuesday, February 15, 2011 3:41 PM

To: 'Jill_Swyernovak@Horizon-BCBSNJ.com'

Cc: Kottenmeier, Erika (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Jill,

Our leadership would like to schedule a call with you to discuss Horizon Blue Cross Blue Shield of New Jersey’s annual limits

waiver application.

Please let me know if you would be available for a call at 10:00am next Wednesday, February 23

Thank you,

Lisa

rd

.

Sent: Thursday, February 03, 2011 4:24 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Lisa,

Thank you very much for the information. I appreciate your help. I will look forward to hearing from you soon.

Regards,

Jill

Jill Swyer Novak Assistant General Counsel 973 - 466 - 7421

HBCBSNJ:000024

973 - 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are not the named addressee, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e- mail if you have received this e-mail by mistake and delete this e-mail from your system.

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

Cc:

"Habit, Sandra (HHS/OCIIO)" <Sandra.Habit@hhs.gov>

Date:

02/03/2011 03:33 PM

Subject:

RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Jill,

I just wanted to let you know that your application is complete, and you should be hearing from HHS soon.

Thank you,

Lisa

Sent: Thursday, February 03, 2011 2:02 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Lisa. Regards, Jill

Jill Swyer Novak

Assistant General Counsel

973 - 466 - 7421

973 - 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Jill. I will let you know if we have additional questions.

Best,

Lisa

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com] Sent: Thursday, February 03, 2011 1:33 PM To: Keels, Lisa (HHS/OCIIO) Cc: Adam_Young@horizonblue.com; Colleen_Brennan@Horizon-BCBSNJ.COM Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Lisa,

I am writing to submit an answer to your question which was as follows:

The spreadsheet column entitled “Total Number of Individuals Covered by Policy (include all dependent

covered)” contains the number

enrollees at the end of the second quarter. Please confirm the number of enrollees under each tier of cov

(i.e., Individual, Employee + Child, etc.).

However, the application letter states that the B&E Plus Plan hadtier of cov (i.e., Individual, Employee + Child, etc.). Ex. 4 On January 4, 2011, Horizon

Ex. 4
Ex. 4

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey sent an email to Ms. Pham cor

members instead of

BCBSNJ does not maintain its data in terms of members per tier. Hori

sheet by indicating that the total number of of individuals covered was

the data

. Horizon

terms of

Ex. 4
Ex. 4
Ex. 4
Ex. 4

BSNJ maintains its d

cont r tier. The Ex. 4 mem Sing Two adults Adult/Child/ren Family Ex. 4
cont
r tier.
The
Ex. 4
mem
Sing
Two adults
Adult/Child/ren
Family
Ex. 4

sents

Ex. 4
Ex. 4

contracts which when broken down by tier is as follows:

Total

contractswhich when broken down by tier is as follows: Total Obviously, the above represents Ex. 4

Obviously, the above represents

Ex. 4
Ex. 4

members in the single category and

Ex. 4
Ex. 4

members in the two adult category.

The question is the number of m

in the Adult/Child/ren and Family c

ies.

I hope this information is helpful.

If I can be of further assistance, please contact me.

Sincerely,

Jill

Jill Swyer Novak

Assistant General Counsel

973 - 466 - 7421

973 - 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are not the named addressee, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e- mail if you have received this e-mail by mistake and delete this e-mail from your system. ============================================================================== This message and any attachments are solely for the intended recipient. If you are not the intended recipient, disclosure, copying, use, or distribution of the information included in this

HBCBSNJ:000026

message is prohibited -- please immediately and permanently delete this message. ============================================================================== ============================================================================== This message and any attachments are solely for the intended recipient. If you are not the intended recipient, disclosure, copying, use, or distribution of the information included in this message is prohibited -- please immediately and permanently delete this message. ==============================================================================

============================================================================== This message and any attachments are solely for the intended recipient. If you are not the intended recipient, disclosure, copying, use, or distribution of the information included in this message is prohibited -- please immediately and permanently delete this message. ==============================================================================

HBCBSNJ:000027

From:

Keels, Lisa (HHS/OCIIO)

Sent:

Wednesday, February 16, 2011 4:33 PM

To:

'Jill_Swyernovak@Horizon-BCBSNJ.com'

Cc:

Adam_Young@horizonblue.com; Kottenmeier, Erika (HHS/OCIIO)

Subject:

RE: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Follow Up Flag:

Follow up

Flag Status:

Flagged

Thank you, Jill. I will work on scheduling the call and will confirm with you as soon as possible.

All the best, Lisa

Sent: Wednesday, February 16, 2011 4:30 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: Re: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional

Information

Hello Lisa.

Wednesday, February 23, 2011 at 10 am is fine. As alternative dates and times, I would like to suggest Thursday, February 24,

2011 at 11 am and Friday, February 25, 2011 at 10 am.

Regards,

Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

Cc:

"Kottenmeier, Erika (HHS/OCIIO)" <Erika.Kottenmeier@hhs.gov>

Date:

02/15/2011 04:06 PM

Subject:

FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

file:///T|/

HBCBSNJ:000028

Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Correspondence%20about%20call%202.16.11.htm[10/25/2011

12:45:42 PM]

Hello again, Jill,

In addition to letting me know if you are available at 10:00am next Wednesday, February 23 rd , could you also please let me know your availability for two additional dates/times? Scheduling changes often arise, and we would like to be able to schedule this call at everyone’s earliest convenience.

Thank you again, Lisa

From: Keels, Lisa (HHS/OCIIO)

Sent: Tuesday, February 15, 2011 3:41 PM To: 'Jill_Swyernovak@Horizon-BCBSNJ.com'

Cc: Kottenmeier, Erika (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Jill,

Our leadership would like to schedule a call with you to discuss Horizon Blue Cross Blue Shield of New Jersey’s annual limits waiver application.

Please let me know if you would be available for a call at 10:00am next Wednesday, February 23

Thank you,

Lisa

rd

.

Sent: Thursday, February 03, 2011 4:24 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Lisa,

Thank you very much for the information. I appreciate your help.

I will look forward to hearing from you soon.

Regards,

Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are not the named addressee, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e- mail if you have received this e-mail by mistake and delete this e-mail from your system.

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

Cc:

"Habit, Sandra (HHS/OCIIO)" <Sandra.Habit@hhs.gov>

Date:

02/03/2011 03:33 PM

Subject:

RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

file:///T|/

HBCBSNJ:000029

Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Correspondence%20about%20call%202.16.11.htm[10/25/2011

12:45:42 PM]

Dear Jill,

I just wanted to let you know that your application is complete, and you should be hearing from HHS soon.

Thank you,

Lisa

Sent: Thursday, February 03, 2011 2:02 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Lisa. Regards, Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Jill. I will let you know if we have additional questions.

Best,

Lisa

file:///T|/

HBCBSNJ:000030

Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Correspondence%20about%20call%202.16.11.htm[10/25/2011

12:45:42 PM]

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com] Sent: Thursday, February 03, 2011 1:33 PM To: Keels, Lisa (HHS/OCIIO) Cc: Adam_Young@horizonblue.com; Colleen_Brennan@Horizon-BCBSNJ.COM Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Lisa,

I am writing to submit an answer to your question which was as follows:

The spreadsheet column entitled “Total Number of Individuals Covered by Policy (include all dependents

covered)” contains the number

enrollees at the end of the seco

(i.e., Individual, Employee + Child, etc.).

. However, the application letter states that the B&E Plus Plan hadend of the seco (i.e., Individual, Employee + Child, etc.). arter. Please confirm the number of

arter. Please confirm the number of enrollees under each tier of cov

Ex. 4
Ex. 4

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey sen

sheet by indicating that the total number of of individuals covered was

BCBSNJ does not maintain its data in terms of members per tier. Hori

contracts per tier.

ail to Ms. Pham correcting the data

members instead of

Ex. 4
Ex. 4
Ex. 4
Ex. 4

Horizon

terms of

BSNJ maintains its d

The Ex. 4 Sing
The
Ex. 4
Sing

members represents

Ex. 4

Two adults

Adult/Child/ren

Family

contracts which when broken down by tier is as follows:members represents Ex. 4 Two adults Adult/Child/ren Family Total Ex. 4 contracts Obviously, the above represents

Total

Ex. 4
Ex. 4

contracts

Obviously, the above represents

Ex. 4
Ex. 4

members in the single category and

Ex. 4
Ex. 4

members in the two adult category.

The question is the number of m

in the Adult/Child/ren and Family c

es.

I hope this information is helpful.

If I can be of further assistance, please contact me.

Sincerely,

Jill

Jill Swyer Novak

Assistant General Counsel

973 - 466 - 7421

973 - 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e- mail if you have received this e-mail by mistake and delete this e-mail from your system. ============================================================================== This message and any attachments are solely for the intended recipient. If you are not the intended recipient, disclosure, copying, use, or distribution of the information included in this message is prohibited -- please immediately and permanently delete this message. ============================================================================== ============================================================================== This message and any attachments are solely for the intended recipient. If you are not the intended recipient, disclosure, copying, use, or distribution of the information included in this message is prohibited -- please immediately and permanently delete this message. ==============================================================================

file:///T|/

HBCBSNJ:000031

Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Correspondence%20about%20call%202.16.11.htm[10/25/2011

12:45:42 PM]

============================================================================== This message and any attachments are solely for the intended recipient. If you are not the intended recipient, disclosure, copying, use, or distribution of the information included in this message is prohibited -- please immediately and permanently delete this message. ==============================================================================

============================================================================== This message and any attachments are solely for the intended recipient. If you are not the intended recipient, disclosure, copying, use, or distribution of the information included in this message is prohibited -- please immediately and permanently delete this message. ==============================================================================

file:///T|/

HBCBSNJ:000032

Blue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Correspondence%20about%20call%202.16.11.htm[10/25/2011

12:45:42 PM]

From:

Jill_Swyernovak@Horizon-BCBSNJ.com

Sent:

Wednesday, February 16, 2011 4:35 PM

To:

Keels, Lisa (HHS/OCIIO)

Subject:

RE: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Follow Up Flag:

Follow up

Flag Status:

Flagged

Thank you very much, Lisa.

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

Cc:

Date:

02/16/2011 04:33 PM

Subject:

RE: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Jill. I will work on scheduling the call and will confirm with you as soon as possible.

All the best, Lisa

Sent: Wednesday, February 16, 2011 4:30 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: Re: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional

Information

Hello Lisa.

Wednesday, February 23, 2011 at 10 am is fine. As alternative dates and times, I would like to suggest Thursday, February 24, 2011 at 11 am and Friday, February 25, 2011 at 10 am.

Regards,

Jill

HBCBSNJ:000033

file:///T|/

ue%20Shield%20of%20New%20Jersey/Correspondence%20about%20scheduling%20a%20call%202.16.11.htm[10/25/2011

12:45:43 PM]

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are not the named addressee, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e- mail if you have received this e-mail by mistake and delete this e-mail from your system.

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

Cc:

"Kottenmeier, Erika (HHS/OCIIO)" <Erika.Kottenmeier@hhs.gov>

Date:

02/15/2011 04:06 PM

Subject:

FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Hello again, Jill,

In addition to letting me know if you are available at 10:00am next Wednesday, February 23

availability for two additional dates/times?

earliest convenience.

rd

, could you also please let me know your

Scheduling changes often arise, and we would like to be able to schedule this call at everyone’s

Thank you again, Lisa

From: Keels, Lisa (HHS/OCIIO)

Sent: Tuesday, February 15, 2011 3:41 PM

To: 'Jill_Swyernovak@Horizon-BCBSNJ.com'

Cc: Kottenmeier, Erika (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Jill,

Our leadership would like to schedule a call with you to discuss Horizon Blue Cross Blue Shield of New Jersey’s annual limits waiver application.

Please let me know if you would be available for a call at 10:00am next Wednesday, February 23 rd .

Thank you,

Lisa

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com] Sent: Thursday, February 03, 2011 4:24 PM To: Keels, Lisa (HHS/OCIIO) Cc: Adam_Young@horizonblue.com Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

file:///T|/

HBCBSNJ:000034

ue%20Shield%20of%20New%20Jersey/Correspondence%20about%20scheduling%20a%20call%202.16.11.htm[10/25/2011

12:45:43 PM]

Dear Lisa,

Thank you very much for the information. I appreciate your help. I will look forward to hearing from you soon.

Regards,

Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

Cc:

"Habit, Sandra (HHS/OCIIO)" <Sandra.Habit@hhs.gov>

Date:

02/03/2011 03:33 PM

Subject:

RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Jill,

I just wanted to let you know that your application is complete, and you should be hearing from HHS soon.

Thank you,

Lisa

Sent: Thursday, February 03, 2011 2:02 PM

To: Keels, Lisa (HHS/OCIIO) Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Lisa. Regards, Jill

Jill Swyer Novak

Assistant General Counsel

973 - 466 - 7421

HBCBSNJ:000035

file:///T|/

ue%20Shield%20of%20New%20Jersey/Correspondence%20about%20scheduling%20a%20call%202.16.11.htm[10/25/2011

12:45:43 PM]

973 - 466 - 7759 email: jill_swyernovak@horizonblue.com

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are not the named addressee, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e- mail if you have received this e-mail by mistake and delete this e-mail from your system.

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Jill. I will let you know if we have additional questions.

Best,

Lisa

Sent: Thursday, February 03, 2011 1:33 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Lisa,

I am writing to submit an answer to your question which was as follows:

The spreadsheet column entitle

covered)” contains the number

enrollees at the end of the secon

(i.e., Individual, Employee + Child, etc.).

tal Number of Individuals Covered by Policy (include all dependent

. However, the application letter states that the B&E Plus Plan hadof Individuals Covered by Policy (include all dependent arter. Please confirm the number of enrollees under

arter. Please confirm the number of enrollees under each tier of cov

Ex. 4
Ex. 4

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey sent an email to Ms. Pham corr

sheet by indicating that the total number of of individuals covered was

BCBSNJ does not maintain its data in terms of members per tier. Hori

the data

Horizon

terms of

Ex. 4
Ex. 4

members instead of

BSNJ maintains its d

Ex. 4
Ex. 4
cont er tier. The Ex. 4 mem Ex. 4 Sing Two adults Adult/Child/ren Family
cont
er tier.
The
Ex. 4
mem
Ex. 4
Sing
Two adults
Adult/Child/ren
Family

sents

contracts which when broken down by tier is as follows:mem Ex. 4 Sing Two adults Adult/Child/ren Family sents HBCBSNJ:000036 file:///T|/

HBCBSNJ:000036

file:///T|/

ue%20Shield%20of%20New%20Jersey/Correspondence%20about%20scheduling%20a%20call%202.16.11.htm[10/25/2011

12:45:43 PM]

Total

Ex. 4
Ex. 4

contracts

Obviously, the above represents

Ex. 4
Ex. 4

members in the single category and

Ex. 4
Ex. 4

members in the two adult category.

The question is the number of m

in the Adult/Child/ren and Family c

ies.

I hope this information is helpful. If I can be of further assistance, please contact me.

Sincerely,

Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

==============================================================================

This message and any attachments are solely for the intended recipient. If you are not the

intended recipient, disclosure, copying, use, or distribution of the information included in this

message is prohibited -- please immediately and permanently delete this message.

==============================================================================

==============================================================================

This message and any attachments are solely for the intended recipient. If you are not the

intended recipient, disclosure, copying, use, or distribution of the information included in this

message is prohibited -- please immediately and permanently delete this message.

==============================================================================

==============================================================================

This message and any attachments are solely for the intended recipient. If you are not the

intended recipient, disclosure, copying, use, or distribution of the information included in this

message is prohibited -- please immediately and permanently delete this message.

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This message and any attachments are solely for the intended recipient. If you are not the

intended recipient, disclosure, copying, use, or distribution of the information included in this

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Please notify the sender immediately by e-

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file:///T|/

HBCBSNJ:000037

ue%20Shield%20of%20New%20Jersey/Correspondence%20about%20scheduling%20a%20call%202.16.11.htm[10/25/2011

12:45:43 PM]

From:

Jill_Swyernovak@Horizon-BCBSNJ.com

Sent:

Wednesday, February 16, 2011 4:30 PM

To:

Keels, Lisa (HHS/OCIIO)

Cc:

Adam_Young@horizonblue.com

Subject:

Re: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Follow Up Flag:

Follow up

Flag Status:

Flagged

Hello Lisa.

Wednesday, February 23, 2011 at 10 am is fine. As alternative dates and times, I would like to suggest Thursday, February 24,

2011 at 11 am and Friday, February 25, 2011 at 10 am.

Regards,

Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

Cc:

"Kottenmeier, Erika (HHS/OCIIO)" <Erika.Kottenmeier@hhs.gov>

Date:

02/15/2011 04:06 PM

Subject:

FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Hello again, Jill,

In addition to letting me know if you are available at 10:00am next Wednesday, February 23 rd , could you also please let me know your availability for two additional dates/times? Scheduling changes often arise, and we would like to be able to schedule this call at everyone’s earliest convenience.

Thank you again, Lisa

From: Keels, Lisa (HHS/OCIIO) Sent: Tuesday, February 15, 2011 3:41 PM

HBCBSNJ:000038

file:///T|/

%20Cross%20Blue%20Shield%20of%20New%20Jersey/Scheduling%20a%20Call%20response%202.16.11.htm[10/25/2011

12:45:44 PM]

To: 'Jill_Swyernovak@Horizon-BCBSNJ.com' Cc: Kottenmeier, Erika (HHS/OCIIO) Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Jill,

Our leadership would like to schedule a call with you to discuss Horizon Blue Cross Blue Shield of New Jersey’s annual limits waiver application.

Please let me know if you would be available for a call at 10:00am next Wednesday, February 23 rd .

Thank you,

Lisa

Sent: Thursday, February 03, 2011 4:24 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Lisa,

Thank you very much for the information. I appreciate your help.

I will look forward to hearing from you soon.

Regards,

Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

Cc:

"Habit, Sandra (HHS/OCIIO)" <Sandra.Habit@hhs.gov>

Date:

02/03/2011 03:33 PM

Subject:

RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Jill,

I just wanted to let you know that your application is complete, and you should be hearing from HHS soon.

file:///T|/

HBCBSNJ:000039

%20Cross%20Blue%20Shield%20of%20New%20Jersey/Scheduling%20a%20Call%20response%202.16.11.htm[10/25/2011

12:45:44 PM]

Thank you,

Lisa

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com] Sent: Thursday, February 03, 2011 2:02 PM To: Keels, Lisa (HHS/OCIIO) Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Lisa. Regards, Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Jill. I will let you know if we have additional questions.

Best,

Lisa

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com] Sent: Thursday, February 03, 2011 1:33 PM To: Keels, Lisa (HHS/OCIIO) Cc: Adam_Young@horizonblue.com; Colleen_Brennan@Horizon-BCBSNJ.COM Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Lisa,

I am writing to submit an answer to your question which was as follows:

file:///T|/

HBCBSNJ:000040

%20Cross%20Blue%20Shield%20of%20New%20Jersey/Scheduling%20a%20Call%20response%202.16.11.htm[10/25/2011

12:45:44 PM]

The spreadsheet column entitled “Total Number of Individuals Covered by Policy (include all dependent

covered)” contains the number

enrollees at the end of the second quarter. Please confirm the number of enrollees under each tier of coverage (i.e., Individual, Employee + Child, etc.).

. However, the application letter states that the B&E Plus Plan hadtier of coverage (i.e., Individual, Employee + Child, etc.). Ex. 4 On January 4, 2011, Horizon

Ex. 4
Ex. 4

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey se sheet by indicating that the total number of of individuals covered was

BCBSNJ does not maintain its data in terms of members per tier. Hori

ail to Ms. Pham correcting the data

members instead of

Ex. 4
Ex. 4
Ex. 4
Ex. 4

Horizon

terms of

BSNJ maintains its d

cont The Ex. 4
cont
The
Ex. 4

r tier. members represents

Ex. 4

Sin

Two adults

Adult/Child/ren

Family

Ex. 4
Ex. 4

contracts which when broken down by tier is as follows:

Total

contractswhich when broken down by tier is as follows: Total Obviously, the above represents Ex. 4

Obviously, the above represents

Ex. 4
Ex. 4

The question is the number of

members in the single category and

in the Adult/Child/ren and Family c

Ex. 4
Ex. 4

members in the two adult category.

ies.

I hope this information is helpful.

If I can be of further assistance, please contact me.

Sincerely,

Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

==============================================================================

This message and any attachments are solely for the intended recipient. If you are not the

intended recipient, disclosure, copying, use, or distribution of the information included in this

message is prohibited -- please immediately and permanently delete this message.

==============================================================================

==============================================================================

This message and any attachments are solely for the intended recipient. If you are not the

intended recipient, disclosure, copying, use, or distribution of the information included in this

message is prohibited -- please immediately and permanently delete this message.

============================================================================== ============================================================================== This message and any attachments are solely for the intended recipient. If you are not the intended recipient, disclosure, copying, use, or distribution of the information included in this message is prohibited -- please immediately and permanently delete this message. ==============================================================================

Please notify the sender immediately by e-

============================================================================== This message and any attachments are solely for the intended recipient. If you are not the intended recipient, disclosure, copying, use, or distribution of the information included in this message is prohibited -- please immediately and permanently delete this message. ==============================================================================

file:///T|/

HBCBSNJ:000041

%20Cross%20Blue%20Shield%20of%20New%20Jersey/Scheduling%20a%20Call%20response%202.16.11.htm[10/25/2011

12:45:44 PM]

From:

Jill_Swyernovak@Horizon-BCBSNJ.com

Sent:

Thursday, February 17, 2011 10:56 AM

To:

Keels, Lisa (HHS/OCIIO)

Cc:

Adam_Young@horizonblue.com

Subject:

RE: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Follow Up Flag:

Follow up

Flag Status:

Flagged

Hi Lisa.

Would it be possible to provide me with an agenda for the call? We would like to be able to have the appropriate people on the

call to respond to your questions.

Thanks very much for your help.

Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

Cc:

Date:

02/16/2011 04:33 PM

Subject:

RE: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Jill. I will work on scheduling the call and will confirm with you as soon as possible.

All the best, Lisa

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com] Sent: Wednesday, February 16, 2011 4:30 PM To: Keels, Lisa (HHS/OCIIO) Cc: Adam_Young@horizonblue.com Subject: Re: FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Hello Lisa.

file:///T|/

HBCBSNJ:000042

lue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Question%20re%20Call%20Agenda%202.17.11.htm[10/25/2011

12:45:44 PM]

Wednesday, February 23, 2011 at 10 am is fine. As alternative dates and times, I would like to suggest Thursday, February 24, 2011 at 11 am and Friday, February 25, 2011 at 10 am.

Regards,

Jill

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

Cc:

"Kottenmeier, Erika (HHS/OCIIO)" <Erika.Kottenmeier@hhs.gov>

Date:

02/15/2011 04:06 PM

Subject:

FW: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Hello again, Jill,

In addition to letting me know if you are available at 10:00am next Wednesday, February 23

availability for two additional dates/times?

earliest convenience.

rd

, could you also please let me know your

Scheduling changes often arise, and we would like to be able to schedule this call at everyone’s

Thank you again, Lisa

From: Keels, Lisa (HHS/OCIIO)

Sent: Tuesday, February 15, 2011 3:41 PM

To: 'Jill_Swyernovak@Horizon-BCBSNJ.com'

Cc: Kottenmeier, Erika (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Jill,

Our leadership would like to schedule a call with you to discuss Horizon Blue Cross Blue Shield of New Jersey’s annual limits waiver application.

Please let me know if you would be available for a call at 10:00am next Wednesday, February 23 rd .

Thank you,

Lisa

file:///T|/

HBCBSNJ:000043

lue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Question%20re%20Call%20Agenda%202.17.11.htm[10/25/2011

12:45:44 PM]

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com] Sent: Thursday, February 03, 2011 4:24 PM To: Keels, Lisa (HHS/OCIIO) Cc: Adam_Young@horizonblue.com Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Lisa,

Thank you very much for the information. I appreciate your help. I will look forward to hearing from you soon.

Regards,

Jill

Jill Swyer Novak

Assistant General Counsel

973 - 466 - 7421

973 - 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are

not the named addressee, you should not disseminate, distribute or copy this e-mail.

mail if you have received this e-mail by mistake and delete this e-mail from your system.

Please notify the sender immediately by e-

From:

"Keels, Lisa (HHS/OCIIO)" <Lisa.Keels@hhs.gov>

To:

Cc:

"Habit, Sandra (HHS/OCIIO)" <Sandra.Habit@hhs.gov>

Date:

02/03/2011 03:33 PM

Subject:

RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Jill,

I just wanted to let you know that your application is complete, and you should be hearing from HHS soon.

Thank you,

Lisa

From: Jill_Swyernovak@Horizon-BCBSNJ.com [mailto:Jill_Swyernovak@Horizon-BCBSNJ.com] Sent: Thursday, February 03, 2011 2:02 PM To: Keels, Lisa (HHS/OCIIO) Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Lisa. Regards,

HBCBSNJ:000044

file:///T|/

lue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Question%20re%20Call%20Agenda%202.17.11.htm[10/25/2011

12:45:44 PM]

Jill

Jill Swyer Novak Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759

This message contains confidential attorney/client privileged information and is intended only for the individual(s) named. If you are not the named addressee, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e- mail if you have received this e-mail by mistake and delete this e-mail from your system.

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Thank you, Jill. I will let you know if we have additional questions.

Best,

Lisa

Sent: Thursday, February 03, 2011 1:33 PM

To: Keels, Lisa (HHS/OCIIO)

Subject: RE: Horizon Blue Cross Blue Shield of New Jersey Annual Limits Waiver Application - Request for Additional Information

Dear Lisa,

I am writing to submit an answer to your question which was as follows:

The spreadsheet column entitled “Total Number of Individuals Covered by Policy (include all dependents

covered)” contains the number

enrollees at the end of the seco

(i.e., Individual, Employee + Child, etc.).

Ex. 4
Ex. 4

. However, the application letter states that the B&E Plus Plan had

arter. Please confirm the number of enrollees under each tier of cov

Ex. 4
Ex. 4

On January 4, 2011, Horizon Blue Cross Blue Shield of New Jersey sen

sheet by indicating that the total number of of individuals covered was

BCBSNJ does not maintain its data in terms of members per tier. Horizon BCBSNJ maintains its d contracts per tier.

The

ail to Ms. Pham corr

members instead of

the data

. Horizon

terms of

Ex. 4
Ex. 4
Ex. 4
Ex. 4
Ex. 4
Ex. 4

members represents

Ex. 4
Ex. 4

contracts which when broken down by tier is as follows:

HBCBSNJ:000045

file:///T|/

lue%20Cross%20Blue%20Shield%20of%20New%20Jersey/Question%20re%20Call%20Agenda%202.17.11.htm[10/25/2011

12:45:44 PM]

Single

Two adults

Adult/Child/ren

Family

Total

Ex. 4

contractsSingle Two adults Adult/Child/ren Family Total Ex. 4 Obviously, the above represents Ex. 4 The question

Obviously, the above represents

Ex. 4
Ex. 4

The question is the number of m

members in the single category and

Ex. 4
Ex. 4

in the Adult/Child/ren and Family c

I hope this information is helpful. If I can be of further assistance, please contact me.

Sincerely,

Jill

members in the two adult category. ies.

Jill Swyer Novak

Assistant General Counsel

973

- 466 - 7421

973

- 466 - 7759