§9703 Plan Benefits

Summary

The trustees of the Combined Fund must enroll eligible people in prepaid health plans and give them health care benefits that, as much as possible, match the coverage those plans had on January 1, 1992 under the 1950 and 1974 UMWA Benefit Plans. The trustees will negotiate payment rates so people in different areas get a similar level of care, and total payments from the Fund for a plan year cannot be more than the premium payments required under section 9704(a) for that year, after certain reductions and increases. Reductions subtract death benefit premiums under section 9704(c) and the amount set aside for administration (up to 5 percent of premiums). Increases add adjustments for transfers under section 9705, any eligible carryover from earlier years the trustees choose to use, and interest the trustees choose to use. Any provider that must be Medicare‑certified to offer services must have that certification. Health benefits start on February 1, 1993, and the Fund may only enroll people who were getting benefits from the 1950 or 1974 plans on July 20, 1992. An “eligible beneficiary” is a coal retiree getting those benefits on July 20, 1992, or someone receiving benefits because of their relationship to such a retiree. The trustees must also give death benefit coverage, starting February 1, 1993, to eligible retirees described above that is the same as the death benefits in the 1950 or 1974 UMWA Pension Plan on July 20, 1992. The two pension plans must be changed so they stop giving those death benefits on and after February 1, 1993, though they may later offer other death benefits.