§9703 Plan Benefits

Summary

Trustees must enroll eligible people in prepaid health plans that give health care. They must use available plan money so coverage is, as much as possible, the same as the 1950 and 1974 UMWA Benefit Plans as of January 1, 1992. Each year trustees will negotiate payment rates that can differ by area so people everywhere get a similar level of benefits, but total payments from the Combined Fund for a year cannot be more than the total premiums required under section 9704(a) for that year. That cap is reduced by death benefit premiums under section 9704(c) and by the amount set aside for administration under subsection (d), and it can be increased by reductions from transfers under section 9705, by certain carryovers from earlier years under 9704(e)(3)(B)(i) if the trustees choose to use them, and by any interest the trustees choose to use. Trustees may not contract with providers who need Medicare certification under title XVIII unless the provider is certified. Health benefits begin on and after February 1, 1993. The trustees may hold back up to 5 percent of premiums each year for administration. The Combined Fund may only enroll people who were receiving benefits under the 1950 or 1974 UMWA Benefit Plans on July 20, 1992. For certain eligible people who were retirees receiving benefits on July 20, 1992, trustees must provide death benefits that match what the 1950 or 1974 UMWA Pension Plan (as appropriate) provided on July 20, 1992, starting on and after February 1, 1993. The 1950 and 1974 Pension Plans must be changed so they stop providing those death benefits on and after February 1, 1993. "Eligible beneficiary" means either a coal industry retiree who was eligible for and receiving benefits from the 1950 or 1974 plans on July 20, 1992, or someone receiving benefits on that date because of their relationship to such a retiree.