26 U.S. Code § 9703 - Plan benefits
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(a) In general
Each eligible beneficiary of the Combined Fund shall receive—
(b) Health benefits
(1) In general
The trustees of the Combined Fund shall provide health care benefits to each eligible beneficiary by enrolling the beneficiary in a health care services plan which undertakes to provide such benefits on a prepaid risk basis. The trustees shall utilize all available plan resources to ensure that, consistent with paragraph (2), coverage under the managed care system shall to the maximum extent feasible be substantially the same as (and subject to the same limitations of) coverage provided under the 1950 UMWA Benefit Plan and the 1974 UMWA Benefit Plan as of January 1, 1992.
(2) Plan payment rates
(A) In general
The trustees of the Combined Fund shall negotiate payment rates with the health care services plans described in paragraph (1) for each plan year which are in amounts which—
(i) vary as necessary to ensure that beneficiaries in different geographic areas have access to a uniform level of health benefits; and
The amount determined under subparagraph (A)(ii) for any plan year shall be reduced—
(i) by the aggregate death benefit premiums determined under section 9704 (c) for the plan year, and
The amount determined under subparagraph (A)(ii) shall be increased—
(i) by any reduction in the total premium payments required to be paid under section 9704 (a) by reason of transfers described in section 9705,
(ii) by any carryover to the plan year from any preceding plan year which—
(3) Qualified providers
The trustees of the Combined Fund shall not enter into an agreement under paragraph (1) with any provider of services which is of a type which is required to be certified by the Secretary of Health and Human Services when providing services under title XVIII of the Social Security Act unless the provider is so certified.
(c) Death benefits coverage
(1) In general
The trustees of the Combined Fund shall provide death benefits coverage to each eligible beneficiary described in subsection (f)(1) which is identical to the benefits provided under the 1950 UMWA Pension Plan or 1974 UMWA Pension Plan, whichever is applicable, on July 20, 1992. Such coverage shall be provided on and after February 1, 1993.
(2) Termination of coverage
The 1950 UMWA Pension Plan and the 1974 UMWA Pension Plan shall each be amended to provide that death benefits coverage shall not be provided to eligible beneficiaries on and after February 1, 1993. This paragraph shall not prohibit such plans from subsequently providing death benefits not described in paragraph (1).
(d) Reserves for administration
(e) Limitation on enrollment
The Combined Fund shall not enroll any individual who is not receiving benefits under the 1950 UMWA Benefit Plan or the 1974 UMWA Benefit Plan as of July 20, 1992.
(f) Eligible beneficiary
For purposes of this subchapter, the term “eligible beneficiary” means an individual who—
(1) is a coal industry retiree who, on July 20, 1992, was eligible to receive, and receiving, benefits from the 1950 UMWA Benefit Plan or the 1974 UMWA Benefit Plan, or
Source(Added Pub. L. 102–486, title XIX, § 19143(a),Oct. 24, 1992, 106 Stat. 3041.)
References in Text
The Social Security Act, referred to in subsec. (b)(3), is act Aug. 14, 1935, ch. 531, 49 Stat. 620, as amended. Title XVIII of the Act is classified generally to subchapter XVIII (§ 1395 et seq.) of chapter 7 of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables.