26 USC 9703 - Plan benefits

U.S Code last checked for updates: Nov 23, 2024

§ 9703.

Plan benefits

(a)

In general

Each eligible beneficiary of the Combined Fund shall receive—

(1)

health benefits described in subsection (b), and

(2)

in the case of an eligible beneficiary described in subsection (f)(1), death benefits coverage described in subsection (c).

(b)

Health benefits

(1)

In general

(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

(ii)

result in aggregate payments for such plan year from the Combined Fund which do not exceed the total premium payments required to be paid to the Combined Fund under section 9704(a) for the plan year, adjusted as provided in subparagraphs (B) and (C).

(B)

Reductions

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

(ii)

by the amount reserved for plan administration under subsection (d).

(C)

Increases

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—

(I)

is derived from amounts described in section 9704(e)(3)(B)(i), and

(II)

the trustees elect to use to pay benefits for the current plan year, and

(iii)

any interest earned by the Combined Fund which the trustees elect to use to pay benefits for the current plan year.

(3)

Qualified providers

(4)

Effective date

(c)

Death benefits coverage

(1)

In general

(2)

Termination of coverage

(d)

Reserves for administration

(e)

Limitation on enrollment

(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

(2)

on such date was eligible to receive, and receiving, benefits in either such plan by reason of a relationship to such retiree.

(Added Pub. L. 102–486, title XIX, § 19143(a), Oct. 24, 1992, 106 Stat. 3041.)

cite as: 26 USC 9703