Internal Revenue Code:Sec. 9703. Plan benefits

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Location in Internal Revenue Code

     TITLE 26 - INTERNAL REVENUE CODE
      Subtitle J - Coal Industry Health Benefits
       CHAPTER 99 - COAL INDUSTRY HEALTH BENEFITS
        Subchapter B - Combined Benefit Fund
         PART I - ESTABLISHMENT AND BENEFITS
       

Statute

    Sec. 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
        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
            (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
        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.
      (4) Effective date
        Benefits shall be provided under paragraph (1) on and after
      February 1, 1993.
    (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
      The trustees of the Combined Fund may reserve for each plan year,
    for use in payment of the administrative costs of the Combined
    Fund, an amount not to exceed 5 percent of the premiums to be paid
    to the Combined Fund under section 9704(a) during the plan year.
    (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
        (2) on such date was eligible to receive, and receiving,
      benefits in either such plan by reason of a relationship to such
      retiree.
 

Sources

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

References in Text

                             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 (Sec. 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.
 

References

                   SECTION REFERRED TO IN OTHER SECTIONS
      This section is referred to in sections 9701, 9704 of this title.