U.S. Code
»
Title 26
» Subtitle Subtitle J— Coal Industry Health Benefits › Chapter CHAPTER 99— COAL INDUSTRY HEALTH BENEFITS › Subchapter Subchapter B— Combined Benefit Fund › Part PART I— ESTABLISHMENT AND BENEFITS
26 U.S.C. § 9703
Plan benefits
(a) In generalEach 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 generalThe 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 generalThe 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) ReductionsThe 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) IncreasesThe 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 providersThe 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 dateBenefits shall be provided under paragraph (1) on and after February 1, 1993.
(c) Death benefits coverage(1) In generalThe 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 coverageThe 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 administrationThe 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 enrollmentThe 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 beneficiaryFor 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.)Editorial NotesReferences in TextThe Social Security Act, referred to in subsec. (b)(3), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. 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.
Notes of Decisions
A. T. Massey Coal Co v. Holland, 472 F.3d 148 (4th Cir. 2007).
· cites it 6× “See 26 U.S.C. § 9703 (b)(1). Because these benefits are more comprehensive and include many benefits that oth- erwise would be provided by Medicare, the benefits provided by the MASSEY COAL CO.”
Fawn Mining Corp. v. Marty D. Hudson, 80 F.3d 519 (D.C. Cir. 1996).
· cites it 8× “See 26 U.S.C. § 9703 (f). Although the retirees had, under the court orders, received reimbursement for costs incurred on (and before) July 20, 1992, they did not receive such coverage until the issuance of the orders, which did not occur until well after that date.”
Holland v. Big River Minerals Corp., 181 F.3d 597 (4th Cir. 1999).
“See 26 U.S.C.A. § 9703 . Second, the Coal Act mandated the continuance of individual employer plans maintained by signatories to the 1978 (and subsequent) NBCWAs; these plans provide health coverage for retirees who were receiving or were eligible to receive retiree benefits as…”
United States Pipe & Foundry Co. LLC v. Michael H. Holland, 32 F.4th 1324 (11th Cir. 2022).
· cites it 3× “26 U.S.C. § 9703 (a), (f ). The covered entities pay an annual premium that is calculated by the Commissioner of Social Security and is based on the number of beneficiaries assigned to the coal company and the Combined Fund’s estimated costs.”
Ass'n of Bituminous Contractors, Inc. v. Apfel, 156 F.3d 1246 (D.C. Cir. 1998).
“The Act established the Combined Benefit Fund as a new source of benefits for coal industry retiree beneficiaries who were eligible under the 1950 and 1974 Plans, see 26 U.S.C. § 9703 (f), and a Board of Trustees to administer the Combined Funds, see 26 U.”
A T Massey Coal Co v. Massanari, Acting, 305 F.3d 226 (4th Cir. 2002).
· cites it 4× “5 26 U.S.C. §§ 9703 (a), (b), (c), & (f). The Combined Fund is financed by annual premiums assessed against "signatory operators," i.”
Fawn Mining Corp. v. Hudson, 878 F. Supp. 240 (D.D.C. 1995).
· cites it 3× “” 26 U.S.C. § 9703 (b)(1). “Eligible beneficiary” was defined by 26 U.”
Barrick Gold Expl., Inc. v. Hudson, 823 F. Supp. 1395 (S.D. Ohio 1993).
“26 U.S.C. § 9703 (f). All 1988 agreement operators are required to make contributions to the Combined Fund ■ during the first eight months, commencing February 1, 1993, in an amount sufficient to pay benefits and administrative costs incurred by the Combined Fund during those…”
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