
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 2, 2001]
[Document not affected by Public Laws enacted between
  January 2, 2001 and January 28, 2002]
[CITE: 26USC9703]

 
                     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
 
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.

(Added Pub. L. 102-486, title XIX, Sec. 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 (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.

                  Section Referred to in Other Sections

    This section is referred to in sections 9701, 9704 of this title.
