Eligibility for Health Benefits

The UMWA Health and Retirement Funds’ provide comprehensive health benefits coverage to eligible retirees and their dependents. To assist with determining if a retiree, surviving spouse, or other dependent may qualify for benefits, see below.

The Health Benefit Application is used for both initial pensioner eligibility and to add dependents to the health card. Contact the Funds’ Pension Call Center at (800) 291-1425 to report any dependency changes, such as a divorce, a new marriage, or adding a family member to the health card.

Individuals that may qualify for Health Benefits:

Retired or disabled mineworkers

• Retired and disabled mine workers who are receiving 1950 Pension Plan pensions, unless they are receiving a Partial Pension and used non-classified (supervisory) service to meet the minimum vesting requirements.
• Certain disabled mine workers who are not eligible for pensions from the Funds.
• Certain retired and disabled mine workers who are receiving 1974 Pension Plan pensions.

Note: In general, 1974 Pension Plan pensioners and their dependents and survivors will be eligible for health benefits from the Funds only if the last signatory coal company that employed the mine workers was a participating employer, and only if that company has been determined by the Funds’ Trustees to be out of business and financially unable to provide the health benefits.

Dependents of retired or disabled mineworkers

• A spouse who is living with you or being supported by you.
• Unmarried children under the age of 22, if they are supported by you.
• Disabled children (with mental or physical disability) of any age if they are living with you or if they are confined to an institution for care and treatment. If such a child is age 22 or older, the disability must have begun before the age of 22 and must have remained continuous. A physician must provide documentation to substantiate the dependent’s inability to live and function independently.
• Unmarried grandchildren under the age of 22, if they live with you and are supported by you.
• Parents and parents-in-law if they have lived with you and been supported by you continuously for a period of at least one year.

Note: In general, you are considered to support a dependent if you provide over one-half of the dependent’s total support on a regular basis. However, a spouse who is living with you is presumed to be your dependent, regardless of the amount of support that you provide. For children who are full-time students, earnings and scholarships are not considered when determining the amount of support. When determining the amount of support for separated spouses, grandchildren, parents and parents-in-law, income from all sources is considered, including Social Security, Black Lung benefits, pensions, and employment.

Surviving spouse of a deceased mineworker

In general, the unmarried surviving spouse is eligible for Funds’ health benefits if the deceased mineworker was eligible for Funds’ pension and health benefits at the time of death, or if he was killed in a mine accident while employed in a classified job for a signatory employer. If you fit into any of the following categories you may be eligible for Funds’ health benefits.

• Widows of deceased mineworkers who were receiving 1950 Pension Plan pensions at the time of death.
• Surviving spouses of certain deceased mineworkers, who were receiving 1974 Pension Plan pensions at the time of death.
• Surviving spouses of certain mineworkers who were killed in mine accidents while they were employed in classified jobs for signatory employers.

Dependents of a surviving spouse

If you are the surviving spouse and you are eligible for Funds health benefits, the following individuals may be eligible for benefits as your dependents:

• Unmarried surviving children under the age of 22, if they are supported by you.
• Disabled surviving children of any age, if they are living with you or if they are confined to an institution for care and treatment. If such a child is over the age of 22, the disability must have begun before the age of 22 and must have remained continuous. A physician must provide documentation to substantiate the dependent’s inability to live and function independently.

If there is no surviving spouse but there are surviving unmarried dependent children, the children may be eligible for Funds’ Health Benefits in the following cases:

• If the deceased mine worker was eligible for Funds’ pension and health benefits at the time of death, the surviving children may be eligible until they reach the age of 22 or for 22 months after the month in which the mineworker died, whichever comes first.
• If the deceased mine worker was killed in a mining accident while employed in a classified job for a signatory employer, the surviving children may be eligible until they reach the age of 22 even if there is no surviving spouse.

Medicare enrollment

There are several types of Medicare coverage, including Part A (Hospital Insurance) and Part B (Medical Insurance). Funds’ beneficiaries who are eligible for Medicare must be enrolled in Part A (no premium) and Part B (a premium is required) at all times. The Funds will not provide health benefits for otherwise-eligible beneficiaries who are not enrolled in Medicare Parts A & B. If you are not enrolled in Medicare Part B coverage at the time you are determined to be otherwise eligible for health benefits from the Funds, the effective date of your health benefits coverage will be delayed until you are enrolled in Part B. Contact your Social Security Office for information about enrolling in Medicare.