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Pennsylvania Employee Benefit Trust Fund Prior Authorization Form

The United Mine Workers of America Health and Retirement Funds (the “Funds”) are a group of multi-employer plans that provide health and retirement benefits to retired coal miners and their eligible dependents. The fund was established at the White House in 1946 in a treaty between the United Mine Workers of America (“UMWA”) and the federal government. Since this year, UMWA and the Bituminous Coal Operators` Association, Inc. (“BCOA”) have been regularly negotiating social benefits for coal miners, retirees and their dependents. Currently, the funds provide services to more than 86,000 beneficiaries. Are you eligible for Medicare? The funds require you to enroll in Medicare Part B and keep your Part B to qualify or keep the health services card for your funds. Remember to register for Part B when you first become eligible and notify the Funds Call Centre at (800) 291-1425 when your health insurance benefits begin. For more information on enrolling in Medicare, visit the following website: United Mine Workers of America Health and Retirement Funds (the “Funds”) are a group of multi-employer plans that provide health and retirement benefits to retired coal miners and their eligible dependents. and you have not yet started receiving your benefits, please contact the Funds Call Centre immediately.

UMWA offers comprehensive health insurance. There are approximately 17,000 cooperating fund providers representing a full range of services. If you receive your maintenance medication through the pharmacy postal service of funds, you will pay a lower co-payment than retail pharmacies and get a 90-day supply of your medication. Plus, you`ll save money on gas because your medications are delivered directly to your home. Using the pharmacy mail service program will also save your money money. Do not hesitate. Call quickly. Start today at: 1-866-443-9160 to have your prescription medications transferred.

Form 1099-R will be shipped by the end of January 2021. You may obtain a copy of your Form 1095-B 2020 upon request by sending this request to: UMWA Health & Retirement Funds 2121 K Street, NW Suite 350 Washington DC 20037 You may contact the funds at (800) 291-1425 if you have any questions. Learn more about our deferred cash savings plans and funds. .

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