Wyo. Code R. 014-0001-2
General Agency, Board or Commission Rules
Chapter 2: Services for Miners
Effective Date: 01/16/2013 to 01/08/2016
Rule Type: Superceded Rules & Regulations
Reference Number: 014.0001.2.01162013
(a) To be eligible for any services or benefits provided by the Board an individual must:
(i) Obtain a Board registration form, provide all information required to fully complete the form, and submit the form as directed; and
(ii) Be a resident of Wyoming at the time any services or benefits are applied for; and
(iii) While a resident of Wyoming have either:
(A) Twelve (12) consecutive months of service at a mine site in Wyoming or a contiguous state; or
(B) Been injured while at work in a mine in Wyoming or a contiguous state and be unable to continue working as a miner due to that injury; and
(iv) Be in need of services or benefits provided by the Board.
(b) The following may be submitted as evidence of an individual’s eligibility for services:
(i) Residency - Any of the following: Voter registration; current Wyoming driver’s license; current Wyoming identification card; current Wyoming resident hunting or fishing license; or any other information which verifies residency acceptable to the board. A general hospital stay does not qualify as time toward meeting the residency period.
(ii) Employment as a miner - Employment records; W-2 forms; notarized attestation by third parties with personal knowledge of the individual’s employment as a miner; or any other information which verifies employment as a miner.
(iii) Injury and inability to work as miner – Workers Compensation records; mine personnel records; medical records; Social Security Records; or any other information which verifies that the injury occurred and the miner is unable to work as a miner due to the injury.
(iv) Need for services – Provider’s written statement.
In order to provide benefits with emphasis on pulmonary/respiratory, hearing loss, cardiac and musculoskeletal conditions of miners and as part of the Board’s plan to meet the miners’ health care needs in the state as required by W.S. 30-6-102(b), benefits for all miners are established as follows:
(a) A Medical Assistance Benefit of not more than five thousand dollars ($5,000.00) per miner/per calendar year for pulmonary/respiratory, cardiac and musculoskeletal conditions of miners which are due to labor in the mining industry.
(i) Benefits for chiropractic treatment are limited to:
(A) Fifty dollars ($50.00) per visit; and
(B) Twenty-one (21) visits per calendar year.
(b) A Hearing Aid Benefit of not more than two thousand dollars ($2,000.00) toward the purchase of new or replacement hearing aids.
(a) To be eligible for the Medical Assistance Benefit an individual must:
(i) Have completed a Board registration form, and have established eligibility as provided in Section 1 and received a Miner’s Hospital Program Identification Card; and
(ii) Suffer from pulmonary/respiratory disease, hearing loss, a cardiac condition or a musculoskeletal condition which is due to labor in the mining industry and requires medical attention and care; and
(iii) Have incurred expenses for medical care, including prescription drugs, related to covered conditions which no third party is obligated to pay.
(b) The following may be submitted as evidence of an individual’s eligibility for the benefit:
(i) Diagnosis of Condition. Written statement of physician or any other information which verifies the condition and need for treatment.
(ii) Exhaustion of Third Party Sources of Payment. Explanation of Benefits from insurance company, medicaid or Medicare or any other third party (except spouse or family member) responsible to pay for treatment received and statement from medical provider that other third party sources of payment have been explored and exhausted. A claimant may submit an affidavit certifying that he or she is not covered by any policy of insurance which provides coverage of or reimbursement for prescription medications.
(iii) Out-of-Pocket Expenses. Statement of medical provider; statement from health insurance company; or statement under penalty of perjury from miner, miner's next-of-kin or personal representative.
(a) Claims for miners having a current Miners' Hospital Identification Card for benefits other than Prescription Drug Assistance will be submitted directly to the Board's third party administrator by the medical provider or miner on a standard health insurance claim form or other form acceptable to the third party administrator.
(b) Claims for Prescription Drug Assistance:
(i) Miners covered by insurance providing prescription drug coverage may submit pharmacy receipts accompanied by their name and mailing address to the Board's third party administrator. The miner's out of pocket costs for covered prescriptions will be paid directly to the miner.
(ii) Miners with no insurance may request a Prescription Hardship. The Hardship will be determined on a case by case basis and will be issued a Miner's Hospital Identification Card which allows pharmacies to charge the entire cost of covered prescriptions, up to the annual maximum allowed under Section 2(a), to the Board. The Prescription Hardship must be renewed every October.
(c) Claims will be accepted on a first received/first accepted basis.
(d) Accepted claims will only be paid on a funds available basis. Once the funds budgeted for the initial period or a calendar year are exhausted, no further claims for services provided during that period or calendar year will be paid.
(e) All claims for a calendar year must be received on or before June 30 of the year following.
(f) Claims received but not accepted or paid due to lack of budgeted funds may not be resubmitted or paid.
All payments except reimbursement for covered prescription drugs will be made directly to medical providers or pharmacies. Payment for prescription drug reimbursement may be made directly to individuals.
Payment of up to two thousand dollars ($2,000.00) will be made to those providers on the Board's preferred provider list and of up to one thousand five hundred dollars ($1,500.00) to other providers. Benefits received for hearing aids are not included in the Medical Assistance Benefit.