Wyo. Code R. 014-0001-2
General Agency, Board or Commission Rules
Chapter 2: Services For Miners
Effective Date: 10/17/2006 to 06/24/2008
Rule Type: Superceded Rules & Regulations
Reference Number: 014.0001.2.10172006
(a) To be eligible for 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.
(ii) Be a resident of Wyoming.
(iii) Be or have been employed as a miner.
(iv) Be in need of services provided by the Board.
(b) The following may be submitted as evidence of an individual's eligibility for services:
(i) Residency-Deed, Lease, or Real Estate Sales Contract; property tax statements; utility bills; voter registration; attestation by third parties; or any other information which verifies residency. A general hospital stay does not qualify as time toward meeting the residency period.
(ii) Employment as a miner-Employment records; W-2 forms; 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) Need for services-Physician'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), a benefit to all miners is established as follows:
For the initial period beginning September 1, 2004, and ending December 31, 2005, and for each calendar year thereafter, there is hereby established a Medical Assistance Benefit of not more than one thousand dollars ($1,000.00) per miner/per calendar year.
(a) To be eligible for the Medical Assistance Benefit an individual must:
(i) Have completed a Board registration form and established eligibility as provided in Section 1.
(ii) Suffer from pulmonary/respiratory disease, hearing loss, a cardiac condition or a musculoskeletal condition which requires medical attention and care.
(iii) Have incurred expenses for medical care related to covered conditions which no third party is obligated to pay, and either:
A. Have no insurance which provides coverage for medical care provided related to covered conditions, or
B. Have incurred one thousand five hundred dollars ($1,500.00) in out-of-pocket expenses for medical care provided the individual for covered conditions during the initial period or calendar year for which claims are submitted.
(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.
(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 previously registered will be submitted directly to the Board's third party administrator by the provider of the medical services on a standard HEALTH INSURANCE CLAIM FORM.
(b) Claims will be accepted on a first received/first accepted basis.
(c) 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.
(d) All claims for the initial period or a calendar year must be received on or before June 30 of the year following.
(e) Claims received but not accepted or paid due to lack of budgeted funds may not be resubmitted or paid.
All payments will be made directly to the providers of medical services. No payment will be made directly to individuals.
Claims for miners covered by medical or hospital insurance will only be paid for out-of-pocket expenses for treatment received by the miner related to covered conditions which exceed one thousand five hundred dollars ($1,500.00) per year.
No payment will be made for hearing aids beyond the one thousand dollar ($1,000.00) payment established previously by the board. Hearing aids are not included in the Medical Assistance Benefit.
No payments will be made for prescription medication.