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受托人的意见
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在再保险
原告: 养老金领取者
被申请人: 雇主
ROD案例编号: 84-553——1988年2月24日
董事会:Joseph P. 康纳斯,老., Chairman; Paul R. 院长,受托人;
威廉·B. Jordan,受托人; William Miller,受托人; Donald E. 皮尔斯,小.,受托人.
Pursuant to Article IX of the United Mine Workers of America (“UMWA”) 1950 好处 Plan and Trust, and under the authority of an exemption granted by the United States Department of Labor, the Trustees have reviewed the facts and circumstances of this dispute concerning the level of health benefits coverage for a 养老金领取者 under the terms of the 雇主 好处 Plan.
背景事实
原告, whose last signatory classified employment in the coal industry was with 被申请人, was awarded a 1974年退休金计划 Deferred Vested pension based on 29 1/4 years of credited service, 4月1日生效, 1987. 投诉人指出被投诉人实施的福利计划, 5月1日生效, 1987, did not provide health benefits coverage at the level prescribed by the terms of the 雇主 好处 Plan established pursuant to the National Bituminous Coal Wage Agreement (“Wage Agreement”) of 1984. 原告 states that benefit payments were subject to a $100 deductible for each of the first three 家庭 members enrolled and, 之后, 福利最高可达服务成本的80%. Information provided to the Funds indicates that 被申请人 terminated the Complainant’s health benefits coverage on October 31, 1987.
争端
Is 被申请人 responsible for the provision of health benefits coverage for the Complainant at the level prescribed by the 雇主 好处 Plan?
双方立场
Position of the 原告: The Respondent is responsible for the provision of health benefits coverage for the Complainant at the level prescribed by the 雇主 好处 Plan.
Position of 被申请人: The Respondent has not responded to repeated correspondence from Funds’ staff regarding its position in this dispute.
相关的规定
Article XX Section (c)(3)(i) of the National Bituminous Coal Wage Agreement of 1984 provides in pertinent part:
(c) 1974年计划及信托
(3)(i) Each signatory 雇主 shall establish and maintain an Employee benefit plan to provide, 通过保险公司实施, health and other non-pension benefits for its Employees covered by this Agreement as well as pensioners, 1974年养恤金计划和信托皇冠搏彩中心网站, 谁的最后一个签署人曾受雇于该雇主. The benefits provided by the 雇主 to its eligible Participants pursuant to such plans shall be guaranteed during the term of this Agreement by that 雇主 at levels set forth in such plans.
雇主福利计划第I(1)、(2)和(5)条规定:
第一条-定义
下列术语具有本协议规定的含义:
(1) “雇主”指(雇主名称).
(2) “工资协议”指1984年《皇冠搏彩中心网站》, 如不时修订及任何后续协议.
(5) “养老金领取者”系指领取养老金的任何人, other than (i) a deferred vested pension based on less than 20 years of credited service, or (ii) a pension based in whole or in part on years of service credited under the terms of Article II G of the 1974 Pension Plan, 或其任何继承者的任何相应段落, under the 1974 Pension Plan (or any successor thereto) whose last classified signatory employment was with the 雇主, 以本计划第二条B款的规定为准.
第二条乙. (1)雇主福利计划规定:
第二条-资格
The persons eligible to receive the health benefits pursuant to 第三条 are as follows:
B. 养老金领取者
Health benefits and life insurance under 第三条 hereof shall be provided to 养老金领取者 as follows:
(1) Any 养老金领取者 who is not again employed in classified signatory employment subsequent to
(a) 根据1974年养恤金计划领取养恤金者的最初退休日期;及
(b) 10月1日, 1984, 都有资格作为养老金领取者享受以下的保险, 并受本计划所有其他条款的约束. Notwithstanding (i) and (ii) of the definition of 养老金领取者 in Article I(5) of this Plan, any such 养老金领取者 who was eligible for benefits under the 1974 好处 Plan as a 养老金领取者 on December 5, 1977, 都有资格享受这些福利, 受本计划所有其他条文规限.
第三条A. (8)《皇冠搏彩中心》相关部分规定:
第三条-福利
A. 健康的好处
(8) 自付额
Certain benefits provided in this Plan shall be subject to the co-payments set forth below and such co-payments shall be the responsibility of the Beneficiary. The Plan Administrator shall implement such procedures as deemed appropriate to achieve the intent of these co-payments.
健康福利的共同支付额确定如下:
好处 公司付款
(a)作为门诊的医生服务 工作组:7美元.50每
如A节所述 参观最高可达150美元
(2)和医生在con- 每12个月期间(*
与利益集的连接 家庭.
第四节第(3)段 非工作小组-每人$5
(c)但只适用于事前和事后 参观最高可达$100
产前检查如果医生 每12个月期间(*
另外收费 家庭.
除费用外
交付和(g)段
通过(m)， (n)段除外
__________________
12个月期间从下列日期开始:3月27日, 1984; March 27, 1985; March 27, 1986年和3月27日, 1987.
住院手术，第(o)段
及第A(7)条第(f)段.
(b)处方药和胰岛素，每份处方或补充5美元
如第A(4)条所述及 每人最多50美元
带回家的药后住院 12个月期间(*)
中所述的禁闭 家庭.
节(1)(A). 注:为此目的
共同支付条款
处方或补药
被视为每30天一次
(或其部分)供应.
讨论
Article XX Section (c)(3)(i) of the 1984 Wage Agreement requires each signatory 雇主 to establish and maintain an 雇主 好处 Plan to provide health and other non-pension benefits to its 养老金领取者 谁的最后一个签署人曾受雇于该雇主. The Wage Agreement stipulates that benefits provided by the 雇主 pursuant to such Plan shall be guaranteed during the term of the Agreement by that 雇主 at levels set forth in such Plan.
第二条乙. of the 雇主 好处 Plan establishes that an individual who is eligible for pension benefits under the 1974年退休金计划 is eligible for health benefits coverage under the 雇主 好处 Plan. Inasmuch as the Complainant was awarded a 1974年退休金计划 pension 4月1日生效, 1987, 他有权获得其最后签字雇主提供的健康福利, 被申请人.
第三条. A (8) of the 雇主 好处 Plan specifies the co-payments which are the responsibility of the beneficiary for medical services and prescriptions. 提供给员工的福利水平, 养老金领取者 and their dependents and survivors are established through collective bargaining and may not be unilaterally changed by an 雇主. The Respondent’s use of a non-conforming 80/20 health coverage plan is inconsistent with the provisions of the 1984 Wage Agreement and the 雇主 好处 Plan. The Respondent is responsible for providing health benefits coverage for the Complainant as a 养老金领取者 at the level specified in the 雇主 好处 Plan, 4月1日生效, 1987.
受托人的意见
The Respondent is responsible for providing health benefits coverage for the Complainant as a 养老金领取者 at the level specified in the 雇主 好处 Plan, 4月1日生效, 1987.