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OPINION OF TRUSTEES
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In Re

Complainant: Employees
Respondent: Employer
ROD Case No: 02-017 – September 15, 2004

Trustees: A. Frank Dunham, Michael H. Holland, Marty D. Hudson and Elliot A. Segal.

受托人审查了有关根据雇主福利计划条款提供福利的争议的事实和情况.

Background Facts

The Complainants are actively employed by the Respondent, a signatory employer. According to the Complainants, 答辩人未能按照2002年《官方网站》(《皇冠搏彩中心网站》)和《皇冠搏彩中心网站》的规定提供健康福利. Specifically, 申诉人说，他们每人本应得到1美元的一次性保健付款,000 as of January 1, 2004, to meet their deductible under the Employer Benefit Plan for 2004. As of May 2004, 被投诉人没有按照2002年《皇冠搏彩中心网站》的要求向申诉人一次性支付医疗费用.

投诉人提交了一份由被投诉人和美国煤矿工人联合会(“UMWA”)签署的谅解备忘录副本。, dated December 18, 2002, which states that “ The Union agrees that [the Employer’s name] will have the first six months of the year 2003 to make payments that relates [sic] to the following: 1) Clothing Allowances; 2) $600.00 Bonus for 2002 and 3) $1,000.00 for Medical Insurance in 2003.” Thus, the Memorandum of Understanding allowed the Respondent to pay the Complainants $1,不迟于6月30日支付2003年医疗保险(一次性医疗保健支付)的000 000美元, 2003.

The Complainant states that under the terms of the Employer Benefit Plan, his coverage does not begin until he has met a $750 deductible and contends that the $1,000 payment should be used to pay the deductible. 申诉人还说，由于申诉人迟交2004年的一次性医疗保健费, he has not received benefits as established under the Employer Benefit Plan.

Dispute

被投诉人实施其医疗保险计划是否违反了2002年工资协议和雇主福利计划?

Positions of the Parties

申诉人的立场:被投诉人执行其医疗保险计划违反了2002年《皇冠搏彩中心》和《皇冠搏彩中心网站》.

被投诉人的立场:被投诉人没有对皇冠搏彩中心网站工作人员就其在该争议中的立场提出的多次请求作出回应.

Pertinent Provisions

Article XX (GENERAL DESCRIPTION OF THE HEALTH AND RETIREMENT BENEFITS) (10) c. of the National Bituminous Coal Wage Agreement of 2002 provides, in pertinent part:

(10) HEALTH CARE:

c. Health Care Payment/Deductible

在本协议有效期内，每年1月1日，每位符合条件的参与者将获得1美元的一次性医疗保健付款,000. For purposes of this provision, “eligible participants” means active Employees, laid-off Employees, and disabled Employees prior to eligibility for Medicare benefits, who are participants in the Employer Plan maintained pursuant to this Article….

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Article I. (1), (2) and (4) of the 2002 Employer Benefit Plan provides:

Article I Definitions

The following terms shall have the meanings herein set forth:

(1) “Employer” means (Employer’s Name).

(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 2002, as amended from time to time and any successor agreement.

(4) “Employee” shall mean a person working in a classified job for the Employer, eligible to receive benefits hereunder.

Article II A. (1) and (4) of the Employer Benefit Plan provides:

Article II Eligibility

根据第三条有资格领取健康津贴的人员如下:

A. Active Employee

(1) is actively at work  for the Employer on the effective Date of the Wage Agreement; or
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(5) 新雇员从为雇主工作的第一天起就有资格享受健康福利.

Article III. A. (8) provides in pertinent part:

Article III Benefits

(8) Co-Payments and Deductibles

Effective January 1, 2002, 本计划提供的福利应受下文规定的共付额和免赔额的约束，该等共付额和免赔额应由受益人负责.

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承保健康福利的免赔额是指受益人在本计划支付任何金额之前必须在一个日历年内支付的承保福利的第一部分. 任何受保家庭成员发生的所有受保医疗费用的第一个750美元将被计入满足免赔额. Vision care and prescription drug expenses are not subject to the deductible. Any deductible applicable to a covered benefit must be met before co-pays apply. 在任何情况下，适用于一个家庭的一个日历年的免赔额不得超过该家庭当年由雇主或根据第20条(一般说明)(10)c款从《皇冠搏彩中心网站》支付的医疗保健付款总额的75%. of the 2002 NBCWA. Deductibles are established as follows:

Benefit Deductible

Physician, Hospital or $750.00 per family
other non-pharmacy services

The following payment will be required as an additional deductible, 不论当年的原免赔额是否已达到，均适用:

Any specified service $300.00, not applied
obtained without required to annual out-of-pocket maximum
precertification
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Discussion

2002年工资协议第XX (c)(3)(i)条要求每个签署雇主建立并维持雇主福利计划，为其雇员提供健康和其他非养老金福利. 协议还规定，在协议有效期内，雇主根据该计划提供的福利应按该计划规定的水平得到保证.

Article II A. 雇主福利计划(1)和(5)为为签署雇主从事分类工作的在职雇员提供健康福利. The Complainants are active Employees; therefore, they are eligible for health benefits coverage under Article II A. (1) and (5) of the Employer Benefit Plan.

According to Article III A. (8), "承保健康福利的免赔额是指受益人必须在本计划支付任何金额之前的一个日历年内支付承保福利的第一部分. 任何受保家庭成员发生的所有受保医疗费用的第一个750美元将被计入满足免赔额.”

Article XX (10) c. 《皇冠搏彩中心》规定:“在本协议有效期内，每年的1月1日 . . . each eligible participant will receive a lump sum health care payment of $1,000.” It further states that “For the purposes of this provision, ‘eligible participants’ means active Employees, laid-off Employees, and disabled Employees prior to eligibility for Medicare benefits, who are participants in the Employer Plan maintained pursuant to this Article. . . . 根据雇主计划，医疗保健付款不得支付给当时无权享受雇主提供的福利的任何个人.”

The Complainants are active Employees entitled to Employer-provided benefits and are not eligible for Medicare benefits; therefore, they are entitled to a lump sum health care payment as of January 1, 2004. 所提交的谅解备忘录涉及2003年一次性支付保健费用的问题，这使答辩人能够在2003年的头六个月支付这种费用. No Memorandum of Understanding was submitted that addressed the payment for 2004. Therefore, 答辩人须于一月一日起向投诉人支付一笔款项, 2004.

Opinion of the Trustees

答辩人执行其医疗保险计划的情况不符合2002年《皇冠搏彩中心网站》和《皇冠搏彩中心网站》的明确规定. 答辩人被要求从1月1日起一次性向申诉人支付医疗费用, 2004, under Article XX (10) c. of the 2002 Wage Agreement.