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受托人的意见
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在再保险
原告: 退休人员及雇员
被申请人: 雇主
ROD案例编号: 84-345——1987年4月27日
董事会:Joseph P. 康纳斯,老., Chairman; Paul R. Dean,受托人; William 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 Benefit Plan and Trust, 并根据美国劳工部授予的豁免授权, the Trustees have reviewed the facts and circumstances of this dispute concerning the provision of health benefits coverage under the terms of the 雇主 Benefit Plan.
背景事实
投诉人为领退休金人士, 谁在煤炭行业的最后一项机密签署工作是为答辩人, 以及11月6日前为被告工作的员工, 1986, 当他们被解雇，被告停止经营. Information reported to the Funds indicates that the Respondent provided the Complainants with health benefits coverage implemented through various insurance carriers at different times. 最近, 保险通过Provident提供到9月30日, 1986, 当所有的保险被终止.
One of the 养老金领取者 in this dispute has submitted unpaid bills for medical services provided to him and his wife during the period from October 25, 1986年至11月2日, 1986. One of the laid-off Employees has submitted unpaid bills for medical services provided to him and his dependents between October 20, 1978年和11月20日, 1979, 6月10日, 1981; he claims that no health benefits coverage was provided by the Respondent when those bills were incurred.
皇冠搏彩中心网站已确定被申请人已不再营业, 11月6日生效, 1986, and the Complainants have been advised by letter that the Funds will provide health benefits coverage for 养老金领取者 who last worked in classified signatory jobs for the Respondent, and for laid-off Employees of the Respondent for their respective periods of eligibility pursuant to Article II of the UMWA 1974 Benefit Plan and Trust, 11月7日生效, 1986.
The Complainants contend that the Respondent is responsible for payment of outstanding medical bills incurred prior to November 7, 1986. The Respondent is signatory to the National Bituminous Coal Wage Agreement (“Wage Agreement”) of 1984. 答辩人亦曾签署一九七八年及一九八一年的工资协议. The Respondent has failed to respond to repeated correspondence from Funds’ staff requesting its position in this dispute.
争端
Whether the Respondent is responsible for payment of the outstanding medical bills incurred by the Complainants prior to November 7, 1986.
双方立场
Position of the Complainants: The Respondent is responsible for payment of outstanding medical bills incurred prior to November 7, 1986.
被投诉人的立场:被投诉人未说明其在该争议中的立场.
相关的规定
Article XX Section (c)(3)(i) of the National Bituminous Coal Wage Agreement of 1978 [1981 and 1984] provides in pertinent part:
第二十条——健康和退休福利
第(c)节1974计划和信托
(3)(i)…[E]ach 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, 谁的最后一次[签署人]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 each 雇主 at levels set forth in such plans.
雇主福利计划第I(1)、(2)、(4)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(煤炭公司).
(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1978 [1981 and 1984], 如不时修订及任何后续协议.
(4) “雇员”系指为雇主从事保密工作的人员, 有资格获得本协议项下的福利.
(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,]根据1974年退休金计划(或其任何后续计划), 谁的最后一次机密工作是在雇主那里, [以本计划第II B条的规定为限.]
第二条A款. (1)、(4)、B. (1)雇主福利计划规定:
第二条-资格
The persons eligible to receive the health benefits pursuant to Article III are as follows:
A. 积极的员工
第III条规定的福利应提供给下列任何员工:
(1) is actively at work* for the 雇主 on the effective date of the Wage Agreement; or
(4) A new Employee will be eligible for health benefits from the first day worked with the 雇主.
B. 养老金领取者
Health benefits and life insurance under Article III hereof shall be provided to 养老金领取者 as follows:
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*Actively at work includes the Employee of the 雇主 who was actively at work on December 5, 1977年3月26日, 1981年9月30日, 1984], and who returns to active work with the 雇主 two weeks after the effective date of the Wage Agreement.
(1) Any Pensioner who is not again employed in classified signatory employment subsequent to
(a)根据1974年养老金计划领取养老金者的最初退休日期，以及
(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 Pensioner in Article I (5) of this Plan, any such Pensioner who was eligible for benefits under the 1974 Benefit Plan as a Pensioner 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.
讨论
1978年第20条第(c)(3)(i)款, 1981, and 1984 Wage Agreements requires a signatory 雇主 to establish an 雇主 Benefit Plan to provide health and other non-pension benefits for its Employees, 以及最后一个签署人分类工作是在该雇主工作的养老金领取者. The Wage Agreements stipulate that benefits provided by the 雇主 pursuant to such Plans shall be guaranteed during the term of the Agreements by that 雇主 at levels set forth in such Plans.
第二条A款. of the 雇主 Benefit Plan provides health benefits coverage for Employees working in classified jobs for a signatory 雇主. 第二条乙. of the Plan provides health benefits coverage to 养老金领取者 who are receiving pensions under the 1974 Pension Plan. 因为投诉人是11月6日被解雇的雇员, 1986, 以及最后签署人曾受雇于答辩人的退休人员, the Respondent is responsible for providing their health benefits coverage during their active employment and during their eligibility for pension benefits, 分别, 直到11月7日, 1986, when the complainants became eligible for such coverage under the 1974 Benefit Plan and Trust.
受托人的意见
The Respondent is responsible for payment of covered medical expenses incurred by the Complainants as Employees and 养老金领取者 during their respective periods of eligibility under the 雇主 Benefit Plan but prior to November 7, 1986.