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受托人的意见
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在再保险
原告: 未亡配偶
被申请人: 雇主
ROD案例编号: 84-387 - 1990年1月9日
董事会:Joseph P. 康纳斯,老., Chairman; Paul R. Dean, Trustee; William Miller, Trustee; Donald E. 皮尔斯,小., Trustee; Thomas H. Saggau,受托人.
Pursuant to Article IX of the United Mine Workers of America (“”UMWA”) 1950 Benefit Plan and Trust, ana under the authority of an exemption granted by the United States Department of Labor, 受托人审查了有关根据雇主福利计划条款提供健康福利的争议的事实和情况.
背景事实
The Complainant is the surviving spouse of an Employee who died on June 6, 1983, 27岁的时候, 因为一场车祸. The Employee last worked for the Respondent on June 4, 1983. 他死后, 被投诉人向投诉人提供了人寿保险，并为投诉人及其合格家属提供了健康保险. The Complainant is not eligible for a 未亡配偶 benefit under the 1974 Pension Plan.
The Complainant claims that the Respondent has not provided health benefits coverage since early 1986. The Complainant indicated that she did not know her coverage had been terminated until July 1986, when she began receiving notices of unpaid medical bills. The Complainant has submitted unpaid medical bills which were incurred between July 1986 and January 1987. The Complainant states that when she telephoned the Respondent about the unpaid bills, she was told that the Respondent had ceased providing health benefits coverage.
The Respondent was signatory to the National Bituminous Coal Wage Agreements (“Wage Agreement”) of 1981 and 1984. The 1984 Wage Agreement expired on January 31, 1988. The Respondent ceased operations in July 1986 and did not sign the 1988 Wage Agreement.
争端
Whether the Respondent is responsible for providing health benefits coverage for the Complainant and her eligible dependents.
双方立场
投诉人的立场:被投诉人负责为投诉人及其符合条件的家属提供医疗保险.
被投诉人的立场:被投诉人未对皇冠搏彩中心网站工作人员多次询问其在该争议中的立场的信函作出回应.
相关的规定
Article XX(c)(3)(i) of the National Bituminous Coal Wage Agreements of 1981 and 1984 provides:
(3)(i) Each signatory 雇主 shall establish and maintain an Employee benefit plan to provide, implemented through an insurance carrier(s), 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, whose last signatory classified employment was with such 雇主. 雇主根据该等计划向其合格参与人提供的福利应在本协议有效期内由该雇主按该等计划规定的水平予以保证. 此类计划还应包括各签署雇主在12月5日之前继续支付死亡抚恤金, 1977, 适用于1974年退休金计划下的已故雇员及退休人员，而其最后签署人的分类受雇是受雇于该雇主, in the same manner and in the same amounts as previously provided for in the 1974 Benefit Plan and Trust. The plans established pursuant to this subsection are incorporated by reference and made a part of this Agreement, 根据这些计划提供的健康和其他非养老金福利的条款和条件应在这些计划中规定.
Article I (1), (2) and (4) 雇主福利计划的成员 provide:
第一条-定义
The following terms shall have the meanings herein set forth:
(1) “雇主”指(雇主名称).
(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1981 (1984), as amended from time to time and any successor agreement.
(4) “Employee” shall mean a person working in a classified job for the 雇主, 有资格获得本协议项下的福利.
第二条A款. (1). (3)雇主福利计划 provide:
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
Benefits under Article III shall be provided to any Employee who:
1. is actively at work* for the 雇主 on the effective date of the Wage Agreement;
E. 未亡配偶 and Dependents of Deceased Employees or Pensioners
第III条规定的健康福利应提供给(i)任何未婚尚存的配偶(在雇员或养老金领取者死亡之前与雇员或养老金领取者生活在一起或由其抚养)和(ii)该配偶的未婚尚存的受抚养子女，如第D段第(2)和(5)项所定义, 雇员或领取退休金人士的死亡∶
(3) At a time when such Employee or Pensioner is entitled to receive health benefits pursuant to paragraph A, B, (二)本条第(三)款, 但(i)该等雇员或领取退休金者在《皇冠搏彩中心网站》生效日期前死亡，且其配偶没有资格领取未亡配偶的福利, 只有在配偶有资格根据第三条C款分期领取死亡抚恤金的期间, 或(ii)该等雇员或养老金领取人在工资协议生效之日或之后死亡，其配偶没有资格获得未亡配偶的福利，而人寿保险或死亡赔偿金是一次性支付的, 则仅在该雇员死亡当月后的60个月内，或仅在该养恤金领取者死亡当月后的22个月内. If life insurance benefits are not payable, health benefits shall be provided only to the end of the month in which the Employee or Pensioner died.
任何未满22岁的子女，如果在未亡配偶或已故雇员或养恤金领取人的直系亲属的家庭(住所)以外就业并居住，则无权领取本E段规定的健康福利.
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*”Actively at work” includes an Employee of the 雇主 who was actively at work on March 26, 1981年9月30日, 1984], and who returns to active work with the 雇主 within two weeks after the effective date of the Wage Agreement.
Health benefits shall continue for a surviving spouse until remarriage of such spouse, but if such spouse is entitled to such benefits under paragraph (3) above, such health benefits will continue not longer than for the period specified in paragraph (3) above. 在未亡配偶按每月至少500美元的收入正常就业的任何月份，不得提供健康福利.
讨论
1981年和1984年工资协议第XX(c)(3)(i)条要求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. The Wage Agreements stipulate that benefits provided pursuant to such Plan shall be guaranteed during the term of the Agreements. 第二条E. 雇主福利计划(3)为根据第二条A款有权领取健康福利而死亡的雇员的未婚未亡配偶和符合条件的受抚养人提供健康福利, B, 或雇主福利计划的C项. 鉴于申诉人是一名雇员的未婚未亡配偶，该雇员在根据第二条A款有权领取健康福利期间死亡. 计划的详情, 在1981年和1984年《官方网站》期间，被投诉人负责为申诉人及其合格受抚养人提供医疗保险.
这里的问题是，在1984年工资协议到期后，被告没有签署1988年工资协议，被告是否有合同义务提供这种保险. 根据第II E条. 雇主福利计划的成员, 某些雇员和养恤金领取者的未亡配偶和受抚养人有权享受特定时期的健康福利. 受托人先前在ROD 81-730(附本)中决定，雇主福利计划明确明确地要求雇主在第二条E款规定的期间内提供健康福利. (3) 计划的详情, even when that period extends beyond the expiration of a Wage Agreement.
根据第II E条. (3) (ii), the unmarried surviving spouse of an active Employee who died while eligible to receive health benefits pursuant to 第二条A款., is eligible to receive health benefits for 60 months following the Employee’s death, if such spouse is not eligible to receive a 未亡配偶 benefit and life insurance benefits are payable in a lump sum. 因为申诉人是一名在职雇员的未婚寡妇，该雇员在去世时有资格领取健康福利, is not eligible to receive a 未亡配偶 benefit, and was eligible for life insurance benefits in a lump sum, 她及其符合条件的受扶养人有权从她丈夫死亡当月起享受答辩人提供的60个月的医疗保险. 由于雇员于6月6日去世, 1983, their period of eligibility extended through June 1988, provided they continued to meet the eligibility requirements of 第二条E. 雇主福利计划的成员.
受托人的意见
答辩人负责在1988年6月之前为申诉人及其合格家属提供医疗保险, in accordance with the provisions of 第二条E. (3)雇主福利计划.