______________________________________________________________________________

受托人的意见
______________________________________________________________________________

在再保险

原告: 未亡配偶
被申请人: 雇主
ROD案例编号: 84-524——1987年12月18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 for the surviving spouse of an Employee under the terms of the 雇主 Benefit Plan.

背景事实

The Complainant is the surviving spouse of an Employee who last worked in a classified position for the Respondent on September 28, 1984, 当他被解雇的时候. 1985年5月13日，雇员因心肺骤停死亡，享年52岁. The Respondent provided the Complainant with a lump sum life insurance benefit and informed her that she was eligible for health benefits coverage for a period of 60 months following the Employee’s death.

The Complainant was subsequently awarded a Pre-Retirement Survivor Annuity under the 1974年退休金计划, 9月1日生效, 1987, 她丈夫将满55岁(退休年龄)的下一个月. The Complainant contends that the Pre-Retirement Survivor Annuity she receives is a 未亡配偶 pension, 因此, 她有权享受医疗保险，直到死亡或再婚为止.

被告已陈述, 根据工资协议及雇主福利计划的条款, there is no requirement to provide health benefits coverage until death or remarriage for a surviving spouse receiving a Pre-Retirement Survivor Annuity. The Respondent maintains that it is only responsible for providing health benefits coverage for the Complainant for a period of 60 months following her husband’s death.

争端

Whether the Respondent is responsible for providing health benefits coverage for the Complainant for a period of 60 months or until her death or remarriage.

双方立场

Position of the 原告: The Respondent is responsible for providing health benefits coverage for the Complainant until her death or remarriage.

Position of the 被申请人: The Complainant is entitled to only 60 months of health benefits coverage following her husband’s death.

相关的规定

雇主福利计划第I(1)、(2)、(4)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.

(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.

第二条E. 雇主福利计划的第(2)和(3)部分规定:

E. 已故雇员或退休人员的尚存配偶及受养人

Health benefits under Article III shall be provided to (i) any unmarried surviving spouse (who was living with or being supported by the Employee or Pensioner immediately prior to the Employee’s or Pensioner,s death) and (ii) such spouse’s unmarried surviving dependent children as defined in subparagraphs (2) and (5) of paragraph D, 雇员或领取退休金人士的死亡∶

(2) Under conditions which qualify such spouse for a 未亡配偶 benefit under the 1974 Pension Plan or any successor thereto;

(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, provided that (i) if such Employee or Pensioner died prior to the effective date of the Wage Agreement and the spouse is not eligible for a 未亡配偶’s benefit, then only for the period that the spouse is eligible to receive death benefits in installment payments pursuant to paragraph C of Article III, or (ii) if such Employee or Pensioner died on or after the effective date of the Wage Agreement and the spouse is not eligible for a 未亡配偶’s benefit and life insurance benefits or death benefits are payable in a lump sum, then only for 60 months following the month of the death of such Employee or only for 22 months following the month of death of such Pensioner. 如果人寿保险赔偿金不支付, health benefits shall be provided only to the end of the month in which the Employee or Pensioner died.

未亡配偶的健康津贴应继续发放，直至其再婚为止, 但如果此种配偶有权享受上述第(3)款规定的此种福利, such health benefits will continue not longer than for the period specified in paragraph (3) above. Health benefits shall not be provided during any month in which such surviving spouse is regularly employed at an earnings rate equivalent to at least $500 a month.

讨论

第二条E. (2) of the 雇主 Benefit Plan requires a signatory 雇主 to provide health benefits coverage to the unmarried surviving spouse of an Employee until remarriage, if the Employee died under conditions which qualify such spouse for a 未亡配偶 benefit under the 1974 Pension Plan. The Complainant in this case contends that the Pre-Retirement Survivor Annuity she receives is a 未亡配偶 benefit and, 因此, 她在再婚前有资格享受医疗保险. 根据1974年养恤金计划的规定, a Pre-Retirement Survivor Annuity and a 未亡配偶 benefit are separate and distinct types of pension benefits, 有不同的资格要求. 作为雇员在退休年龄前去世的未亡配偶, the Complainant is unable to satisfy the eligibility requirements for a 未亡配偶 benefit under the terms of the 1974 Pension Plan. 相应的, the Complainant is not entitled to health benefits coverage until remarriage pursuant to Article II. E. (2).

第二条E. (3) (ii) of the 雇主 Benefit Plan requires a signatory 雇主 to provide health benefits coverage to the unmarried surviving spouse of an Employee for a 60-month period, 如雇员在工资协议生效日期后去世, 如果未亡配偶没有资格领取未亡配偶福利, 如果人寿保险赔偿金一次性支付给未亡配偶. 因为申诉人的丈夫在《皇冠搏彩中心》生效日期之后去世, 投诉人没有资格领取未亡配偶津贴, 而且人寿保险金是一次性支付的, the Respondent is responsible for providing the Complainant with health benefits coverage for 60 months following the month of her husband’s death, 前提是她在此期间未婚.

受托人的意见

The Respondent is responsible for providing health benefits coverage to the Complainant for a period of 60 months following the month of her husband’s death, 前提是她在此期间未婚.