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受托人的意见
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在再保险
原告: 员工
被申请人: 雇主
ROD案例编号: 88-019 - 1988年10月4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, 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 provision of health benefits coverage for an 员工’s parent under the terms of the 雇主 Benefit Plan.
背景事实
The Complainant is an active 员工 of the Respondent who lives with his mother in her house. The Complainant states that he pays all of the bills and he contends that his mother is therefore eligible for health benefits coverage as his dependent.
The Respondent contends that the Complainant’s mother is not eligible for health benefits coverage under the terms of the 雇主 Benefit Plan. The Respondent states that the Complainant has failed to establish that he provides over one-half of his mother’s support as required under 第二条D. (3)计划的内容. 被告进一步辩称，根据问答(Q&A) H-22(78)(随函附上副本), the Complainant’s mother must reside in the Complainant’s home in order to qualify for health benefits coverage.
争端
Whether the Respondent is responsible for providing health benefits coverage for the Complainant’s mother.
双方立场
Position of the 原告: The Complainant’s mother is eligible for health benefits coverage as the Complainant’s dependent because the Complainant and his mother reside in the same household and the Complainant is responsible for payment of all the bills.
Position of the 被申请人: The Complainant’s mother does not reside in the Complainant’s household and the Complainant has failed to establish that he provides over one-half of his mother’s support. 因此, she does not qualify for health benefits coverage as an eligible dependent under the 雇主 Benefit Plan.
相关的规定
雇主福利计划第I(1)、(2)、(4)和(7)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) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1988, 如不时修订及任何后续协议.
(4) “员工” 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.
(7) “Dependent” shall mean any person described in Section D of Article II hereof.
第二条D. (3)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:
D. 合格的家属
Health benefits under Article III shall be provided to the following members of the family of any 员工, 养老金领取者, 或根据R段领取健康福利的残疾雇员, B, 或本条第2款(C)项:
(3) 合格雇员的父母, 领取养老金者或配偶, if the parent has been dependent upon and living in the same household (residence) with the eligible 员工 or 养老金领取者 for a continuous period of at least one year;
为本D段的目的, 一个人应被视为依赖于合格的雇员, 领取退休金者或配偶(如该雇员), 领取养老金者或配偶 provides on a regular basis over one-half of the support to such person.
讨论
第二条D. of the 雇主 Benefit Plan states that health benefits coverage under Article III shall be provided to an 员工’s parent, if the parent has been living in the same household with the eligible 员工 for a continuous period of at least one year and the 员工 provides over one-half of the parent’s support.
The Respondent has stated that the Complainant’s mother could not qualify for health benefits coverage because in this case the Complainant (participant) and his mother reside in the mother’s home, 而不是申诉人的家. 尽管答辩人声称Q&A H-22(78) requires a parent to reside in the 员工’s home in order to qualify for health benefits coverage, Q&H-22(78)被Q取代&H-2(81)(附副本). Q&A H-2(81) requires only that the parent must be living in the same household (residence) as the participant for a continuous period of one year in order to be eligible for health benefits coverage, 提供依赖项要求已被满足.
受托人先前已在第81-300条中作出结论, 84-011, 84-014 and 84-020 that an 雇主 may require 员工s to submit information reasonably necessary to establish dependency. Funds’ staff have reviewed the information the Complainant submitted to the Respondent and find that such information is not sufficient to establish that the Complainant’s mother has been dependent on the Complainant for over one-half of her support for a continuous period of one year. Although the Complainant claims he has listed his mother as a dependent on Federal and State income tax returns, he has not submitted copies of his tax returns or a statement from a certified public accountant or notary public to support his assertion. 除了, the household bills and payment receipts submitted do not indicate that the Complainant has regularly paid such bills over a one year period. 没有足够的依赖证明, the Trustees conclude that the Respondent is not responsible for providing health benefits coverage for the Complainant’s mother. 受托人说明, 然而, that the Respondent may reconsider the Complainant’s mother’s eligibility for health benefits coverage upon submission of additional evidence.
受托人的意见
没有足够的依赖证明, the Respondent is not responsible for providing health benefits coverage for the Complainant’s mother.