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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:88-262 - 1990年6月8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 计划
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 Employee under the terms of the Employer Benefit
计划.
背景事实
的 Complainant was employed in a classified job by the Respondent from the summer of 1988
until April 3, 1989, when he quit to accept employment with another signatory Employer. 的
Respondent provided health benefits coverage for the Complainant through Blue Cross and Blue
Shield until March 1, 1989, when his coverage was terminated. 投诉人已提交
copies of unpaid bills for medical services rendered in March 1989; 的 Complainant’s
representative contends that the Respondent is responsible for payment of these medical bills
that were incurred during the Complainant’s employment with the Respondent. 被申请人
is signatory to the National Bituminous Coal Wage Agreement (“Wage Agreement”) of 1988.
争端
Is the Respondent responsible for payment of the Complainant’s unpaid medical bills incurred
1989年3月期间?
双方立场
Position of the Complainant: 被申请人 is responsible for payment of the Complainant’s
medical bills incurred during his employment with the Respondent.
受托人的意见
争议的解决
情况下没有. 88-262
第二页
Position of the Respondent: 被申请人 has not replied’ to repeated correspondence from
Funds’ staff requesting its position in this dispute.
相关的规定
Article XX Section (c)(3)(i) of the National Bituminous Coal Wage Agreement of 1988 provides
在相关部分:
(3)(i) Each signatory Employer shall establish and maintain an Employee
benefit plan to provide, implemented through an insurance carrier(s), health and
other non-pension 员工福利 covered by this Agreement as well
as pensioners, under the 1974 Pension 计划 and Trust, whose last signatory
classified employment was with such Employer. 提供的好处
Employer to its eligible Participants pursuant to such 计划 shall be guaranteed
during the term of this Agreement by that Employer at levels set forth in such
计划.
Article I (1), (2) and (4) of the Employer Benefit 计划 provide:
第一条-定义
的 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 1988, as amended from time to time and any successor
协议.
(4) “Employee” shall mean a person working in a classified job for the
Employer, eligible to receive benefits hereunder.
第二条A款. (4) of the Employer Benefit 计划 provides:
第二条-资格
的 persons eligible to receive the health benefits pursuant to Article III are as follows:
A. 积极的员工
(4) A new Employee will be eligible for health benefits from the first day
与雇主合作.
受托人的意见
争议的解决
情况下没有. 88-262
第3页
第三条D. (1)(e) of the Employer Benefit 计划 provides 在相关部分:
D. 一般规定
(1)续保
(e)辞职或解雇
If an Employee quits (for any reason) or is discharged, health, life
and accidental death and dismemberment insurance coverage will
自上次工作日期起终止.
讨论
Article XX Section (c)(3)(i) of the 1988 Wage Agreement requires a signatory Employer to
establish and maintain an Employer Benefit 计划 to provide health and other non-pension
员工福利. 的 Wage Agreement stipulates that benefits provided by the
Employer pursuant to such 计划 shall be guaranteed during the term of the Agreement by that
Employer at levels set forth in such 计划.
第二条A款. of the Employer Benefit 计划 provides health benefits coverage for active
Employees working in classified jobs for a signatory Employer. 第三条D. (1)(e)规定:
if an Employee quits for any reason, health, life and accidental death and dismemberment
coverage will 自上次工作日期起终止. Information provided in this case indicates
that the Respondent terminated the Complainant’s health benefits coverage on March 1, 1989.
的 Complainant, however, was actively employed in a classified position by the Respondent
from the summer of 1988 until April 3, 1989, when he quit to accept other employment.
Accordingly, the Respondent is responsible for payment of the covered medical expenses
incurred by the Complainant and his eligible dependents 1989年3月期间.
受托人的意见
被申请人 is required to pay the covered medical expenses incurred by the Complainant
and his eligible dependents during his employment with the Respondent in March 1989,
consistent with the terms of the Employer Benefit 计划.