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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: 88-282——1990年6月12日
董事会:Joseph P. 康纳斯,老., Chairman; Paul R. 院长,受托人;
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, 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 the dependent of an 员工.
背景事实
The Complainant is eligible for health benefits coverage from the Respondent as an active 员工. According to a court document submitted by the Complainant in this case, the Complainant was awarded legal custody of his niece on November 17, 1988. A representative for the Complainant asks whether the Complainant’s niece is eligible for health benefits coverage since the Complainant is her legal guardian and he provides full support. The representative states that adoption procedures cannot be initiated by the Complainant because the parents of the child cannot be located.
The Respondent states that the Complainant’s niece is not eligible for health benefits coverage because nieces are not listed as eligible dependents under 第二条D. 雇主福利计划的成员. The Respondent also states that its position is supported by a previous decision of the Trustees in ROD 84-209.
争端
Whether the Respondent is required to provide health benefits coverage for the Complainant’s niece.
双方立场
Position of the 原告: The Complainant’s niece should be eligible for health benefits coverage because the Complainant has been appointed her legal guardian, 他为她提供所有的支持, 他也不能提起领养诉讼.
Position of the 被申请人: Under the terms 雇主福利计划的成员 and consistent with a previous decision of the Trustees, the Complainant’s niece does not quality for health benefits coverage as an eligible dependent of the Complainant.
相关的规定
Article I (1), (2), (4) and (7) 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 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. 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, or disabled 员工 receiving health benefits pursuant to paragraphs A, B, 或本条第2款(C)项:
(1) A spouse who is living with or being supported by an eligible 员工 or 养老金领取者;
(2) Unmarried dependent children 合资格雇员的 or 养老金领取者 who have not attained age 22;
(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;
(4) Unmarried dependent grandchildren 合资格雇员的, 领取养老金者或配偶 who have not attained age 22 and are living in the same household (residence) with such 员工 or 养老金领取者;
(5) 受抚养儿童(任何年龄), 合资格雇员的, 领取养老金者或配偶, who are mentally retarded or who become disabled prior to attaining age 22 and such disability is continuous and are either living in the same household with such 员工 or 养老金领取者 or are confined to an institution for care or treatment. Health benefits for such children will continue as long as a surviving parent is eligible for health benefits.
为本D段的目的, a person shall be considered dependent upon an eligible 员工, 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. 雇主福利计划的成员 provides health benefits coverage for certain dependent family members of any 员工, 养老金领取者 or disabled 员工 receiving health benefits pursuant to paragraphs A, B, 或计划第II条的C项. However, a niece is not included among the eligible dependent family members. The issue of an 员工’s niece’s eligibility for health benefits coverage has previously been addressed by the Trustees in ROD 84-209 (copy enclosed herein). The Trustees concluded that the niece of an 员工 does not qualify for health benefits unless she is adopted by the 员工. 因此, although the Complainant has been awarded custody of his niece and provides all of her support, his niece does not qualify for health benefits coverage under 第二条D. 计划的详情, notwithstanding the fact that the Complainant claims adoption proceedings cannot be initiated. 相应的, the Respondent is not required to provide health benefits coverage for the Complainant’s niece.
受托人的意见
The Respondent is not required to provide health benefits coverage for the Complainant’s niece under the terms 雇主福利计划的成员.