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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: 88-451 - 1991年10月29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, 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 根据雇主福利计划的条款.

背景事实

The Complainant is a classified 员工 of the Respondent, a signatory 雇主. The Complainant states that his mother has lived with him for over one year. He contends that he provides over one-half of her support and that she is eligible for health benefits coverage as his dependent.

The Respondent reviewed documentation provided by the Complainant concerning his mother’s income and their household expenses. The Respondent states that the Complainant’s mother’s income provides over one-half of her support requirements; therefore, she is not eligible for benefits under the 雇主 Benefit Plan.

争端

Whether the Respondent is required to provide health benefits coverage for the Complainant’s mother.

双方立场

Position of the 原告: The Respondent is required to provide health benefits coverage for the Complainant’s mother because she resides in the Complainant’s household and the Complainant provides more than one-half of her support.

Position of the 被申请人: The Respondent is not required to provide health benefits coverage to the Complainant’s mother because the Complainant does not provide more than one-half of her support.

相关的规定

Article I (1), (2), (4) and 7 of the 雇主 Benefit Plan provide:

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, or disabled 员工 receiving health benefits pursuant to paragraphs A, 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, 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. 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. 根据Q&H-2(81)(附副本), 支持包括住宿的公平租金价值, 合理的板费, 服装, miscellaneous household services and education expenditures; support is not limited to necessities. Q&H-2(81)也表明, 在确定参与者父母的依赖关系时, 考虑所有来源的收入, 包括社会保障, 黑肺和养老金, 还有就业收入.

The Complainant submitted to the Respondent an estimate of $11,367.每年的家庭开支为10美元. 经审查所提供的证明文件, it is evident that the Complainant included his mother’s insurance costs and board in the calculation for household expenses. As these are personal expenses which are attributable to the Complainant’s mother, 它们不应该包括在家庭开支中. 除了, some of the expenses included in the household estimate are monthly charges, 而另一些则是按年收费. Funds’ staff have recalculated the yearly household expenses on the basis of the documentation provided. 投诉人提交的资料, and upon which the 雇主 based its eligibility determination, 显示家庭总开支大约等于10美元,047.52. 由于家庭由申诉人及其母亲组成, 每个人按比例分摊的费用是5美元,023.76. 除了, the Complainant submitted information to the Respondent concerning expenses for health insurance and board which are attributable to the Complainant’s mother, 而不是整个家庭, 总共大约5美元,400. Combining the Complainant’s mother’s pro rata portion of household expenses and her clamined direct personal expenses shows total annual expenses for the Complainant’s mother of approximately $10,423.76 .根据所提供的资料.

It should be noted that the Complainant’s mother’s annual expenses may actually be less than $10,423.76. The fair rental value of her lodging may have been overestimated by allowing both a monthly mortgage payment and a monthly charge of $350.00 for board (described as “rent” on the receipts submitted by the Complainant). 然而, 即使两个数量都是允许的, 申诉人母亲的年收入合计为9美元,564.00 from Social Security and Black Lung benefits provides considerably more than 50% of her annual support requirements. 相应的, the Trustees conclude that the Complainant does not provide over one-half of his mother’s support and the Respondent is not required to provide health benefits coverage for her.

受托人的意见

The Respondent is not required to provide health benefits coverage for the Complainant’s mother, 根据雇主福利计划的条款.