______________________________________________________________________________
OPINION OF TRUSTEES
______________________________________________________________________________
In Re
Complainant: Employee
Respondent: Employer
ROD案例编号:84-125 - 1986年4月7日
董事会:Joseph P. Connors, Sr., Chairman; Paul R. 院长，受托人. Jordan,
Trustee; William Miller, Trustee; Donald E. Pierce, Jr., Trustee.
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 Employee under the terms of the Employer Benefit
Plan.
Background Facts
The Complainant, a classified Employee of the Respondent, maintains that the Respondent is
currently utilizing a health coverage plan which obligates the Employee to pay 20% of the
在提供服务时对提供者产生的医疗费用. The Complainant has
submitted unpaid bills for medical services rendered between August 2, 1985 and October 28,
1985. The Complainant has also submitted a statement from the current insurance carrier which
表明投诉人受免赔额和共同保险的约束. The Complainant
1981年6月视力保健保险被取消. 投诉人询问是否
the current level of health benefits coverage is in violation of the 1984年煤炭工资协定
其中列出了具体的共同支付额(7美元.50)提供的医疗服务，包括
视力保健的覆盖范围.
The Respondent agrees that the current level of health benefits coverage differs from that set
forth in the 1984年煤炭工资协定 but claims that all Employees fully understood and
approved the plan.
Dispute
Is the provision of a non-conforming health coverage plan by the Respondent in violation of the
1984年煤炭工资协定?
各方立场
Position of the Complainant: The Respondent is in violation of the 1984年煤炭工资协定
by its use of a substandard health coverage plan and its failure to provide vision care.
Opinion of Trustees
Resolution of Dispute
Case No. 84-125
Page 2
Position of the Respondent: The Respondent has not violated the 1984年煤炭工资协定
因为雇员批准了有效的健康保险计划.
Pertinent Provisions
Article XX (c) (3) (i) and (10) of the 1984年煤炭工资协定 provides in pertinent part:
Each signatory Employer shall establish and maintain an Employee benefit plan to
provide, implemented through an insurance carrier(s), health and other non-pension
benefits for its Employees covered by this Agreement as well as pensioners, under the
1974 Pension Plan and Trust, whose last signatory classified employment was with such
Employer. The benefits provided by the Employer to its eligible Participants pursuant to
such plans shall be guaranteed during the term of this Agreement by that Employer at
levels set forth in such plans… The plans established pursuant to this subsection are
incorporated by reference and made a part of this Agreement, and the terms and
conditions under which the health and other non-pension benefits will be provided under
该等计划应在该等计划中提出.
Article XX, paragraph (10) of the National Bituminous Coal Wage Agreement of 1984 provides
in pertinent part:
Health care benefits are guaranteed during the term of this Agreement subject to the
terms of this Agreement at the level of benefits provided in the 1950 Benefit Plan, 1974
福利计划和雇主福利计划.
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(煤炭公司).
(2)“工资协议”系指《皇冠搏彩中心网站》
不时修订的1984年及任何后续协议.
(4) “Employee” shall mean a person working in a classified job for the Employer,
有资格获得本协议项下的福利.
雇主福利计划第II条A(1)款规定:
第二条-资格
Opinion of Trustees
Resolution of Dispute
Case No. 84-125
Page 3
The persons eligible to receive the health benefits pursuant to Article III are as follows:
A. Active Employees
第III条规定的福利应提供给下列任何员工:
(1) is actively at work* for the Employer on the effective date of the Wage
Agreement; or …
Article III A (8) of the Employer Benefit Plan provides in pertinent part:
Article III – Benefits
A. Health Benefits
(8) Co-Payments
Certain benefits provided in this Plan shall be subject to the co-payments set forth
以下及此类共同付款应由受益人负责. The
Plan Administrator shall implement such procedures as deemed appropriate to
实现这些共同支付的目的.
* * *
健康福利的共同支付额确定如下:
Benefit Co-Payment
(a)作为外工作组的医生服务- $7.50
在A节中所列的病人，每次访问，直到A
(2)和医生就诊，每人最多150美元
与设定的12个月期间的利益挂钩(*)
第四部分A(3)，每个家庭段.
(e)但只适用于非工作小组会议之前和之后
产前检查如果医生每次检查5美元，最多一次
单独收费，每次收费上限为100元
除12个月期间的收费外(*)
每个家庭的交付和(g)段.
通过(m)， (n)段除外
住院手术，第(o)段
以及第A(7)条第(f)段.
_____________
Opinion of Trustees
Resolution of Dispute
Case No. 84-125
Page 4 * “Actively at work” includes an Employee of the Employer who was actively at work on
September 30, 1984, and who returns to active work with the Employer within two weeks after
工资协议的生效日期.
* The 12-month periods shall begin on the following dates: March 27, 1984;, March 27, 1985;
March 27, 1986; March 27, 1987.
(b)处方药和保险:每份处方5美元
如章节A(4)所述，或补充至A
还有带回家的药品每人最多付50美元
(*)每12个月住院
in Section A(1)(a). family. Note: For purposes
of this co-payment proviIf an employee is covered under an sion, a prescription employee Plan
(1)既定的追求或补充应是
(1978年的NBCWA)被认为是每30个以上
一名雇主在几天(或几天)内签字
一个12个月的期限(*)，其中的总供应量.
由雇员支付的共同费用
在此期间应是
计入12个月的最大值.
Discussion
Article III A (9) of the Employer Benefit Plan describes the Vision Care Program required under
the Plan.
Under Article XX (c) (3) (i) and paragraph (10) of the 1984年煤炭工资协定, health care
benefits are guaranteed during the term of the Agreement, subject to the terms of the Agreement,
at the level of benefits provided in the 1950 Benefit Plan, 1974 Benefit Plan, and the Employer
Benefit Plan.
Article III A(8) of the Employer Benefit Plan specifies that the beneficiary will be subject only
to a co-payment.of $5.00 or $7.每次出诊、出诊、住院和
门诊或门诊部就诊. 雇主福利计划第III A(9)条规定
雇主计划承保的视力保健服务.
Levels of benefits to be provided to Employees, Pensioners and their dependents and survivors
which are established through collective bargaining may not be unilaterally changed by an
Employer. The Respondent’s use of a non-conforming health coverage plan and its failure to
provide vision care coverage is inconsistent with the provisions of the 1984 Wage Agreement
及雇主福利计划;
Opinion of Trustees
Resolution of Dispute
Case No. 84-125
Page 5
受托人的意见
The Respondent’s use of a substandard health coverage plan is inconsistent with the express
1984年《皇冠搏彩中心网站》的规定. 被申请人有责任提供
benefits coverage for its Employees, Pensioners and their dependents and survivors at the level
specified in the Employer Benefit Plan incorporated by reference into the 1984 Coal Wage
Agreement.