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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:84-178 - 1986年8月28日
董事会:Joseph P. 康纳斯,老., Chairman; Paul R. Dean,受托人; William B Jordan,
Trustee; 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 福利计划
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
level of health benefits coverage for Employees under the terms of the 雇主 福利计划.
背景事实
The Complainants are the Employees of the Respondent. 投诉人代表
contends that the Respondent is providing substandard health benefits through the New York
人寿保险公司. He has submitted a Group Insurance Plan implemented through New
York 人寿保险公司 which indicates that benefit payments under this Plan are subject
to a $100 deductible for individual coverage and a $200 deductible for family coverage; the
雇主 福利计划 does not include deductible payments. 提交的计划
Complainants’ representative also indicates that benefit payments under this Plan are made for
between 80 percent and 100 percent of covered expenses; the 雇主 福利计划 provides
确定特定服务的付款金额. 此外，还有几种健康益处
that are required under Article III of the 雇主 福利计划, including vision care, are not
covered in the New York Life Insurance Plan submitted by the Complainants.
投诉人代表 asks that the Respondent be found responsible for the
provision of health benefits coverage at the level prescribed by the terms of the 雇主
福利计划 established pursuant to the National Bituminous Coal Wage Agreement of 1984.
The Respondent has failed to reply to repeated correspondence from the Funds regarding its
在这场争论中的立场.
争端
Is the Respondent responsible for the provision of health benefits coverage for the Complainants
at the level prescribed by the 雇主 福利计划?
各方立场
受托人的意见
争议的解决
情况下没有. 84-178
第二页
Position of the Complainant: The Respondent is responsible for the provision of health benefits
coverage for the Complainants at the level prescribed by the 雇主 福利计划.
Position of the Respondent: The Respondent has failed to Provide its 在这场争论中的立场.
相关的规定
Article XX Section (c)(3)(i) of the National Bituminous Coal Wage Agreement of 1984 provides
在相关部分:
第(c)节1974计划和信托
(3)(i) Each signatory 雇主 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 雇主. 的好处
provided by the 雇主 to its eligible Participants pursuant to such plans shall
be guaranteed during the term or this Agreement by that 雇主 at levels set
在这样的计划中.
Article I (1), (2), and (4) of the 雇主 福利计划 provide:
第一条-定义
The following terms shall have the meanings herein set forth:
1. “雇主”指(煤炭公司).
2. “Wage Agreement” means the National Bituminous Coal Wage Agreement of
1984, as amended from time to time and any successor agreement.
4. “Employee” 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.
第二条A款. 雇主福利计划第(1)及(4)条规定:
第二条-资格
The persons eligible to receive the health benefits pursuant to Article III are as follows:
A. 积极的员工
受托人的意见
争议的解决
情况下没有. 84-178
第3页
应提供第三条规定的福利
(1) is actively at work* for the 雇主 on Wage Agreement;
(4) A new Employee will be eligible for heal day worked with the 雇主
讨论
Article XX Section (c)(3)(i) of 一九八四年工资协议 requires each signatory 雇主 to
establish and maintain an 雇主 福利计划 to provide health and other non-pension
员工福利. The Wage Agreement stipulates that benefits provided by the
雇主 pursuant to such plan shall be guaranteed during the term of the Agreement by that
雇主在这些计划中规定的水平. 由于投诉人是公司的雇员
Respondent, they are eligible for health benefits coverage under the terms of the 雇主
福利计划.
Article III of the 雇主 福利计划 specifies the level of benefits to be provided by an
雇主. Levels of benefits to be provided to Employees are established through collective
bargaining and may not be unilaterally changed by an 雇主. The Respondent’s use of a nonconforming health coverage plan and its failure to provide certain types of coverage is
inconsistent with the provisions of 一九八四年工资协议 and the 雇主 福利计划.
受托人的意见
The Respondent’s use of a substandard health coverage plan violates the express provisions of
一九八四年工资协议. The Respondent is responsible for the provision of health benefits
coverage for the Complainants at the level specified in the 雇主 福利计划.
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* Actively at work includes an Employee of the 雇主 who was actively at work on
September 30, 1984, and who returns to active work with the 雇主 two weeks after the
工资协议生效日期.