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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: 84-209——1986年7月24日

董事会:Joseph P. 康纳斯,老., Chairman; Paul R. 院长,受托人;
威廉·B. Jordan,受托人; William Miller,受托人; Donald E. 皮尔斯,小.,受托人.

Pursuant to 篇文章中,我X of the United Mine Workers of America 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 level of health benefits coverage for the dependent of an employee.

背景事实

The Complainant is an active mine worker employed in classified-service by the Respondent. The Respondent is providing the Complainant health benefits as an active 员工.

The Complainant claims to have been.given legal guardianship of his minor niece on April 20, 1986, and contends that the Respondent should provide health benefits to his niece as his eligible dependent. 答辩人声明, according to the 雇主 Benefit Plan, the niece of an 员工 is not an eligible dependent unless she has been adopted by the 员工. Because the Complainant’s niece has not been adopted by the Complainant, the Respondent contends it is not required to provide her benefits.

争端

Is the Respondent responsible for providing health benefits for the Complainant’s niece?

双方立场

Position of 原告: Because the niece is an eligible dependent of the Complainant, the Respondent is responsible for providing her health benefits.

Position of 被申请人: The Complainant’s niece is not an eligible dependent as defined by the 雇主 Benefit Plan and it is not responsible for providing her health benefits.

相关的规定

篇文章中,我. (1), (2), (4), and (7) of the 雇主 Benefit Plan provide:

第一条定义

The following terms shall have the meanings herein set forth:

(1) “雇主” means (雇主’s Name) .

(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1984, as amended from time to time and any successor agreement.

(4) “员工” shall mean a person working in a classified job for the 雇主, eligible to receive benefits hereunder.

(7) “Dependent” shall mean any person described in Section D of 第二条 hereof.

第二条. D (2) of the 雇主 Benefit Plan provides:

D. 合格的家属

健康的好处 under 第二条I 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C, 第1条:

(2) Unmarried dependent children of an eligible 员工 or 养老金领取者 who have not attained age 22;,

For purposes of this paragraph D, a person shall be considered dependent upon an eligible 员工, 养老金领取者 or spouse if such 员工, 养老金领取者 or spouse provides on a regular basis over one-half of the support to such person.

问题与回答(Q&A) H-3 (81) (Part 3) provides:

主题: Health benefits; Dependent Children

Reference: (50B) II C; (74B) II C

问题:

Assuming all elements of dependency are met, may the following relatives qualify for health benefits as dependents of participants?
(3) Nieces, nephews, foster children, brothers and sisters.

答:

(3) Nieces, nephews, foster children, brothers and sisters are not covered. They may be included, 然而, if adopted by the participant.

讨论

Under 第二条 D (2) of the 雇主 Benefit Plan, health benefits are provided to eligible dependent children of 员工s. 在这种情况下, 然而, a question has been raised as to whether the Respondent is obligated to provide benefits to the Complainant’s niece. 问下&A H-3, the niece of an 员工 does not qualify for health benefits unless she is adopted by the 员工. The Complainant does not claim to have adopted his niece, but only claims that he has been appointed legal guardian. Because guardianship does not meet the requirements for eligibility as explained in Q&A H-3, the Respondent is not responsible for the provision of health benefits to the Complainant’s niece.

受托人的意见

The Respondent is not responsible for providing health benefits to the Complainant’s niece.