____________________________________________________________________________

受托人的意见
____________________________________________________________________________

在再保险

原告: 养老金领取者
被申请人: 雇主
ROD案例编号: 93-111- 2002年3月13日

受托人: A. 弗兰克·邓纳姆，迈克尔·H. 霍兰德，马蒂·D. 哈德逊和 艾略特一. 西格尔.

The Trustees have reviewed the facts and circumstances of this dispute concerning the provision of benefits under the terms of the 雇主 Benefit Plan.

背景事实

投诉人已收到2月1日的信函通知, 2001, that he was eligible for a 1974年退休金计划 Minimum Disability pension, 11月1日生效, 1996. 投诉人被建议与被投诉人联系, 最后签署人雇主, regarding his eligibility for health benefits coverage as a 养老金领取者. The Respondent has refused to provide health benefits coverage for the Complainant.

争端

Is the Respondent required to provide health benefits coverage for the Complainant as a 养老金领取者?

双方立场

Position of the 原告: The Respondent is required to provide health benefits coverage for the Complainant as a 养老金领取者.

Position of the 被申请人: The Respondent is not required to provide health benefits coverage for the Complainant because the Complainant is not eligible for a disability pension under the 1974 Pension Plan for the following reasons: 1) the Complainant was not permanently and totally disabled on October 2, 1996; 2) the Complainant was not disabled at the time of his termination on 2月1日4, 1997; and 3) the Complainant was not permanently and totally disabled as a result of a mine accident.

相关的规定

Article XX Section (c)(3)(i) of the National Bituminous Coal Wage Agreement of 1993 provides in pertinent part:

(3)(i) Each signatory 雇主 shall establish and maintain an Employee
提供的福利计划, 通过保险公司实施, health and other non-pension benefits for its Employees covered by this Agreement as well as pensioners, 1974年养恤金计划和信托皇冠搏彩中心网站, whose last signatory classified employment was with such 雇主 and who are not eligible to receive benefits from a plan maintained pursuant to the Coal Act. The benefits provided by the 雇主 to its eligible Participants pursuant to such plan shall be guaranteed during the term of this Agreement by that 雇主 at levels set forth in such plan. . . .

Article I (1), (2) and (5) of the 1993 雇主 Benefit Plan provide:

第一条-定义

(1) “雇主”指(雇主名称).

(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1993, as amended from time to time and any successor agreement.

(5) “养老金领取者” shall mean any person who is receiving a pension, other than (i) a deferred vested pension based on less than 20 years of credit service, or (ii) a pension based in whole or in part on years of service credited under the terms of Article II G of the 1974 Pension Plan, 或其任何继承者的任何相应段落, 根据1974年退休金计划(或其任何后续计划), whose last classified signatory employment was with the 雇主, 以本计划第二条B款的规定为准. “养老金领取者” shall not mean any individual entitled to benefits under section 9711 of the Internal Revenue Code of 1986, as amended by the Coal Industry Retiree Health Benefit Act of 1992.

第二条乙. 1993年雇主福利计划第(1)条规定:

第二条-资格

The persons eligible to receive the health benefits pursuant to Article III are as follows:

B. 养老金领取者

Health benefits under Article III hereof shall be provided to 养老金领取者 as follows:

(1) Any 养老金领取者 who is not again employed in classified signatory employment subsequent to

(a) such 养老金领取者’s initial date of retirement under the 1974 Pension Plan, and

(b) 2月1日, 1993, 都有资格作为养老金领取者享受以下的保险, 并受本计划所有其他条款的约束. Notwithstanding (i) and (ii) of the definition of 养老金领取者 in Article I(5) of this Plan, any such 养老金领取者 who was eligible for benefits under the 1974 Benefit Plan as a 养老金领取者 on December 5, 1977, 都有资格享受这些福利, 受本计划所有其他条文规限.

讨论

第二条乙. of the 雇主 Benefit Plan established pursuant to the 1993 Wage Agreement states that health benefits coverage shall be provided for 养老金领取者 who are receiving pension benefits under the 1974 Pension Plan. Article I (5) of the 雇主 Benefit Plan defines such 养老金领取者 as any person whose last classified signatory employment was with the 雇主, and who is receiving a pension under the 1974年退休金计划 with certain exceptions not relevant here. The Complainant is receiving a disability pension from the 1974 Pension Plan. 因此, he satisfies the definition of “养老金领取者” as set forth in Article I (5) of the Plan and is eligible for health benefits coverage under 第二条乙. of the 雇主 Benefit Plan established by 最后签署人雇主, the Respondent.

The Respondent has asserted that the Complainant is not entitled to a disability pension from the 1974 Pension Plan. The Respondent’s challenge of a pension eligibility decision under the 1974 Pension Plan may not be addressed by the Trustees in the ROD process. The Respondent’s challenge has been addressed in a separate procedure authorized by Article XX Section (g)(3) of the Wage Agreement.

受托人的意见

The Respondent is required to provide health benefits coverage for the Complainant as a 养老金领取者, 11月1日生效, 1996, 符合雇主福利计划的条款. Any 雇主 challenge of a pension eligibility decision must be raised in a separate procedure authorized by Article XX Section (g)(3) of the Wage Agreement, 受托人可能不会在审查审查程序中处理的问题.