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受托人的意见
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在再保险
原告: 养老金领取者
被申请人: 雇主
ROD案例编号: 88-257——1990年6月19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.
根据美国煤矿工人联合会(“UMWA”)1950年福利计划和信托的第九条, 并根据美国劳工部授予的豁免授权, the Trustees have reviewed the facts 和 circumstances of this dispute concerning the provision of benefits coverage for a 养老金领取者 under the terms 雇主福利计划的成员.
背景事实
原告, 谁的生日是7月16日, 1929, 在八月二十四日为答辩人执行机密工作时受了可予赔偿的伤害, 1987. 由于这次受伤, 申诉人无法返回工作岗位，因此获得了工人赔偿. 投诉人于1988年2月29日被被告解雇.
根据1974年养恤金计划，申诉人获得55岁退休养恤金, 7月1日生效, 1989, 根据签署者12又3/4年的机密服务. 有人建议他与最后签字的雇主联系, 被申请人, 关于他作为养恤金领取者是否有资格享受健康福利的问题.
被投诉人拒绝为投诉人作为养恤金领取者提供医疗保险. 被告的代表声称, 根据1988年全国烟煤工资协议(“工资协议”), the Complainant is not entitled to an Age 55 retirement pension because the Complainant was not a working miner when he retired; rather, 他是残疾人，在领取养恤金之前就处于下岗状态. 该代表争辩说，申诉人应该得到一笔延期的既得退休金和, 因为他的服役年限还不到20年, 他没有资格享受医疗保险. The Respondent also suggests that the Complainant may have earnings in excess of the earnings limitation under the Plan. The Respondent’s representative also contends that the Complainant is not entitled to health benefits coverage as a disabled Employee because he does not have the 20 years of credited service required for “disability benefit retirement.“终于, the representative claims that 被申请人 is not responsible for providing the Complainant’s health benefits coverage because the Complainant became a 养老金领取者 after the expiration of the 1984 Wage Agreement, 被告于4月14日签署《皇冠搏彩中心》时，他并不具有“雇员身份”, 1988.
争端
Is 被申请人 responsible for providing health 和 other non-pension 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 responsible for providing health 和 other non-pension benefits coverage for the Complainant as a 养老金领取者.
Position of 被申请人: The Respondent is not responsible for providing health benefits coverage for the Complainant because the Complainant does not meet the eligibility requirements established pursuant to the 1988 Wage Agreement.
相关的规定
《皇冠搏彩中心网站》第20条第(c)(3)(i)款相关部分规定:
(3)(i)各签署雇主应建立并维持员工福利计划，以提供, 通过保险公司实施, health 和 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, 谁的最后一个签署人曾受雇于该雇主. The benefits provided by the 雇主 to its eligible Participants pursuant to such plans shall be guaranteed during the term of this Agreement by that 雇主 at levels set forth in such plans.
第二条A款. 1974年养恤金计划规定:
第II条-资格.
55岁退休
Any Participant who (a) has at least 10 years of signatory service or at least twenty years of credited service, 包括第Iv(C)(6)条规定的签字人送达金额。, 和 (b) has attained the age of 55 years (but not the age of 62) prior to retirement shall be eligible to retire on or after 2月1日, 1988, 并在退休时(以下简称“55岁退休”)有资格领取养老金.
雇主福利计划第I(1)、(2)和(5)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(雇主名称)
(2) “工资协议”指1988年全国烟煤工资协议, 如不时修订及任何后续协议.
(5) “养老金领取者”系指领取养老金的任何人, 除了(i)根据少于20年的记帐服务领取的递延既得退休金, or (ii) a pension based in whole or in part on years of service credited under the terms of Article II & 1974年养恤金计划, 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), 谁的最后一次机密签署工作是在雇主处, 以本计划第二条B款的规定为准.
第二条乙. 雇主福利计划第(1)及(4)条规定:
第二条-资格
根据第三条有资格领取健康津贴的人员如下:
B. 养老金领取者
Health benefits 和 life insurance 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, 和
(b) 2月1日, 1988, 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. 尽管本计划第1(5)条对退休金领取人的定义(i)及(ii)另有规定, 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.
(4) Health benefits shall not be provided during any month in which the 养老金领取者 is regularly employed at an earnings rate equivalent to at least $500 per month.
讨论
The representative for 被申请人 contends that the Complainant is not entitled to an Age 55 retirement pension. Regulations governing the determination of eligibility for a pension are set forth in the 1974年退休金计划. Funds’ staff have reviewed the evidence in the Complainant’s pension file 和 affirmed the Funds’ previous determination that the Complainant is entitled to an Age 55 retirement pension pursuant to 第二条A款. 1974年养恤金计划.
The determination of eligibility for health benefits coverage for a 养老金领取者 is governed by the provisions of 第二条乙. 雇主福利计划的成员.
第二条乙. 为领取1974年养恤金计划养恤金的养恤金领取者提供健康福利, other than a deferred vested pension based on less than 20 years of credited service or a pension based in whole or in part on years of service credited under the terms of Article II G. 1974年养恤金计划. 鉴于申诉人领取1974年养老金计划55岁退休养老金, 不是递延既得养恤金，也不是根据第II条G款记入的服务而领取的养恤金, 根据第二条B款，他有资格作为养恤金领取者享受健康福利. 雇主福利计划的成员. Although 被申请人 alleges that the Complainant may have exceeded the earnings limitation under 第二条乙. (4)雇主福利计划，没有证据支持被投诉人的指控.
The Respondent’s representative also claims that 被申请人 is not responsible for providing the Complainant’s health benefits coverage because he became a 养老金领取者 after the expiration of the 1984 Wage Agreement 被告于4月14日签署《皇冠搏彩中心》时，他并不具有“雇员身份”, 1988. Article XX Section (c)(3)(i) of the 1988 Wage Agreement requires each signatory 雇主 to establish 和 maintain an 雇主 Benefit Plan to provide health 和 other non-pension benefits for 养老金领取者 谁的最后一个签署人曾受雇于该雇主. Inasmuch as 被申请人 is signatory to the 1988 Wage Agreement 和 the Complainant is a 养老金领取者 whose last signatory classified employment was with 被申请人, 被申请人 is required to provide health benefits coverage for the Complainant as a 养老金领取者 和 for his eligible dependents from the effective date of his pension, 7月1日, 1989.
受托人的意见
The Respondent is responsible for providing health benefits coverage for the Complainant 和 his eligible dependents, 7月1日生效, 1989, 根据工资协议及雇主福利计划的条款.