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OPINION OF TRUSTEES
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In Re
Complainant: Employees
Respondent: Employer
ROD Case No: 81-645 – February 24, 1986
Board of Trustees: Joseph Connors, Sr., Chairman; Paul R. Dean, Trustee; William B. 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
level of health benefits coverage for the dependent of an Employee under the terms of the
Employer Benefit Plan.
Background Facts
According to information reported to the Funds by the Respondent, the Complainant began
working for the Respondent in a classified position in February 1983. The Complainant has
stated that in June 1984, the Respondent, an Employer signatory to the National Bituminous
Coal Wage Agreement of 1981, changed insurance carriers and replaced its former plan with an
“80/20” health coverage plan which obligates Employees to pay 20% of selected medical charges
incurred. The Complainant has submitted medical invoices for services rendered to his wife
after June 1984 stating that the new insurance carrier failed to make any payment for these
invoices on the basis that it was not the carrier at the time the charges were incurred.
The Complainant has asked that the Respondent be found responsible for the provision of health
benefits coverage for his wife at the level prescribed by the terms of the Employer Benefit Plan.
The Respondent has failed to respond to repeated correspondence from the Funds regarding its
position in this dispute. Therefore, the Trustees must issue a decision based upon the available
information.
Dispute
Opinion of Trustees
Resolution of Dispute
Case No. 81-645
Page 2
Is the Respondent responsible for the provision of health benefits coverage for the Complainant’s
wife at the level prescribed by the Employer Benefit Plan?
Position of Parties
Position of the Complainant: The Respondent is responsible during the Complainant’s period of
active employment for the provision of health benefits coverage for the Complainant’s wife at the
level prescribed by the Employer Benefit Plan.
Position of the Respondent: The Respondent has failed to present its position in this dispute.
Pertinent Provisions
Article XX Section (c)(3)(i) of the National Bituminous Coal Wage Agreement of 1981
provides:
(c) 1974 Plans and Trusts
(3)(i) 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.
Article I (1), (2), and (4) of the Employer Benefit Plan provide:
Article I – Definitions
The following terms shall have the meanings herein set forth:
(1) “Employer” means (coal company).
(2) “Wage Agreement” means the National Bituminous Coal Wage
Agreement of 1981, as amended from time to time and any successor
agreement.
Opinion of Trustees
Resolution of Dispute
Case No. 81-645
Page 3
(4) “Employee” shall mean a person working,in a classified job for the
Employer, eligible to receive benefits hereunder.
Article II A. (1) and (4) and D. (1) of the Employer Benefit Plan provide:
Article II – Eligibility
The persons eligible to receive the health benefits pursuant to Article III are as follows:
A. Active Employees
Benefits under Article III shall’ be provided to any Employee who:
1. is actively at work* for the Employer on the effective date of the Wage
Agreement; or
4. A new Employee will be eligible for health benefits from the first day worked
with the Employer.
______________________
*
“Actively at work” includes an Employee of the Employer who was actively at work on March
26, 1981, and who returns to active work with the Employer two weeks after the effective date of
the Wage Agreement.
D. Eligible Dependents
Health benefits under Article III shall be provided to the following members of the
family of any Employee, Pensioner, or disabled Employee receiving health benefits
pursuant to paragraphs A, B, or C of this Article II;
1. A spouse who is living with or being supported by an eligible Employee or
Pensioner;
Discussion
The Complainant has submitted medical bills for services rendered to his wife during his
employment with the Respondent which he claims have not been paid. The Complainant
therefore claims he has not been provided the level of health benefits coverage specified in the
Employer Benefit Plan.
Article XX Section (c)(3)(i) of the Wage Agreement requires each signatory
Employer to establish and maintain an Employee Benefit Plan and states that benefits provided
by the Employer pursuant to such plan shall be guaranteed during the term of the Agreement by
that Employer at levels set forth in such plans.
Opinion of Trustees
Resolution of Dispute
Case No. 81-645
Page 4
Under Article II A(1) and (4) of the Employer Benefit Plan, persons who are actively at work for
the Employer on the effective date of the Wage Agreement are eligible to receive health benefits
pursuant to Article III of the Plan. Persons employed after the date of the Wage Agreement will
be eligible from the first day worked with the Employer. Article II D. (1) of the Employer
Benefit Plan provides health benefits coverage for the eligible spouse of an active Employee.
Inasmuch as the Complainant satisfied the definition of active Employee as set forth in Article II
A. (1) and (4) of the Plan, the Complainant’s wife is eligible to receive, and the Respondent is
required to provide, health benefits coverage at the levels prescribed by the Employer Benefit
Plan for as long as she satisfies the eligibility requirements of Article II D. of the Plan.
The Trustees have addressed the issue of an Employer’s use of an “80/20” health coverage plan
in RODs 81-556 and 84-030 (enclosed herein), and concluded that the level of benefits to be
provided to Employees, Pensioners and their dependents and survivors is established through
collective bargaining and may not be unilaterally changed. Accordingly, the Trustees conclude
that the Respondent’s use of an “80/20” health coverage plan is inconsistent with the provisions
of the Wage Agreement and the Employer Benefit Plan.
Opinion of the Trustees
The Respondent is responsible, under the National Bituminous Coal Wage Agreement of 1981,
for the provision of health benefits coverage for the Complainant’s wife at the levels specified in
the Employer Benefit Plan during his active employment with the Respondent.