______________________________________________________________________________
OPINION OF TRUSTEES
______________________________________________________________________________
In Re
Complainant: Employee
Respondent: Employer
ROD Case No: 84-125 – April 7, 1986
Board of Trustees: Joseph P. 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
provision of health benefits coverage for an Employee under the terms of the Employer Benefit
Plan.
Background Facts
The Complainant, a classified Employee of the Respondent, maintains that the Respondent is
currently utilizing a health coverage plan which obligates the Employee to pay 20% of the
incurred medical charges to the provider at the time of the service. The Complainant has
submitted unpaid bills for medical services rendered between August 2, 1985 and October 28,
1985. The Complainant has also submitted a statement from the current insurance carrier which
indicates that the Complainant is subject to a deductible and coinsurance. The Complainant
maintains that vision care coverage was canceled in June 1981. The Complainant asks whether
the current level of health benefits coverage is in violation of the 1984 Coal Wage Agreement
which sets forth specific co-payments ($7.50) for rendered medical services and includes
coverage for vision care.
The Respondent agrees that the current level of health benefits coverage differs from that set
forth in the 1984 Coal Wage Agreement but claims that all Employees fully understood and
approved the plan.
Dispute
Is the provision of a non-conforming health coverage plan by the Respondent in violation of the
1984 Coal Wage Agreement?
Position of the Parties
Position of the Complainant: The Respondent is in violation of the 1984 Coal Wage Agreement
by its use of a substandard health coverage plan and its failure to provide vision care.
Opinion of Trustees
Resolution of Dispute
Case No. 84-125
Page 2
Position of the Respondent: The Respondent has not violated the 1984 Coal Wage Agreement
because the Employees approved the health coverage plan in effect.
Pertinent Provisions
Article XX (c) (3) (i) and (10) of the 1984 Coal Wage Agreement provides in pertinent part:
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… The plans established pursuant to this subsection are
incorporated by reference and made a part of this Agreement, and the terms and
conditions under which the health and other non-pension benefits will be provided under
such plans are as to be set forth in such plans.
Article XX, paragraph (10) of the National Bituminous Coal Wage Agreement of 1984 provides
in pertinent part:
Health care benefits are guaranteed during the term of this Agreement subject to the
terms of this Agreement at the level of benefits provided in the 1950 Benefit Plan, 1974
Benefit Plan, and the Employer Benefit Plan.
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
1984, as amended from time to time and any successor agreement.
(4) “Employee” shall mean a person working in a classified job for the Employer,
eligible to receive benefits hereunder.
Article II A (1) of the Employer Benefit Plan provides:
Article II – Eligibility
Opinion of Trustees
Resolution of Dispute
Case No. 84-125
Page 3
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 …
Article III A (8) of the Employer Benefit Plan provides in pertinent part:
Article III – Benefits
A. Health Benefits
(8) Co-Payments
Certain benefits provided in this Plan shall be subject to the co-payments set forth
below and such co-payments shall be the responsibility of the beneficiary. The
Plan Administrator shall implement such procedures as deemed appropriate to
achieve the intent of these co-payments.
* * *
Co-payments for Health Benefits are established as follows:
Benefit Co-Payment
(a) Physician services as an out- Working Group – $7.50
patient as set forth in Section A per visit up to a
(2) and physician visits in con- maximum of $150 per
nection with the benefits set 12 month period(*)
forth in Section A(3), paragraph per family.
(e) but only for pre- and post- Non-Working Group —
natal visits if the physician $5 per visit up to a
charges separately for such visits maximum of $100 per
in addition to the charge for 12-month periods(*)
delivery, and paragraphs (g) per family.
through (m), paragraph (n) except
inpatient surgery, paragraph (o)
and Section A(7) paragraph (f).
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Opinion of Trustees
Resolution of Dispute
Case No. 84-125
Page 4 * “Actively at work” includes an Employee of the Employer who was actively at work on
September 30, 1984, and who returns to active work with the Employer within two weeks after
the effective date of the Wage Agreement.
* The 12-month periods shall begin on the following dates: March 27, 1984;, March 27, 1985;
March 27, 1986; March 27, 1987.
(b) Prescription drugs and insu- $5 per prescription
lin, as set forth in Section A(4) or refill up to a
and take-home drugs following a $50 maximum per
hospital confinement as set forth od(*) 12-month period per
in Section A(1)(a). family. Note: For purposes
of this co-payment proviIf an employee is covered under an sion, a prescription employee Plan
(established pursu- or refill shall be
ant to the NBCWA of 1978) by more deemed to be each 30 than
one signatory employer during days (or fraction
a 12-month period(*), the total thereof) supply.
co-payments made by the employee
during such period shall be
counted toward the 12-month maximum.
Discussion
Article III A (9) of the Employer Benefit Plan describes the Vision Care Program required under
the Plan.
Under Article XX (c) (3) (i) and paragraph (10) of the 1984 Coal Wage Agreement, health care
benefits are guaranteed during the term of the Agreement, subject to the terms of the Agreement,
at the level of benefits provided in the 1950 Benefit Plan, 1974 Benefit Plan, and the Employer
Benefit Plan.
Article III A(8) of the Employer Benefit Plan specifies that the beneficiary will be subject only
to a co-payment.of $5.00 or $7.50 per office visit, house call, in-hospital medical admission and
clinic or out-patient department visit. Article III A(9) of the Employer Benefit Plan specifies the
vision care services to be covered under an Employer Plan.
Levels of benefits to be provided to Employees, Pensioners and their dependents and survivors
which are established through collective bargaining may not be unilaterally changed by an
Employer. The Respondent’s use of a non-conforming health coverage plan and its failure to
provide vision care coverage is inconsistent with the provisions of the 1984 Wage Agreement
and the Employer Benefit Plan,
Opinion of Trustees
Resolution of Dispute
Case No. 84-125
Page 5
Opinion of the Trustees
The Respondent’s use of a substandard health coverage plan is inconsistent with the express
provisions of the 1984 Coal Wage Agreement. The Respondent is responsible for providing
benefits coverage for its Employees, Pensioners and their dependents and survivors at the level
specified in the Employer Benefit Plan incorporated by reference into the 1984 Coal Wage
Agreement.
