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OPINION OF TRUSTEES
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In Re
Complainants: Employees, Pensioners and Surviving Spouses
Respondent: Employer
ROD Case No: 88-029 – October 12, 1988
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 art 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 under the terms of the Employer Benefit Plan.
Background Facts
The Complainants are active Employees, Pensioners and surviving spouses of Pensioners, whose
last signatory classified employment was with the Respondent. The representative for the
Complainants states that the Respondent has failed to pay insurance premiums for the
Complainants’ health benefits coverage in a timely manner. As a result, the Complainants have
incurred unpaid bills for medical services. The Complainants have submitted copies of unpaid
bills, notices from collection agencies of payments due, and a letter indicating that one provider
will no longer honor the medical card provided to the Respondent’s Employees because of the
number of pending claims. The representative contends that the Respondent is not providing
health benefits coverage for the Complainants as required by Article XX (c)(3)(i) of the National
Bituminous Coal Wage Agreement (“Wage Agreement”) of 1988.
Dispute
Whether the Respondent is responsible for payment of the medical expenses incurred by the
Complainants and their eligible dependents.
Positions of the Parties
Position of the Complainants: The Respondent is responsible for providing health benefits
coverage for the Complainants and for payment of the covered medical expenses incurred by the
Complainants and their eligible dependents.
Opinion of Trustees
Resolution of Dispute
Case No. 88-029
Page 2
Position of the Respondent: The Respondent has not replied to repeated correspondence from
Funds’ staff requesting its position in this dispute.
Pertinent Provisions
Article XX(c)(3)(i) of the National Bituminous Coal Wage Agreement of 1988 provides in
pertinent part:
(3)(i) Each signatory Employer shall establish and maintain an Employee benefit
plan to provide, implemented through an insurance carrier(s), health and other nonpension 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), (4) and (5) of the Employer Benefit Plan provide:
Article I – Definitions
The following terms shall have the meanings herein set forth:
(1) “Employer” means (Employer’s Name).
(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of
1988, 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.
(5) “Pensioner” shall mean any person who is receiving a pension, other than (i) a
deferred vested pension based on less than 20 years of credited service, or (ii) a
pension based in whole or if, part on years of service credited under the terms of
Article II & of the 1974 Pension Plan, or any corresponding paragraph of any
successor thereto, under the 1974 Pension Plan (or any successor thereto), whose
last classified signatory employment was with the Employer, subject to the
provisions of Article II B of this Plan.
Article II A. (1) and (4), B. (1) and E. (2) of the Employer Benefit Plan provide:
Article II – Eligibility
The persons eligible to receive the health benefits pursuant to Article III are as
follows:
Opinion of Trustees
Resolution of Dispute
Case No. 88-029
Page 3
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.
B. Pensioners
Health benefits and life insurance under Article III hereof shall be provided to
Pensioners as follows:
(1) Any Pensioner who is not again employed in classified signatory
employment subsequent to
(a) such Pensioner’s initial date of retirement under the 1974 Pension
Plan, and
(b) February 1, 1988, shall be eligible for coverage as a Pensioner
under, and subject to all other provisions of this Plan.
Notwithstanding (i) and (ii) of the definition of Pensioner in
Article 1(5) of this Plan, any such Pensioner who was eligible fur
benefits under the 1974 Benefit Plan as a Pensioner on December
5, 1977, shall be eligible for such benefits, subject to all other
provisions of this Plan.
E. Surviving Spouse and Dependents of Deceased Employees or Pensioners
Health benefits under Article III shall be provided to (i) any unmarried surviving
spouse (who was living with or being supported by the Employee or Pensioner
immediately prior to the Employee’s or Pensioner’s death) and (ii) such spouse’s
unmarried surviving dependent children as defined in subparagraphs (2) and (5)
of paragraph D, of an Employee or Pensioner who died:
(2) Under conditions which qualify such spouse for a Surviving Spouse
benefit under the 1974 Pension Plan or any successor thereto.
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* Actively at work includes an Employee of the Employer who was actively at work on January
31, 1988, and who returns to active work with the Employer two weeks after the effective date of
the Wage Agreement.
Discussion
Opinion of Trustees
Resolution of Dispute
Case No. 88-029
Page 4
Article XX (c)(3)(i) of the 1988 Wage Agreement requires a signatory Employer to establish and
maintain an Employer Benefit Plan to provide health and other non-pension benefits for its
Employees and Pensioners whose last signatory classified employment was with such Employer.
The Wage Agreement stipulates 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
Plan.
Article II A. of the Employer Benefit Plan provides health benefits coverage for active
Employees working in classified jobs for a signatory Employer. Article II B. establishes that
individuals who are eligible for pension benefits under the UMWA 1974 Pension Plan are
eligible for health benefits coverage under the Employer Benefit Plan. Article II E. of the Plan
requires a signatory Employer to provide health benefits coverage to the unmarried surviving
spouses of Pensioners who receive Surviving Spouse benefits under the 1974 Pension Plan.
Inasmuch as the Complainants are active Employees, Pensioners and surviving spouses of
Pensioners whose last signatory classified employment was with the Respondent, the
Respondent is responsible for payment of the covered medical expenses incurred by the
Complainants and their eligible dependents during their individual periods of eligibility for
health benefits coverage, consistent with the terms of the Wage Agreement and the Employer
Benefit Plan.
Opinion of the Trustees
The Respondent is responsible for payment of the covered medical expenses incurred by the
Complainants and their eligible dependents during their individual periods of eligibility for
health benefits coverage, consistent with the terms of the Wage Agreement and the Employer
Benefit Plan.
