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受托人的意见
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在再保险

原告: 残疾员工
被申请人: 雇主
ROD案例编号: 93-059 - 1997年3月4日

受托人: 托马斯·F. 迈克尔·康纳斯. 霍兰德，唐纳德·E. 皮尔斯,小., 和艾略特A. 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

The Complainant is a disabled employee who receives Social Security Disability Insurance benefits, has over 20 years of signatory service, has not attained age 55 and became disabled while employed with the Respondent. The Complainant received a divorce in July 1994. The divorce decree states that the child born during the marriage “is not the natural child” of the Complainant. The divorce decree also states that “parental rights or presumption that might have been created . . . by the birth of said child during the marriage . . . 特此消灭.” The Complainant is not required to provide support for the child.

在申诉人离婚后, the Respondent terminated health benefits coverage for the Complainant’s divorced spouse and the child. 1995年7月, the Complainant requested that the Respondent reinstate health benefits coverage for the child.

争端

Is the Respondent required to reinstate health benefits coverage for Complainant’s divorced spouse’s child?

双方立场

Position of the 原告: The Respondent is required to provide health benefits coverage for the child because the child lives with the Complainant part time and receives Social Security benefits as a dependent of the Complainant.

Position of the 被申请人: The Respondent is not required to reinstate the child’s health benefits coverage because the child is not an eligible dependent of the Complainant. The Respondent states that its position is supported by a previous decision of the Trustees in ROD 84-092.

相关的规定

篇文章中,我. (1), (2), (4) and (7) of the 雇主 Benefit Plan provides:

第一条-定义

The following terms shall have the meanings herein set forth:

(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.

(4) “Employee” shall mean a person working in a classified job for the 雇主, eligible to receive benefits hereunder.

(7) “Dependent” shall mean any person described in Section D of 第二条 hereof.

第二条. D. (2)雇主福利计划 provides:

第二条-资格

D. 合格的家属

Health benefits under 第二条I shall be provided to the following members of the family of any Employee, 养老金领取者, or disabled Employee receiving health benefits pursuant to paragraphs A, B, 或本条第2款(C)项:

* * * * * * * * *

(2) Unmarried dependent children of an eligible Employee or 养老金领取者 who have not attained age 22;

* * * * * * * * *

为本D段的目的, a person shall be considered dependent upon an eligible Employee, 养老金领取者 or spouse if such Employee, 养老金领取者 or spouse provides on a regular basis over one-half of the support to such person.

问题与回答(Q&A) H-3(81)规定:

主题: 健康的好处; Dependent Children
Reference: (50B) II C; (74B) II C

问题:

Assuming all elements of dependency are met, may the following relatives qualify for health benefits as dependents of participants?

(1) Stepchildren, illegitimate children and adopted children
(2) 孙子
(3) Nieces, nephews, foster children, brother and sisters

答:

(1) Stepchildren, illegitimate children and adopted children are covered for health benefits. Coverage for adopted children begins the date they begin living in the participant’s household, provided the adoption process has begun.

(2) 孙子 are covered provided they are living in the same household as the participant. Their eligibility terminates upon the death of such participant; they are not included for health benefits as the dependent of a surviving spouse.

(3) Nieces, nephews, foster children, brothers and sisters are not covered. They may be included, however, if adopted by the participant.

讨论

根据第二条. D. (2)雇主福利计划, health benefits are provided to unmarried dependent children of an eligible Employee who have not attained age 22. Q&A H-3 (81) further states that stepchildren, illegitimate and adopted children may qualify for health benefits coverage assuming all elements of dependency are met.

在申诉人离婚后 in July 1994, the child ceased to be the Employee’s stepchild. (见ROD 84-092.因此,), the child does not qualify for health benefits coverage as an eligible dependent of the Complainant.

受托人的意见

The Respondent is not required to reinstate health benefits coverage for the Complainant’s divorced spouse’s child.