______________________________________________________________________________
OPINION OF TRUSTEES
______________________________________________________________________________
In Re
Complainant: Surviving Spouse
Respondent: Employer
ROD Case No: 335 – May 28, 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 eligibility for health benefits coverage for a surviving spouse under the terms of the Employer Benefit Plan.
Background Facts
The Complainant is the surviving spouse of a miner who died on March 14, 1977
at age 51. He had more than 20 years of classified service for the Respondent and was receiving Social Security Disability Insurance benefits at the time of
his death. The Complainant was not eligible for a death benefit, but was eligible for health benefits under the UMWA 1974 Benefit Plan and Trust, effective December 6, 1974 until death or remarriage, pursuant to Article II.E.(2).
The Complainant received health benefits from the 1974 Benefit Plan and Trust for the term of the 1974 Wage Agreement. Following the expiration of the NBCWA of 1974, the Respondent apparently provided health benefits until March 1982, but Complainant has been without health benefits coverage since that time.
Dispute
Is the Respondent responsible for the provision of additional health benefits coverage to the Complainant?
Position of the Parties
Position of the Complainant: The Respondent or the 1974 Benefit Plan and Trust is responsible for health benefits coverage until death or remarriage.
Position of the Respondent: The Respondent is not eligible for health benefits.
Pertinent Provisions
Article II.C.(1) and E(2) of the UMWA 1974 Benefit Plan and Trust, effective December 6, 1974, provide:
C. Disabled Miners
In addition to disabled miners who are receiving pension benefits and are therefore entitled to receive health benefits under paragraph B of this Article II, health benefits under Article III shall also be provided to any miner who:
(1) (a) Has completed 20 years of credited service, including the required number of years of signatory service pursuant to Article IV C(6) of the 1974 Pension Plan,
(b) as not attained age 55, and
(c) becomes disabled after the effective date and is eligible for Social Security Disability Insurance Benefits under Title Il of the Social Security Act or its successor;
E. Surviving Spouse and Dependents of Deceased Miners
Health benefits under Article III shall be provided to (1) any unmarried surviving spouse and (2) her unmarried surviving dependent children as defined in subparagraphs (2) and (5) of paragraph D, of a miner who died:
(2) At a time when he is entitled to receive health benefits pursuant to paragraph B or C of this Article II;
Article l, (1),(2),(4), and (6) of the 1978 Employer Benefit Plan provides:
Article I – Definitions
The following terms shall have the meanings herein set forth:
1. “Employer” means (Coal company).
2. “Wage Agreement” means the Bituminous Coal Wage Agreement of 1978, 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.
6. “Beneficiary” shall mean any person who is eligible pursuant to the Plan to receive benefits as set forth in Article III hereof.
Article II.C.(1) and E(3) of the 1978 Employer Benefit Plan provide:
C. Disabled Employees
In addition to disabled Pensioners who are receiving pension benefits and are therefore entitled to receive health benefits under paragraph B of this Article Il, health benefits under Article Il shall also be provided to any Employee who:
1. (a) Has completed 20 years of credited service, including the required number of years of signatory service pursuant to Article IV C(6) of the 1974 Pension Plan or any corresponding paragraph of any successor thereto, and
(b) has not attained age 55, and
(c) became disabled after December 6, 1974 while in classified employment with the Employer, and
(d) is eligible for Social Security Disability Insurance Benefits under Title II of the Social Security Act or its successor;
E. Surviving Spouse and Dependents of Deceased Employees or Pensioners
Health benefits under Article III shall be provided to (i) any unmarried surviving spouse 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:
3. At a time when such Employee or Pensioner is entitled to receive health benefits pursuant to paragraph A, B, or C of this Article II, provided that (i) if such Employee or Pensioner died prior to the effective date of the Wage Agreement and the spouse is not eligible for a Surviving Spouse’s benefit, then only for the period that the spouse is eligible to receive death benefits in installment payments pursuant to paragraph C of Article III, or (ii) if such Employee or Pensioner died on or after the effective date of the Wage Agreement and the spouse is not eligible for a Surviving Spouse’s benefit and life insurance benefits or death benefits are payable in a lump sum, then only for 60 months following the month of the death of such Employee or only for 22 months following the month of death of such Pensioner. If life insurance benefits or death benefits are not payable, health benefits shall be provided only to the end of the month in which the Employee or Pensioner died.
Discussion
At the time of his death, the Complainant’s husband was a disabled employee, entitled to receive health benefits under Article II.C. of the 1974 Benefit Plan. The Complainant was therefore eligible, under Article 11.E.(2) of the 1974 Benefit Plan, for health benefits “until her death or remarriage.” In addition, the Complainant was entitled to a death benefit payable in 60 monthly installments.
Article XX(c)(3)(i) of the 1978 Wage Agreement required each signatory employer to establish an employee benefit plan to provide health and other non-pension benefits to its employees and pensioners and to their eligible dependents. Article II.E.(3)(i) of the 1978 Employer Benefit Plan provides health benefits to the unmarried surviving spouse of an employee who died at a time he was eligible to receive health benefits pursuant to Article II.C, provided that if the Employee “died prior to the effective date of the Wage Agreement and the spouse is not eligible for a Surviving Spouse’s benefit, then only for the period that the spouse is eligible to receive death benefits in installment payments.”
In addition to establishing the Employer Benefit Plan, the 1978 Wage Agreement amended the 1974 Benefit Plan by adding to it Article II.E.(3), which is substantively identical to Article II.E.(3) of the Employer Benefit Plan. In administering the 1974 Benefit Plan as amended, the Trustees considered the question of the continuing eligibility of an unmarried surviving spouse of an employee who died prior to the effective date of the 1978 Wage Agreement at a time when he was eligible to receive health benefits pursuant to Article II.C. of the 1974 Benefit Plan. In Q&A H-8, a copy of which is enclosed, the Trustees decided that such a surviving spouse continues to be entitled to health benefits from the 1974 Benefit Plan.
The Employer Benefit Plan is designed to continue benefits coverage previously provided under the 1974 Benefit Plan. The Trustees therefore conclude that, consistent with their interpretation set forth in Q&A H-8, the Complainant continues to be eligible for health benefits under the Employer Benefit Plans.
Opinion of the Trustees
The Respondent is responsible for the provision of health benefits to the Complainant until her remarriage and to her dependent children under the terms of the Employer Benefit Plans.