Eligibility For Retiree Benefits

[Guest ooota]

Is a participant entitled to retiree benefits under the following scenario:

The participant is a member of a multiemployer health and welfare fund. The participant initially became eligible for benefits in 1973, the employee worked off and on from 1973 to 1995. The employee's eligibility was terminated in 1995 when the employee left to start his own business. In 2000, the employee returned to the fund and became eligible for benefits after fullfilliing the initial eligibility requirements of the fund.

The plan states that if an employee's coverage is terminated and the employee did not make self payments or elect COBRA coverage, and the employee's coverage has been terminated for more than one year, the employee must meet the Plan's initial eligibility requirements before the employee's coverage will be reinstated.

Also, to be considered a Retiree under the plan, the employee must have performed at least ten thousand hours of covered employment since he initially became a covered employee.

As per the definition of retiree, did the participant become initially eligible for benefits in 1973 or in 2000? The answer to this question would be more clear cut if the word reinstated was not included in the above plan language.

Any opinions in regard to this matter will be greatly appreciated.

[mal]

My initial reaction would be yes, I think he would be entitled to retiree coverage.

Assuming the trust/plan document allow the trustees the authority to

interpret any ambiguities, I think the Board could conceivably come down

on either side of this issue. However, depending on your Circuit, a

federal judge may be willing second guess the Board and declare

their decision arbitrary and capricious.