Opinion ID: 758774
Heading Depth: 3
Heading Rank: 4

Heading: Standing Under PG & E Health Plan

Text: 31 In order to have standing to sue under PG & E's health plan, the plaintiffs must establish that they have a colorable claim of right to vested benefits under that plan. See Firestone, 489 U.S. at 117, 109 S.Ct. 948. The district court found that the plaintiffs lacked standing because (1) health benefits are not vested benefits under ERISA, and (2) the plaintiffs had not participated in the health plan. 32 Health care benefits are included within the term welfare benefits, which are not subject to the same minimum vesting requirements under ERISA as pension benefits. See West v. Greyhound Corp., 813 F.2d 951, 954 (9th Cir.1987). However, this does not mean that the plaintiffs cannot have a colorable claim to accrued or vested benefits under the plan. The plaintiffs are not asserting that they are entitled to health plan benefits for medical expenses incurred after their period of employment. Instead, the plaintiffs contend that as common-law employees of PG & E, they had been automatically enrolled in the medical plan and therefore entitled to reimbursement for medical expenses the plaintiffs incurred during their employment at the Center, the same as the regular PG & E employees received. In a more general sense, then, the plaintiffs are claiming a right to a benefit, i.e. reimbursement for medical expenses incurred as employees enrolled under the plan, to which any PG & E employee enrolled in the plan would be entitled. 33 Under the terms of the Basic Health Plan, if the plaintiffs qualify as common-law employees, then they were automatically enrolled in the plan upon commencement of their employment, and thus participants in the health plan. 8 The PG & E Basic Health Plan provides: 3. PARTICIPATION 34 a. Except as specified in Section 3.b below, to become a PARTICIPANT, an EMPLOYEE must submit a completed ENROLLMENT FORM to the COMPANY within 31 days of becoming an EMPLOYEE.... 35 b. An EMPLOYEE shall automatically be enrolled in the PLAN without DEPENDENT coverage on the first day of employment with the COMPANY or an EMPLOYER. EMPLOYEE coverage shall continue until the date coverage commences under another COMPANY-offered medical plan following the EMPLOYEE'S election. 36 c. An EMPLOYEE who does not enroll in the PLAN when initially eligible, or who fails to submit a completed ENROLLMENT FORM during an open enrollment period designated by the COMPANY once each year, shall automatically be enrolled in the PLAN without DEPENDENT coverage. EMPLOYEE must wait until the next open enrollment period, as designated by the COMPANY once each year, before he may change plans and/or enroll his eligible DEPENDENTS. Such benefits shall become effective the following January 1. 37 The plan requires that in order to become eligible for more extensive health coverage, including dependent coverage, a PG & E employee must complete and return to the company an enrollment form. However, even in the absence of the enrollment form, each PG & E employee is automatically enrolled in a more basic health coverage plan that does not include dependent coverage. Therefore, if the district court determines that the plaintiffs qualify as common-law employees of PG & E under the Darden test, then the plaintiffs have a colorable claim to benefits, and thus have standing to sue for benefits under the health plan.