June 28, 1983
(Opinion issued in letter form; name and address deleted)
Re: Opinion of Trustees Resolution of Dispute
Case No. 81-153
Pursuant to Article IX of the United Mine Workers of America 1950 Benefit Plan and Trust, and under the authority of an exemption granted by the United States Department of Labor, the Trustees have reviewed your Request for Advisory Opinion concerning coverage for your oral surgery under the Employer’s Plan.
Article III. A. (3)(e) of your Employer’s Plan specifically excludes benefits for dental services. Under Article III. A. (1)(g) of the Employer’s Benefit Plan, as amended June 7, 1981, benefits are provided for hospitalization for dental procedures only if the hospitalization is necessary due to a preexisting medical condition and prior approval is received from the Plan Administrator. Because your dependent had no preexisting medical condition and prior approval was not obtained from your Plan Administrator, your Employer is not responsible for payment of charges for your dependent’s hospitalization for oral surgery.
Sincerely,
Harrison Combs, Chairman John J. O’Connell, Trustee Paul R. Dean, Trustee