December 11, 1979
(Opinion issued in letter form; name and address deleted)
Re: Resolution of Dispute
Case No. 76
Pursuant to Article IX of the UMWA 1950 Benefit Plan and Trust, and under the authority of an exemption granted by the U.S. Department of Labor, the Trustees have received a question concerning coverage for oral surgery performed for treatment if periodontal disease under the Employer’s benefit plan.
According to Article III, Section A (3)(e) of the Employer Plan, benefits are not provided for dental services. However, with the approval of the Trustees, benefits are provided for the following limited oral surgical procedures, if performed by a dental surgeon or general surgeon.
o tumors of the jaw (maxilla and mandible)
o fractures of the jaw; including reduction and wiring
o fractures of the facial bones
o frenulectomy, when related to ankyloglossia (tongue tie)
The procedure performed on your wife for treatment of periodontal disease is not one of the four mentioned oral surgical procedures and therefore, it is not a covered benefit.
Harrison Combs, Chairman
John J. O’Connell, Trustee
Paul R. Dean, Trustee