March 17, 1980
(Opinion issued in letter form; name and address deleted)
Re: Resolution of Dispute
Case Number 91
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 surgical procedures for an Employee’s dependent spouse under the Employer’s benefit plan.
The Employer’s benefit plan states in Article III, Section A, (3) that benefits are provided for the following limited oral surgical procedures if performed by a dental surgeon or general surgeon:
• Tumors of the jaw (maxilla or mandible)
• Fractures of the jaw, including reduction and wiring
• Fractures of the facial bones
• Frenulectomy when related only to an ankyloglossia (tongue tie)
Oral surgery for treatment of periodontal disease is not one of the four mentioned oral surgical procedures. Therefore, treatment of your wife’s periodontitis is not a covered benefit.
Sincerely,
Harrison Combs, Chairman
John J. O’Connell, Trustee
Paul R. Dean, Trustee