(Editor’s Note; This ROD not complete. Full copy not available. EMJ 3/27/97)
November 24, 1980
Re: Opinion of Trustees
Resolution of Dispute
Case No. 169
Pursuant to Article IX of the UMWA 1950 Benefit Plan and Trust, and under the authority of an exemption granted by the United States Department of Labor, the Trustees have reviewed the facts and circumstances of this dispute concerning coverage for dental services required as a result of an accident. Their opinion is answered in Question and Answer form as follows:
Subject: Dental and Oral Surgical Services
Reference:Article III, Section A(1)(g) and Section A(3)(e) of the Employer’s Plan.
Question: Are the following dental and oral surgical procedures covered under the 1978 Agreement?
a. Extraction of teeth?
b. Gingevectomy, alveolectomy, operculectomy?
e. Gingivoplasty, alveoplasty, vestibuloplasty?
d. Treatment of abscessed teeth?
e. Resection of prognathic mandible?
f. Mandibular bone staple?
Answer: The dental and oral surgical procedures listed above, when performed in a hospital, are covered only when they are part of a treatment for an illness or injury which is otherwise a covered benefit. Examples of this would be: 1) the extraction of teeth during treatment for an auto accident involving extensive facial damage; 2) the extraction of teeth during treatment for cancers of the head and mouth; or 3) the insertion of a mandibular bone staple to repair a fractured jaw.
Except as provided in the above paragraph, none of these seven procedures is covered under the 1978 Agreement.
Dental Services are specifically excluded from coverage, except for those listed under the Oral Surgery benefit in Section A(3)(e). These include surgical treatment for:
– tumors of the jaw
– fractures of the jaw, including reduction and wiring
– fractures of the facial bones
– frenulectomy, when related to ankyloglossia (tongue tie)