February 22, 1983
(Opinion issued in letter form; name and address deleted)
Re: Opinion of Trustees
Resolution of Dispute
Case No. 81-136
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 of your hospitalization for oral surgery (removal of impacted wisdom teeth) under the terms of your Employer’s Benefit Plan.
Article III. A. (3)(e) of your Employer’s Benefit Plan specifically excludes dental services from coverage.
Under Article III. a. (1)(g) of the Employer’s Plan, 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 you had no preexisting medical condition, and prior approval was not obtained from your Plan Administrator, your Employer is not responsible for payment of the charges for your hospitalization for oral surgery.
Harrison Combs, Chairman
John J. O’Connell, Trustee