August 26, 1985
(Opinion issued in letter form; name and address deleted)
Re: Opinion of the Trustees
ROD No: 84-061
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 Resolution of Dispute concerning coverage of hospital charges resulting from your daughter’s outpatient dental care.
According to the applicable provisions of the Employer Benefit Plan, benefits are provided for hospitalization for dental procedures only if the hospitalization is necessary due to a pre-existing medical condition and prior approval is received from the Plan Administrator. There is no medical information to establish that your daughter’s outpatient hospitalization for dental care was necessary because of a pre-existing medical condition.
Because there is no evidence your daughter had a pre-existing medical condition and because prior approval was not obtained from your Plan Administrator, your Employer is not responsible for payment of charges for your daughter’s outpatient hospitalization for dental care.
Joseph P. Connors, Sr., Chairman
Paul R. Dean, Trustee
William B. Jordan, Trustee
William Miller, Trustee
Donald E. Pierce, Jr., Trustee