Resolution of Disputes by yaosaigeng

VIEWS: 3 PAGES: 23

									                                 Resolution of Disputes

                 Cumulative Index of Opinions- August 1, 2009
Note: This Index of Opinions follows the general format of the Employer Benefit Plans.
Opinions are arranged alphabetically by subject matter. Opinions under the 1978 National
Bituminous Coal Wage Agreement (Wage Agreement) are listed by number only, i.e.”38.” All
others are designated with the Wage Agreement year as a prefix, i.e.”88-390.” Coal Act Cases
are listed with the prefix “CA”. A Q&A with a prefix of “81” is a health Q&A. All others are
eligibility Q&A’s. To view an opinion, just click on the highlighted ROD number. To return to the
Index, just click on the back arrow.

       ARTICLE II A. ACTIVE EMPLOYEES
   Back pay award, 81-422
   Contract mining agreement with another company, 81-027, 81-117, 81-631, 81-652
   Employer’s responsibility to provide coverage, 81-301, 81-416, 81-498, 81-516, 81-556,
    81-573, 81-595, 81-682, 84-027, 84-034, 84-054, 84-055, 84-060, 84-174, 84-195, 84-243,
    84-251, 84-364, 84-409, 84-470, 84-489, 84-515, 84-556, 84-575, 84-579, 84-621, 84-690,
    84-722, 88-011, 88-020, 88-029, 88-035, 88-079, 88-145, 88-156, 88-188, 88-218, 88-244,
    88-262, 88-302, 88-383, 88-490, 88-649, 88-706, 98-038
   Employer sells to, becomes or merges with another employer
    --alter ego, 81-327, 84-470
    --merger, 84-324, 84-327
    --transfer of ownership, 81-346, 84-548
   Financial status of employer, 84-409, 84-515, 88-649, 88-798
   Insurance carrier
    --bankrupt /insolvent, 84-202, 84-243, 84-341, 84-422, 84-429, 84-430, 84-431, 84-445,
    84-490, 84-495, 84-509, 84-520, 84-538, 84-548, 84-584, 84-593, 84-609, 84-621, 84-647,
    84-655, 84-677, 88-344
    --coverage implemented through an insurance carrier, 88-235, 88-353, 88-374
   Insurance plan
    --implementation of/method of payment, 84-030, 88-235, 88-353, 88-374
    --payment of claims in timely manner, 98-031, 98-046, 02-022, 02-023
    --substandard plan, 81-301, 81-491, 81-519, 81-645, 84-030, 84-034, 84-058, 84-125,
    84-147, 84-148, 84-162, 84-178, 84-205, 84-547,88-034, 88-146, 88-235, 88-333, 88-374,
    88-591, 88-633, 88-658, 88-673
   Insurance premiums
    --nonpayment of, 81-176, 81-198, 84-243, 84-251, 84-438, 84-575, 84-579, 84-690, 88-029,
    88-156, 88-188, 88-206
    --reimbursement of premiums paid by employees, 81-017, 88-146, 88-169, 88-178, 88-195,
    88-196, 88-383
   Lapses in coverage, 81-682, 84-556, 88-333
   Level of heath benefits coverage, 81-301, 81-491, 81-498, 81-556, 81-645, 84-034, 84-058,
    84-125, 84-147, 84-178, 84-205, 84-215, 84-238, 84-325, 84-547, 88-146, 88-235, 88-278,
    88-279, 88-333, 88-344, 88-374
   Medicare, 20
   No longer in business (NLIB) determination under 1974 Benefit Plan and Trust, 84-027,
    84-060, 84-075, 84-076, 84-077, 84-121, 84-174, 84-318, 84-345, 88-248
   Non-classified employees, 81-114
   Offset (recoup insurance payments), 88-694
   Reciprocal coverage, (NBCWA/NCMCA), 5, 43
   Strike, following expiration of Wage Agreement, 32, 289, 309, 81-066, 81-631
   Sub-contractor, employed by, 243
   Suspension, period of, 84-088, 84-111, 88-707
   Training and retraining classes, 81-721, 84-239, 84-287, 84-305
   Wage Agreement
    --effective date of coverage, 32, 81-573, 84-055, 88-058, 88-141
    --expiration, coverage beyond, 81-054, 81-631, 81-637, 88-746
    --expiration, lockout, 88-711
    --letter of agreement, 81-682, 84-054, 84-055, 84-405, 88-011, 88-020
   Waiver, signed by employee, 81-198, 81-632, 88-328, 88-360, 88-527, 93-030
   Work stoppage, 84-279, 88-169, 88-174, 88-175, 88-176, 88-178, 88-183, 88-189, 88-191,
    88-192, 88-194, 88-195, 88-196, 88-197, 88-218, 88-229, 88-232, 88-238
   Workers’ compensation, 36, 81-575, 88-525, 88-726

       ARTICLE II B. PENSIONERS

   30-and-Out pensioner and disabled employee, 02-015
   Age 55 retirement pension, 81-205, 81-638, 81-669, 81-703, 84-115, 84-202, 84-333,
    84-371, 84-443, 84-529, 84-582, 88-206, 88-231, 88-248, 88-257, 88-702, 88-762, 02-010
   Back pay award, based on last signatory employment, 81-632, 84-557,02-038, 07-0001,
    07-0009
   Construction pension credit (pension eligibility based on), 98-042
   Contract mining agreement with another company, 81-041, 81-046, 81-047, 81-069, 81-083,
    81-311, 81-313, 81-348, 81-536, 81-600, 81-607, 81-608
   Deferred vested pension, 70, 81-155, 81-522, 81-609, 81-700, 81-707, 84-206, 84-475,
    84-553, 84-653, 02-024
   Definition of pensioner, 78-343, 81-521, 84-437, 88-230, 88-367, 98-018
   Disability pension, 81-413, 81-419, 81-492, 81-616, 81-635, 81-666, 84-139, 84-203, 84-262,
    84-277, 84-322, 84-360, 84-458, 84-481, 84-523, 84-546, 88-003, 88-023, 88-065, 88-149,
    88-193, 88-230, 88-324, 88-326, 88-538, 88-564, 88-567, 88-573, 88-654, 88-660, 88-758,
    88-807, 93-108, 93-111, 98-035, 98-051, 98-0052
    --awarded SSDI for closed period, 88-367
    --Coal Act, eligible for benefits under, CA-037
    --disability pension based on injury during previous employment, 84-198, 88-231, 88-357,
    88-425
    --modified wage agreement, employer signed, 98-015, 98-018, 98-039
   Discharged employee, 70, 81-490, 84-607, 88-443
   Earnings limitation, 81-155, 81-703, 84-203, 98-043, 07-0007
    --unemployment compensation, 117
   Effective date of coverage, 273, 343, 81-258, 81-521, 81-638, 81-660, 84-437, 84-600,
    84-724, 88-327, 88-367, 88-425, 88-564
   Employer sells to, becomes or merges with another employer
    --alter ego, 81-303, 84-523
    --successor company, 325, 326, 81-041, 81-046, 81-047, 81-069, 81-083, 81-499, 81-666,
    81-732, 84-134, 84-202, 84-372, 84-377, 84-523, 88-027, 88-111, 88-182, 88-587
                                               2
    --transfer of ownership, 81-615, 81-666, 81-727, 84-372, 88-027, 88-768, 07-043
   Employer’s responsibility to provide coverage, 1, 2, 70, 93, 117, 153, 273, 293, 310, 325,
    326, 337, 81-017, 81-041, 81-046, 81-069, 81-083, 81-117, 81-138, 81-155, 81-205, 81-228,
    81-262, 81-264, 81-303, 81-311, 81-313, 81-348, 81-349, 81-413, 81- 419, 81-434, 81-449,
    81-468, 81-490, 81-492, 81-499, 81-500, 81-512, 81-519, 81-522, 81-536, 81-609, 81-616,
    81-635, 81-666, 81-669, 81-684, 81-693, 81-707, 84-115, 84-166, 84-203, 84-206, 84-262,
    84-360, 84-498, 84-506, 84-529, 84-575, 84-579, 84-582, 84-724, 88-029, 88-230, 88-307,
    88-324, 88-443, 88-460, 88-538, 88-564, 88-567, 88-573, 88-676, 88-702, 88-747, 88-762
   Financial status of employer, 81-264, 84-262, 84-360, 84-582, 84-529, 88-702, 98-035
   Independent contractor, pensioner worked as, 81-449, 84-333
   Insurance carrier
    --bankrupt/insolvent, 84-202, 84-429, 84-431
    --refuses to enroll pensioner, 88-538
   Insurance plan
    --implementation/method of payment, 88-492
    --payment of claims in timely manner, 88-492, 98-045, CA-040
    --substandard plan, 84-290, 84-412, 84-553, 84-632, 88-326, 88-658, 88-701
   Insurance premiums
    --nonpayment of, 84-579, 88-029, 88-206, 88-307, 84-575
    --payment of covered medical expenses, 88-369
    --reimbursement of insurance premiums, 273, 81-660, 84-437, 88-161, 88-327, 88-369,
    88-450
   Laid-off employee becomes a pensioner, 81-468, 84-200, 84-437
   Last signatory employer, 1, 2, 70, 153, 310, 81-138, 81-434, 81-499, 81-652, 81-721,
    84-206, 84-333, 84-475, 84-557, 88-391, 88-587,
    --Coal Mine Construction Agreement, 88-561
    --employee injured, previous employer, 88-231
    --employer challenges assignment of, 98-030, 02-024
    --issue not ripe for Trustees decision, 98-046
    --Memorandum of Understanding, 98-025, 07-043
          --not regular employee, 98-025
    --panel/recalled pensioner, 98-046
    --pension based on construction and coal employment, 98-042
    --pension credit deleted-new last signatory employer, 93-112
    --pensioner returns to active employment then ceases work, 81-452, 02-007
    --self-employed, 84-122
   Length of service, no limitation on, 81-138, 81-611, 81-652, 81-721, 84-443, 84-653, 88-231,
    88-391, 98-025
   Level of benefits coverage, 81-519, 81-522, 84-412, 84-553, 84-632, 88-326
   Medicare, 81-260, 88-644
   Medicare Part D, 07-0021
   No longer in business determination under 1974 Pension Plan and Trust, 81-205, 81-228,
    81-349, 81-499, 81-635, 84-200, 84-262, 84-318, 84-345, 84-360, 84-371, 84-582, 88-248
   Non-classified and classified positions, pensioner worked, 81-512
   Non-signatory employer, pensioner last worked for a, 81-652, 84-122, 84-333, 84-443
   Offset (recoup insurance payments), 88-561



                                               3
   Pension eligibility, employer challenges to, 81-413, 81-419, 81-492, 81-638, 81-703, 84-139,
    84-166, 84-277, 84-322, 84-458, 84-481, 88-003, 88-149, 88-193, 88-230, 88-257, 88-326,
    88-347, 88-424, 88-437, 88-567, 88-660, 88-758, 88-792, 88-828, 88-830 , 02-024
    --discharged employee, 81-490, 88-443
   Pensioner goes to work for another signatory employer, 81-452, 81-500
   Retirement prior to 3/27/78, 74
   Returns to work, 153, 81-500
   Special Permanent Layoff pensioner and disabled employee, 98-007, 98-020
   Wage Agreement
    --expiration, coverage beyond 1978, 1981 Wage Agreements, 325, 326, 330, 340, 341,
    81-210, 81-218, 81-219, 81-339, 81-340, 81-376, 81-523, 81-528, 81-578, 81-589, 81-600,
    81-605, 81-606, 81-607, 81-608, 81-615, 81-619, 81-622, 81-629, 81-641, 81-642, 81-654,
    81-666, 81-681, 81-684, 81-690, 81-693, 81-698, 81-700, 81-701, 81-707, 81-715, 81-716,
    81-718, 81-719, 81-721, 81-722, 81-724, 81-725, 81-726, 81-728, 81-729, 81-732, 84-372
    --1987 Employment Economic Security Pact, 88-182, 88-357
    --extension of Wage Agreement, 81-725
    --interim agreement, 88-023, 88-248
    --letter of intent, 84-115, 84-134
    --modified wage agreement, 98-015, 98-018
    --retroactive effective date of Wage Agreement, 81-017
    --strike, 26, 81-629, 81-690, CA-074
   Waiver (Workers’ Compensation), 88-527, 93-030

       ARTICLE II C. DISABLED EMPLOYEES
   Continuation of coverage, 261, 267, 272, 312, 81-252, 81-314, 81-315, 81-327, 81-494,
    81-499, 81-582, 81-684, 84-090, 84-120, 84-147, 84-190, 84-498, 84-515, 84-610, 84-663,
    88-058, 88-244, 88-381, 88-657, 88-677, CA-074
   Employer sell to, becomes, or merges with another employer
    --alter ego, 81-327, 81-314
    --sale of stock, 81-727
   Insurance carrier
    --bankrupt/insolvent, 84-341
   Layoff, disabled while on, 151, 166, 81-488, 81-653, 84-291, 84-310, 88-378, 88-555,
         88-710, CA-074
   Level of benefits coverage, 88-034
   Life insurance, 69, 56, 84-062, 84-291, 88-376, 07-0052
   Over 20 years service /receives SSDI, 166, 298, 81-349, 81-361, 81-435, 81-488, 81-494,
    81-653, 81-704, 81-713, 81-727, 84-221, 84-234, 84-310, 84-407, 84-663, 88-378, 88-555,
    88-710, 93-109, 98-008
    --disabled while in classified employment, 151, 166, 81-488, 81-653, 81-713, 84-356,
    84-499, 84-618, 88-251, 88-378
    --discharged, 84-499, 98-008
    --effective date of coverage, 81-494
    --eligible for special permanent layoff pension, 98-007, 98-020
    --eligible for 30-and-Out pension, 02-015
    --not disabled while in classified employment, 93-097, 93-106
   Period between coverage termination and notification of SSDI award, 84-310

                                               4
   Sickness and Accident benefits, 267, 81-327, 81-582, 84-062, 84-356, 84-618, 88-058,
    88-299, 88-706
    --based on injury during previous employment, 84-618
    --quit slip, 81-582
   Wage Agreement
    --employer does not sign subsequent agreement, 93-109
    --expiration, coverage beyond, 81-648, 81-713
    --interim agreement, 88-034
    --modified wage agreement -employer signs, 98-008
   Workers’ Compensation/disabled within 4 years, 64, 69, 89, 81-269, 81-382, 81-456, 84-090,
    84-507, 84-663, 88-004, 88-707, 88-726
    --total disability, 81-382carods\CA-065.doc



       ARTICLE II D. ELIGIBLE DEPENDENTS
   Brothers and sisters, 81-048, 84-124, 84-480
   Child, 84-010, 84-020, 84-043, 84-045, 84-218, 88-456
    --adopted child, 88-312
    --age of child, 88-737
    --common-law spouse’s child, 88-245
    --employed child, 81-408, 81-433, 81-469, 93-060
    --married child, 84-078
    --not living with employee, 84-043, CA-065, 98-032
    --stepchild, 71, 84-092 93-059
   Common-law spouse, 156, 81-414, 84-127, 84-256, 88-162, 88-245
    --tax on health coverage, 98-021
   Dependency, proof of , requested by employer, 81-300, 81-335, 84-010, 84-011, 84-014,
    84-020, 84-043, 84-045, 84-401, 88-265
    --court ordered child support, 84-020, 84-045, 88-009, CA-065
    --definition of dependency, 84-056, 88-009, 88-382
    --income tax return, 84-010, 02-013
    --newborn, 84-218
    --Social Security payments in lieu of child support, CA-065
   Disabled dependent, 81-503, 84-028, 84-050, 88-410, 02-019
    --chronic mental illness, 88-087
    --definition of disabled, 88-030, 88-087, 88-740
    --married, 98-002
    --medical rating used by insurance carrier, 98-041
    --no longer resides with participant, 88-252
   Divorced spouse, 10, 84-087
    --child living with divorced spouse, 88-265, 98-032
    --stepchild, 84-092
   Effective date of eligibility, 8
   Foster Children, 81-484, 81-554, 84-569
   Grandchildren, 81-186, 84-392, 88-610, 02-013, 02-014
    --court order for grandchild’s father to provide health coverage, 02-014
    --not living with pensioner, 84-013
                                              5
    --step grandchildren, 84-392
   Illegitimate child, 88-456
   Insurance premiums, non-payment of, 309, 81-066
   Legal guardian of child, 81-135, 81-554, 84-209, 84-569, 88-282, 88-312, 88-629, 98-011
   Nieces and nephews, 84-209, 88-282, 88-629, 98-011
   Parent, 173, 81-107, 81-328, 81-545, 84-056, 84-068, 88-019, 88-040, 88-382, 88-451,
    88-500, 88-664
    --after employee’s death, 81-401, 88-219
    --one year residency requirement, 88-040
   Sister-in law, 81-135, 84-051
   Spouse, 5, 18, 44, 84-060, 84-224
    --employed –primary insurer, 88-132, 88-496
    --separated, Q&A H-13, Q&A H-14, 02-011
    --same sex, CA-050

       ARTICLE II E. SURVIVING SPOUSE AND DEPENDENTS OF
       DECEASED EMPLOYEES OR PENSIONER
   Coal Haulers’ Contract, 88-328
   Contract miner, employer operated as, 81-127, 84-685
   Dependent children, 88-709
    --deceased divorced pensioner, 81-679, 88-224
    --laid-off, 46, 84-709
    --mine fatality, 81-679, 84-459
    --surviving spouse remarries, 141, 81-377
   Employer sells to, becomes, merges with another employer
    --successor, 81-127, 81-237, 81-264, 81-687
   Grandchild
    --adopted by surviving spouse, CA-008
    --death of pensioner, 88-688
    --of deceased employee, 88-295, 07-0055
   Insurance carrier
    --bankrupt/insolvent, 84-674, 84-685
   Insurance premiums, nonpayment of, 84-685, 88-029, 88-221
    --reimbursement of, 88-690
   No longer in business (NLIB) determination under 1974 BP&T, 81-237, 84-339
   Parent of deceased employee, 81-401, 88-219
   Surviving spouse, 81-520, 84-339, 88-029
    --30-and-out pensioner (widow of), 02-028
    --active employee, 73, 217, 81-237, 81-264, 81-687, 84-685, 88-221, 88-328, 93-027
    --common-law spouse, 156, 81-685, 88-707, CA-080
    --died while eligible for coverage under 1974 BP, 137, 335, 81-197
    --disabled employee, 81-197, 81-261, 81-264, 81-481, 81-520, 81-730, 84-339, 84-351,
    84-428, 84-688
    --disabled employee receiving SSDI, 260, 298, 335, 81-285, 81-442, 81-506, 84-062,
    84-120, 84-291, 84-466, 88-054, 88-277, 88-677
    --discharged employee, 84-131
    --earnings limitation, 81-593
                                              6
    --laid-off employee, 46, 81-371, 81-520, 84-339, 84-709, 88-850
    --mine fatality, 217, 342, 81-439, 81-493, 84-400, 84-455, 84-674, 84-720
    --named beneficiary, 88-001
    --pensioner, 333, 81-127, 81-611, 81-629, 84-213, 84-351, 84-506, 88-029, 88-690
    --pre-retirement survivor annuity, 84-466, 84-524
    --Sickness and Accident employee, 81-481, 81-520, 84-062, 84-339
    --special permanent layoff pensioner, 98-022
    --SPLP pensioner (widow of), 98-022
   Surviving spouse remarries, 137, 84-685
    --dependent children, 141, 81-377
   Wage Agreement
    --death occurred after expiration of, 81-054, 81-629
    --death occurred during strike, 81-066
    --expiration, coverage beyond, 340, 81-523, 81-606, 81-629, 81-692, 81-724, 81-725,
    81-726, 84-213, 88-850
    --expiration during 60-month period of eligibility, 81-261, 81-696, 81-730, 84-387, 84-524,
    84-688
   Waiver, 88-328

       ARTICLE III – BENEFITS

       ARTICLE III A. (1) INPATIENT HOSPITAL BENEFITS
   Accredited/ approved hospital, 81-391, 84-067, 84-660, 88-165, 88-285
   Alcoholism and drug abuse, 81-391, 84-067, 84-157, 84-229, 84-614, 84-660, 84-717,
    84-718, 84-723, 88-127, 88-165, 88-270, 88-285, 88-341, 88-495, 88-698, 88-730, 88-849,
    88-833, CA-031, 93-017
    --court ordered treatment, 93-110
   Anesthesia, 81-299, 81-322, 81-323, 81-471, 84-260
    --dental services, 108, 84-105, 88-060, 88-340
    --obstetrical charges, 25
   Cardiac rehabilitation, 81-406, 81-410
   Co-payment for physician visits during hospitalization, 61, 81-085
   Dental procedures, outpatient hospitalization for, 17, 81-031, 81-425, 84-061, 84-367,
    84-666, 88-061, 88-101, 88-287, 88-291, 02-041
   Injured during criminal activity, 202
   Laser surgery procedure, 254
   Length of stay-dispute unnecessary hospitalization days, 88-335, 88-377, 88-449, 88-485,
    88-507, 88-509, 88-599, 88-648, 88-783, 88-825, 93-080
   Maternity benefits, change of employers, 5, 18, 44, 73
   Medical necessity, 81-447, 84-149, 84-171, 84-467, 84-611, 84-686, 88-134, 88-363,
    07-0010
   Mental illness, coverage for, 58, 81-024, 81-598, 84-457, 84-611, 84-614, 88-463, 88-632,
    88-833
    --continuing inpatient treatment for medical symptoms, 84-686
    --over 30 days of inpatient care, 84-686
    --over 60 days of inpatient care, 84-701
    --over 90 days of inpatient care, 58, 81-024, 81-598, 84-457
                                                7
   Obesity, surgery for, 138, 168, 175
   Obstetrical charges
    --excessive fee, 29, 84-149
    --pregnancy discrimination act, 73, 84, 171
   Oral surgical/dental services, 52, 67, 76, 108, 282, 321, 81-038, 81-062, 81-080, 81-123,
    81-136, 81-139, 81-153, 81-167, 81-179, 81-195, 81-201, 81-244, 81-259, 81-280, 81-363,
    81-370, 81-409, 81-511, 81-529, 81-612, 81-664, 84-085, 84-128, 84-404, 84-439
    --age of patient, 81-409, 84-085, 84-342, 84-594, 88-340
    --impacted wisdom teeth, 23, 30, 81-038, 81-136, 88-101, 88-340
    --noncovered procedures, 81-664, 81-672, 84-142, 84-158, 84-411, 84-418, 84-519,
    84-532, 84-559, 84-594, 88-015, 88-021, 88-060, 88-109, 88-125, 88-227, 88-240, 88-255,
    88-272, 88-274, 88-291, 88-303, 88-436, 88-565, 88-697
    --orthodontic, 93-024
    --orthognathic surgery, 93-016
    --periodontal disease treatment in relation to other illness, 187
    --preexisting medical condition, 81-471, 81-664, 84-093, 84-105, 84-172, 84-342, 84-367,
    84-404, 84-418, 84-447, 84-460, 88-287, 88-288, 88-340, 84-404
    --situational anxiety, 84-158, 84-172, 84-342, 84-404, 84-594, 88-061, 88-565
    --temporomandibular joint dysfunction, 81-075, 81-245, 81-388, 84-128, 84-156, 84-286,
    84-402, 84-411, 84-476, 88-021, 88-272, 88-303
   Physical therapy, 81-334
   Pre-admission certification, 84-196, 88-253
   Private room charges, 165, 81-307, 84-349
    --medical necessity, 84-533, 84-540, 88-167, 88-208, 88-335, 88-398, 88-507
   Psychiatric hospitalization, group therapy, 88-788
   Room and board, leave of absence, 98-023
   Self-inflected injury, 84-611
   Semi-private room, 84-171
   Venipuncture, 84-468

       ARTICLE III A. (2) OUTPATIENT HOSPITAL BENEFITS

   Emergency room
    --acute medical symptoms, 54, 81, 81-267, 81-430, 84-508, 84-555, 84-659, 84-694,
    84-696, 84-699, 84-704, 84-707, 84-708, 84-714, 88-047, 88-064, 88-159, 88-163, 88-225,
    88-236, 88-267, 88-294, 88-409, 88-415, 88-418, 88-435, 88-462, 88-470, 88-471, 88-487,
    88-514, 88-515, 88-519, 88-550, 88-553, 88-554, 88-560, 88-595, 88-598, 88-616, 88-628,
    88-699, 88-732, 88-781, 88-784, 88-799, 88-811, 88-824, 88-853, CA-045, 93-012, 93-094,
    98-034, 07-0025, 07-049
    --acute symptoms of chronic condition, 84-380, 84-620, 84-703, 88-427, 88-520,
    ----dental vs. medical conditions, 84-713, 88-409, 02-041,
    --forty-eight (48) hour limitation on benefits, 54, 81, 85, 81-096, 81-430, 84-048, 84-316,
    84-330, 84-555, 84-592, 84-617, 84-642, 84-672, 84-680, 84-704, 84-707, 88-045, 88-047,
    88-057, 88-214, 88-222, 88-267, 88-483, 88-548, 88-620, 88-744, 88-745, 88-787, 88-831,
    88-682, 88-789, 93-095, 02-039, 02-042
    --inappropriate setting, 88-520
    --injured during criminal activity, 202
    --instead of physician’s office or outpatient facility, 87, 84-518, 84-627, 02-039, 02-042,
                                                8
    07-049
    --medical necessity, 81-553, 84-268, 84-380, 84-699, 84-703, 88-267, 02-042
         --migraine headaches-excessive visits, 81-553, 84-703, 88-267, 88-754, 98-027
    --no acute medical symptoms, 81-096, 84-048, 84-316, 84-330, 84-352, 84-494, 84-518,
    84-580, 84-592, 84-627, 84-642, 84-672, 84-673, 84-680, 84-687, 84-695, 84-696, 84-703,
    84-707, 84-708, 84-713, 88-045, 88-057, 88-071, 88-100, 88-112, 88-118, 88-130, 88-214,
    88-222, 88-301, 88-342, 88-851, 88-365, 88-372, 88-389, 88-532, 88-533, 88-584, 88-602,
    88-603, 88-609, 88-641, 88-671, 88-680, 88-696, 88-718, 88-719, 88-743, 88-754, 88-785,
    88-793, 88-794, 88-813, 88-820, 88-822, 93- 028, 93-071, 93-095, 93-096, CA-038, CA-
    044, CA-068, 07-0025
    --physician’s charge, lab, x-ray, etc., 88-598, 88-718, 88-719, 88-789, 88-831
    --recurrence of acute medical symptoms, 88-092
    --subsequent follow-up treatment, 214, 88-372, 88-486, 88-508, 88-549, CA-038

       ARTICLE III A. (3) PHYSICIANS’ SERVICES AND OTHER
       PRIMARY CARE
   Allergy desensitization therapy, 320
   Allergy testing, 81-591
   Anesthesia services , 81-200, 81-293, 81-299, 81-322, 81-323, 81-559, 81-711, 84-260
    --malignant hyperthermia, 88-116
    --nurse anesthetist, 88-395
    --preoperative evaluation, 84-583, 88-276
    --related to dental procedures, 187, 81-095, 81-139, 81-244, 81-259, 81-280, 81-408,
    81-471, 84-105, 84-460, 84-594, 88-061, 88-101, 88-287, 88-728
   Artificial fertilization, 84-241
   Assistant surgeon’s fee, 159, 167, 81-563, 88-260, 88-276, 88-412, 93-067
    --medical necessity, 88-043, 88-106, 88-449, 93-067
   Athletic trainer, 88-242
   Attention Deficit Disorder (ADD), 93-052
   Birth control-Norplant, 88-627
   Blood pressure monitoring, 88-630, 88-466
   Cardiac rehabilitation, 81-406, 81-410, 81-415, 88-269
   Charges for writing a prescription, 84-224
   Chelation therapy, 84-712, 88-128, 88-729, 02-018
   Chemotherapy, 187, 88-154, 88-256, 88-321
   Chiropractor services, 229, 81-005, 81-253, 81-290, 84-306, 84-602, 84-662, 88-024, 88-126
    --x-rays, 109
   Cleft palate surgery, 84-312, 88-002, 88-355
   Contact lenses after cataract surgery, 84-282
   Cosmetic surgery, 81-733, 84-242, 84-350, 84-424, 88-114, 88-209, 88-263, 88-280, 88-361,
    88-402, 98-005, 07-0010
   Dermatology services
    --alopecia areata, 88-008
   Dyslexia, 93-068
   Examinations for cancer, 84-639
    --Magnetic Resonance Imaging (MRI), 88-117
    --PET Scans, 02-046, 07-0008, 07-0015
                                              9
   Emergency room physician’s charges
    --acute medical symptoms, 88-236, 88-435
    --forty-eight (48) hour limitations on benefits, 81, 85, 81-048, 84-617
   Eye care services, 88-012
   Immunizations, 84-413, 88-153, 88-371, 88-458, 88-592, 07-0017, 07-0061
   Impacted wisdom teeth, 23, 30, 81-038, 81-136
   Incidental surgery, 129, 81-156, 84-436, 88-070
    --tubal ligation, 81-656
   In-hospital visits, 61, 81-085, 81-447
   Injured during criminal activity, 202
   Intravenous antibiotic therapy, 88-028
   In vitro fertilization, 88-685
   Laboratory tests, 81-175, 84-224, 84-280
    --blood typing, 84-581
    --chromatography, 93-046
    --dental in nature, 88-311
    --histocompatibility testing, 88-063
    --immunoassay, 93-046
    --muscle biopsy, 88-116
    --screening and diagnostic procedures, 84-053, 84-059, 84-399, 84-628, 84-639,
    88-116, 88-117, 88-239, 88-306, 88-349, 88-423, 88-612, 88-806, CA-002, 07-048
    --visual field testing, 84-628
   Laser, 254, 81-711, 84-628, 93-061, 93-023
   Light box, 88-652
   Mammogram, CA-035
   Mastectomy, 88-637, 88-815
   Medical consultation, 84-583
   Medical necessity, 81-733, 84-242, 84-260, 84-268, 84-280, 84-282, 84-284, 84-348,
    84-363, 84-419, 84-420, 84-424, 84-434, 84-462, 84-510, 84-630, 84-656, 84-712, 88-002,
    88-008, 88-012, 88-028, 88-067, 88-128, 88-209, 88-239, 88-311, 88-317, 88-319, 88-349,
    88-359, 88-361, 07-0010, 07-0011, 02-045, 07-0057
   Nasal surgery, 84-424, 88-280, 88-388, 88-668, 07-0057
   Naturopathic services, 295
   Obesity treatment-nonsurgical, 104, 81-238, 81-476, 88-313
   Obstetrical charges
    --anesthesia, 25
    --delivery services, 81-301
    --excessive fee, 29, 84-149
    --pregnancy discrimination act, 73, 84, 171
   Office visits, 84-224
    --medical necessity, 84-268, 88-482
   Oral surgical procedures, 76, 91, 108, 129, 169, 201, 213, 282, 81-038, 81-153, 81-195,
    81-244, 81-259, 81-280, 81-388, 81-409, 81-425, 81-453, 81-511, 84-312, 84-367, 84-519,
    84-594, 88-436, 88-541, 88-621, 88-672, 93-075, 93-077, 02-040
    --bone grafts, 84-559, 88-201, 88-303, CA-007
    --dental implants, 84-362, 84-396, 84-418, 84-442, 84-564, 88-217, 88-240, 88-397, 88-399,
    88-624, 93-091, CA-069
    --extensive noncovered procedures, 81-672, 84-411, 88-061, 88-621, 88-608, 02-041

                                              10
    --mandibular augmentation, 81-655, 84-332, 84-362, 84-396, 84-418, 88-227, 88-274,
    88-303, 93-075
    --mandibular/maxillary osteotomy, 81, 56, 81-529, 81-672, 84-142, 84-286, 84-312, 84-402,
    84-411, 84-439, 84-447, 84-476, 84-519, 84-532, 88-015, 88-021, 88-060, 88-095, 88-109,
    88-125, 88-201, 88-211, 88-255, 88-272, 93-034
    --mandibular bone stapling, 88-227
    --part of treatment of covered illness, 187, 201, 282, 84-312, 84-603, 84-697, 88-355, 02-
    041
    --sinus condition, 93-091
    --whether required as the direct result of an accident, 94, 105, 240, 81-031, 81-385, 81-453,
    84-086, 84-381, 88-122, 93-102
    --sleep apnea, in connection with, 88-356
    --teeth extractions, 17, 23, 129, 84-603, 84-666, 84-697, 88-288, 88-298, 88-308, 88-323,
    93-013, 93-083, 93-086, 07-0006
    --temporomandibular joint dysfunction (TMJ), 52, 67, 313, 81-179, 81-233, 81-245, 81-388,
    81-544, 81-599, 81-683, 84-118, 84-128, 84-156, 84-286, 84-315, 84-362, 84-402, 84-411,
    84-419, 84-420, 84-462, 84-476, 84-496, 84-532, 84-630, 88-021, 88-060, 88-080, 88-109,
    88-122, 88-142, 88-152, 88-211, 88-272, 88-303, 88-317, 88-319, 88-387, 88-426, 88-622,
    93-076
    --tumors of the jaw, 213, 84-697, 88-541, 88-489, 88-859
    --vestibuloplasty, 81-056, 81-075, 88-303
   Organ transplant, 84-657, 81-404, 81-19
   Orthodontic services, 81-179, 81-544, 81-599, 81-655, 81-676, 81-683, 84-315, 84-381,
    88-021, 88-080, 88-109, 88-122, 88-142, 88-152, 88-211, 93-024, 93-102, 02-009
   Osteopathic physicians, 88-126
   Periodontal disease, 76, 91, 81-244
   Physical therapy, 81-334, 88-448, 93-047, CA-082
    --ultrasound therapy, 81-358
   Physician extender, 81-110, 81-299, 81-322, 81-563, 84-260, 88-260, 88-276, 88-395,
    88-412
   Podiatrist services, 81-337, 81-432, 81-455, 84-081, 88-760
    --assistant surgeon, 159
    --minor surgery, 81-337, 84-296, 88-816
    --noncovered routine care, 84-079
   Polysomnography testing, 88-655
   Pregnancy, termination, 84-149
   Pulmonary impairment, 84-059, 84-284
   Radial keratotomy, 84-222, 84-408, 88-579, 88-723, 93-061
   Specialist care, 67, 320, 84-496
    --optometrist care, 88-012
   Surgical benefits, 84-242, 88-002
    --percutaneous diskectomy, 88-036
    --radiofrequency sympathectomy, 88-566
   Surgical services limitations
    --blepharoplasty, 84-242, 84-348
    --collagen injections, 88-209
    --cosmetic surgery, 318, 81-310, 81-733, 84-348, 84-424, 88-114, 88-209, 88-263, 88-280,
      88-361, 88-402, 88-604, 07-0010
                                               11
    --incidental concurrent surgery, 81-156, 84-436, 88-070
    --mammoplasty, 318, 81-551, 88-263, 88-402, 88-420, 98-026
    --organ transplant, 81-404, 84-657, 88-364
    --plastic surgery, 318, 84-510, 88-209, 88-361, 88-402, 88-637, 88-815
    --prosthesis for cleft palate, 88-002
    --reconstructive surgery, 84-350, 84-510, 88-637, 88-815
   --treatment of obesity, 138, 168, 175, 296, 81-134, 81-212, 84-071, 84-247, 84-254, 84-363,
    84-383, 84-434, 84-633, 02-034
   Varicose veins, 88-604, 88-826, 07-0023
   Vision testing, 88-675
   Warts, 81-711, 84-079, 88-816
   Wig, 88-154, 88-321, 07-0012

       ARTICLE III A. (4) PRESCRIPTION DRUGS
   Allergy medication, 93-029
   Benefits excluded
    --medication dispensed by physician, 116, 81-057
    --medication experimental in nature, 81-504, 84-123, 88-445
    --medically reasonable and necessary, 88-099, 88-256, 88-293, 93-090, CA-072
    --obesity treatment, 104, 296, 88-293
   Dosage limits-override, 02-006
   Estrogens/progestogens, 88-202, 88-445
   Formulary drug program with surcharge, 98-013, 98-014, 02-002, CA-056, 93-098, CA-072,
    07-050
   Generic vs. brand name, 93-079, 93-098, CA-072
   Human growth hormone, 84-041
   Infant formula, 126, 227, 84-408
   Liquid nutrient, 88-103, 88-313
   Non-prescription drugs/ over the counter, 81-021, 81-561, 84-098, 84-502, 84-504
   Payment of initial prescriptions, 13
   Pregnancy /ovulation assisting medication, 93-026
   Refills beyond the initial six month prescription, 88-099
   Transdermal nicotine patches, 88-578
   Viagra, CA-055, 98-024, CA-097

       ARTICLE III A. (5) SKILLED NURSING CARE AND EXTENDED
       CARE UNITS
   Intermediate care facility, 81-229, CA-016
   Occupational therapy, 88-164
   Physical therapy, 81-334, 88-164
   Skilled nursing care facility, 249, 81-291, 81-474, 84-343, 84-565, 88-164, 88-210, 88-216,
    88-855, CA-001, CA-004, CA-011, CA-019
    -- Alzheimer patient, facility for, CA-070
    --intermediate care unit, 84-482, 84-561
   Speech therapy, 88-164

                                               12
       ARTICLE III A. (6) HOME HEALTH SERVICES AND EQUIPMENT
   Bed
    --adjustable, 88-385, 88-651
    --water, 81-487
   Air conditioner, 81-398
   Air Filter unit, 178, 304, 84-155, 88-046, 88-069, 88-084
   Aqua K pad, 84-240
   Bathroom safety equipment, 88-115, 88-394
   Blood pressure monitor, 88-466
   Breast pump/electric, 84-537, 88-691
   Carpet cleaning device, 88-084
   Chair
    -- three-wheeled motorized, 84-270, 84-340, 88-250
    --seat-lift, 84-135, 84-219, 84-261, 88-430
    --wheelchair, 84-232, 02-025
   Convenience item
    --reacher, 88-394
    --shower hose, 88-394
    --sock aid, 88-394
   Croup tent, 84-425
   Donut ring, 88-516
   Ear plugs-custom made, 84-656
   Elevator lift, 233, 98-049
    --prior authorization for, 98-049
   Environmental control supplies, 84-636
   Exercise equipment, 81-415, 84-288
    --stationary bicycle, 88-148, 88-546
    --treadmill, 88-269
   Home health services, 84-096, 84-283, 84-635, 88-039, 88-066, 88-089, 88-368, 88-589,
    88-727, 88-763, 88-855
    --approval of Plan Administrator, 88-066, 88-089
    --definition of homebound, 88-066, 88-089
   Hospital bed, electric, 84-530
   Incontinent patient supplies, 81-224, 81-277, 84-297,
    --reimbursement for, CA-062
   Insulin injection device, 88-455
   Jay cushion, 88-139
   Light box
    --seasonal affective disorder, 88-652
    --ultraviolet-B for psoriasis, 88-044
   Massager, 84-374
   Mattress, 88-338
   Nebulizer, 88-638
   Neuromuscular stimulator, 98-016
   Overhead transfer device, 98-049
   Oxygen, Q&A 81-90, 81-581, 88-638, 93-089
   Paraffin bath, 88-773

                                             13
   Recliner/rollabout chair, 88-338
   Sheepskin, 88-314
   Speech synthesizer, augmentation system, 84-331, 93-100
   Stockings, Jobst, 93-018
   TENS unit, 07-0028
   Wheelchair, 84-232, 02-025
   Wheelchair lift, 81-131, 88-261, 07-0032
   Whirlpool, 84-433, 88-050

                      ARTICLE III A. (7) OTHER BENEFITS
   Activity therapy, 98-023
   Ambulance charges, 84-237
    --air ambulance, 81-485, 84-133, CA-005
   Ambulette, 93-040
   Hearing aids, 81-185, 88-329, 88-593, 88-704, 88-791, 93-087
    --nonparticipating vendor, CA-003, 93-087
    --two aids (binaural), 88-593, CA-002, CA-006
   Orthopedic devices
    --elbow braces, 88-320
    --shoes, 220, 81-405, 81-495
   Outpatient drug and alcohol rehabilitation, 88-270, 88-846, 88-847
    --co-dependency therapy, 88-401
    --methadone maintenance program, 98-037
    --treatment at facility specified by employer, 88-847
   Outpatient mental health, medical necessity, 88-223, 88-249, 88-774
   Physical therapy, 81-334, 84-230, 88-135, 88-448, 02-025
    --athletic trainer, 88-242
    --co-payment for, CA-062
    --Iontophoresis, CA-082, 07-0026
   Private tutor, 98-023
   Prosthetic devices, 84-331
    --breast, 98-048
    --dental, 84-442, 84-564, 88-067, 88-217, 88-240, 88-397, CA-069
    --enteral nutrition, 88-103
    --penile prosthesis, 98
    --wig, 88-321, 07-0012
   Speech therapy, 88-007
   Travel expenses, 81-058, 81-181, 81-211, 84-113, 88-241, 93-008
    --ambulette, 93-040
    --escort, 113, 320, 88-093, 88-241
    --lodging charges, 315, 81-181, 88-093
    --meal expenses, 88-241
    --out of area medical center, 320, 84-237, 84-245, 84-248, 84-288, 84-500, 88-184
    --renal dialysis, related to, 88-241, 93-008, 93-040, CA-073



       ARTICLE III A. (8) CO-PAYMENTS AND DEDUCTIBLES
                                              14
   Allergy desensitization therapy, 204
   Anesthesiologists’ services, Q&A 81-55
   Coordination of benefits/copayment, Q&A 81-62, 60
   Deductible and Annual Health Benefit elimination, 07-0002, 07-0003, 07-0004, 07-0005
   Definition of physician visit, Q&A 81-50
   Employer charges co-payment for all services except inpatient hospital services, CA-062
   Formulary drug program with surcharge, 98-013, 98-014, 02-002 CA-056, CA-072
   HMO enrollees, Q&A 81-63
   Home health nurse visits, Q&A 81-56
   Individuals changing status, Q&A 81-58
   Insulin, Q&A 81-64
   Laboratory and x-ray services, Q&A 81-52, CA-062
   Lump sum health care payment, 93-031, 02-017
   Mail-order, 88-613
    --maintenance prescription drugs, CA-066, 02-001
   Medicare-eligible beneficiaries (Part B deductible), 102, 02-026, CA-074
   Obstetrical delivery services, Q&A 81-51
   Pernicious anemia injections, 197
   Pharmacy, network, 88-613
   Physician visits during hospitalization, Q&A 81-50, 61, 81-085, 88-493
   PPL-employer does not establish, 93-035
   Prescription drugs, Q&A 81-53, Q&A 81-54, 88-322, CA-097
   Primaries, two under same plan, Q&A 81-59
   Reimbursement procedures, 28, 132, 84-042, CA-074
   Responsibility of employee, 81-573, 84-413, 88-440
   Schedule of 12-month periods, 81-087
   Substandard health coverage plan, 81-426, 84-030, 84-034, 84-125, 84-147, 84-148,
    84-162, 84-178, 84-205, 84-290, 84-412, 84-553, 84-547, 84-632, 88-034, 88-146, 88-235,
    88-278, 88-279, 88-326, 88-333, 88-344, 88-431, 88-581
   Surgery, Q&A 81-57
   Transfer of copayment between employers during plan year, 231, 81-538, 88-354, 88-733

       ARTICLE III A. (9) VISION CARE
   Contact lenses 84-282, 88-406
   Experimental services or supplies, 84-222, 88-408
   Frequency of covered eye examination, 182, 81-015, 81-019, 81-029, 81-213, 81-462,
    84-231, 88-544
   Nonconforming coverage plan, 88-344
   Orthoptics/visual therapy, Q&A 81-66, 84-170, 84-230, 88-476, 88-738, 88-851, 93-015
   Prescription change, 66, 131, 206
    --surgically caused refractive errors, 84-129, 84-282, 88-406
    --visually impaired by medical condition, 84-514
   Vision care program, 84-125, 84-162

       ARTICLE III A. (10) GENERAL PROVISIONS

                                             15
   Acceptance of Plan by providers, 28
   Bonus, health care, 93-031
   Coordination of benefits/copayment, 60
    --copayment for spouse with coverage from employer, 98-017
   Cost containment, 88-024, 88-253
    --formulary drug program with surcharge, 98-013 , 98-014, 02-002 CA-056, CA-072
    --hospital admission precertification, 84-196, 88-253
    --implementation of network pharmacy program, 88-322, 88-403, 88-411
    --maintenance drug mail order program, CA-066
    --second surgical opinion, 88-253
   Excessive charges, 254
   Health maintenance organization (HMO), 81-411, 81-533, 88-302
   Hold harmless provision, 88-609, 88-667
    --beneficiary signs contract of adhesion, 84-531
    --deductible-must meet for hold harmless, 93-105
    --excessive charges, 84-260, 84-264, 84-412, 84-484, 84-583, 88-076, 98-048, CA-040
    --medical necessity, 84-280, 84-531, 88-043, 88-134, 88-335, 88-412, 88-449, 88-485,
    88-486, 88-507, 88-509, 88-513, 88-520, CA-038, CA-044, 02-046, 07-0008, 07-0023
    --promulgation of rules, 84-264, 84-484, 84-702, 88-076, 88-253, 88-452, 88-505, 88-508,
    88-558, 88-667
    --reimbursement of beneficiary’s payment, 84-264, 84-484, 88-105, 88-335
    --services not provided under Plan, 84-467, 84-602
   Medicare, 102, 81-044
    --active employee over age 65, 20
    --beneficiary fails to enroll in Part A & B, Q&A H-12, 20, 81-044, 81-260, 84-103, 84-271,
    84-448, 84-491, 84-497, 84-516, 84-542, 84-637, 84-679, 88-205, 88-467, 88-644, 88-650,
    88-659, CA-022, CA-071
    --beneficiary receives SSDI benefits, 88-650, CA-071
    --bonus, health care, 93-031
    --enrollment in Part D, 02-029, 02-030, 02-031, 02-033, CA-076, CA-077, CA-078, CA-079,
    07-0021
    --notification of obligation to enroll in Part A & B, 84-448, 84-491, 84-516, 84-679
    --spouse fails to enroll Medicare Part B, 84-637, 02-026
   Non-duplication, 78, 81-411, 81-462, 81-496, 84-128, 88-063, 88-141
    --copayment for spouse with coverage from employer, 98-017
    --individual insurance policy, 88-369
    --Medicare, CA-031
    --spouse’s employer offers coverage, 88-132, 88-496, CA-074
   Notice of coverage termination, 84-440, 84-606, 88-674, CA-047
   Preferred Provider List (PPL), 93-035, CA-062
   Promulgation of rules, 81-155, 81-593, 84-042, 84-196
    --alcoholism and drug rehabilitation program, 88-847
    --claims reimbursement procedures, 132, 88-440
    --drug utilization, 88-411, 88-414, 88-571
    --employment status questionnaire, 88-113, CA-047
    --enrollment Medicare Part D, 02-029, 02-030, 02-031, CA-076, CA-077, CA-078, CA-079,
    07-0021
    --formulary drug program with surcharge        , 98-013, 98-014, 02-002 CA-056, CA-072
                                              16
    --generic vs. brand name drugs, 88-403, 93-079, CA-072
    --hold harmless procedures, 84-264, 84-484, 88-076
    --mail order, 88-613, 93-029, CA-066, 02-001, 02-003
    --prescription drug reimbursement procedures, 84-042, 88-322 88-403, 88-411, 88-414,
         88-571, 88-613
    --time limit on claims submission, 337, 81-697, 81-710, 88-645
   Subrogation, 84-252, 84-565, 88-141, 88-369
    --auto insurance, 93-104, 98-049
    --cases covered by workers’ compensation laws, 88-055, 88-525, 88-678
   Substandard health coverage plan, 81-556, 81-645, 84-030, 84-034, 84-058, 84-125,
    84-147, 84-205, 84-215, 84-238, 84-290, 84-325, 84-412, 84-547, 84-632, 88-278, 88-326,
    88-623, 88-625, 88-832, 93-035

       ARTICLE III A. (11) GENERAL EXCLUSIONS
   Allergy
    --dust allergy apparatus, 178
    --tests/inpatient treatment, 84-467
   Anesthesia services
    --dental procedure, 81-095, 81-244, 84-367, 84-460
   Biofeedback therapy, 81-222, 81-643, 81-674
   Black lung tests, 319, 84-059, 84-284
   Blood glucose monitoring, 81-273
   Contact lenses, 84-282
   Custodial care, 249, 84-096, 84-283, 88-039, CA-001, CA-004, CA-011, CA-016, CA-019
    --covered under unusual circumstances, CA-058
   Dental services, 94, 105, 108, 112, 129, 169, 240, 282, 81-031, 81-038, 81-062, 81-139,
    81-363, 81-370, 81-383, 81-385, 81-409, 81-425, 81-453, 81-544, 81-599, 81-664, 88-323
    --dentures, 84-396, 88-067
    --extensive surgical procedures, 96, 112, 81-672, 84-142, 84-532, 02-041
    -- impacted wisdom teeth, 23, 30, 81-038, 81-136, 84-172, 88-308, 88-764
    --implants, 84-362, 84-418, 84-442, 84-564, 88-217, 88-240, 88-397, CA-069
    --oral surgery, 81-259, 81-388, CA-007, 02-041
    --oral orthopedic appliance, 81-544, 81-599, 81-655, 81-670, 81-676, 81-683, 84-070,
    84-073, 84-315, 84-381, 88-080, 88-152, 88-355
    --outpatient hospitalization, 17, 84-085
    --periodontal disease, 76, 187, CA-025
    --root canals, 105, 84-594
    --teeth extractions, 84-603, 88-298, 88-323, 07-0006
    --temporomandibular joint dysfunction (TMJ), 52, 67, 313, 81-233, 81-241, 81-544, 81-599,
    81-670, 81-676, 81-683, 88-311
   Dyslexia therapy, 93-068, 98-003
   Excessive fees, 29, 144, 176, 254, 322, 81-079, 81-124, 81-149, 81-183, 81-184, 81-196,
    81-216, 81-225, 81-265, 81-274, 81-297, 81-317, 81-326, 81-341, 81-343, 81-360, 81-366,
    81-407, 81-412, 81-428, 81-541, 81-566, 81-571, 81-634, 81-656, 84-484
   Exercise equipment
    --bicycle ergometer and pulsemeter, 81-415
    --exercise bicycle, 88-148

                                              17
    --heart rate monitor, CA-020
    --treadmill, 88-269
   Experimental medical devices and therapy, 254, 320, 81-082, 81-173, 81-222, 81-230,
    81-273, 81-287, 81-581, 81-591, 81-592, 81-711, 84-123, 84-222, 88-008, 88-656
    --biofeedback therapy, 81-643, 81-674
    --bone marrow transplant, 88-364
    --emerging medical procedure, CA-082
    --light box for seasonal affective disorder, 88-652
    --Lung Volume Reduction Surgery (LVRS), CA-033
    --medication, 84-123, 88-256
    --morphometric analysis, CA-032
    --percutaneous diskectomy, 88-036
    --thermography, 88-359, 88-390
   Eyeglasses/-surgically caused refractive error, 84-129, 84-231, 84-282
    --vision impaired by medical condition, 84-514
   Finance charges, 81-293, 81-516, 81-573, 88-666, 93-101
   Heart rate monitor, see exercise equipment
   Insulin infusion pump, 81-273, 81-287
   In vitro fertilization, 88-685
   Iontophoresis, CA-082
   Medicare Part A & B, 81-044, 84-497, 84-516
   Mental deficiencies/ inpatient treatment, 81-447
   Obesity, 104, 296, 81-212, 81-238, 81-476, 81-482, 84-003, 84-071, 84-247, 84-254, 84-363,
    84-383, 84-434, 84-573, 84-633, 88-290, 88-413, 88-444, CA-061
    --prescription drugs, 88-290
    --surgical reduction, 175, 84-247, 84-434, 88-114, 88-619
    --weight loss program, 81-238, 81-476, 84-573, 88-233, 88-313, 88-404, 88-700
    --excess skin, 07-0010
   Obstetrical charges/ excessive fee, 29
   Orthoptic (see heading under Vision Care)
   Physical conditioning, 88-135, 88-242
   Podiatrist services, routine care, 84-079
   Preexisting conditions, 81-638, 88-326
   Pregnancy, 18
   Private duty nursing, 84-283
   Private room charges, 165, 81-307, 84-349, 84-533, 84-540, 88-167, 88-208
   Private tutor, 98-023
   Reversal of sterilization procedures, 241, 81-018, 81-078, 84-150
   Services,
    --furnished by governmental, tax-support or voluntary agency, 93-068, 98-003
                 --not specifically provided, 159, 81-161, 81-238, 81-273, 84-111, 84-170, 84-241,
    88-135, 88-154, 88-242, 88-321
   Services rendered after eligibility period ends, 239, 81-509, 84-078, 84-160, 84-190, 88-329
   Special education, 81-161
   Visual therapy (see Vision Care listing)
   Wigs, 88-154, 88-321, 07-0012
   Workers’ compensation, 36, 81-402, 81-575, 81-686, 84-090, 88-055, 88-525, 88-726


                                               18
       ARTICLE III B. LIFE AND ACCIDENTAL DEATH AND
       DISMEMBERMENT INSURANCE

       LIFE INSURANCE
   Disabled employee, 51, 56, 69, 110, 223, 298, 323, 81-442, 81-506, 84-015, 84-062, 84-120,
    84-339, 84-466, 88-277, 88-376, 88-677
    --laid-off prior to disability, 84-291
    --unable to return to work after strike, 51
   Employees, 339, 81-258, 81-371
    --death occurs during strike, 289, 81-066
    --discharged, 84-131
    --last worked prior to 12/6/77, 14, 51
    --leave of absence, 84-272
    --named beneficiary, 339
    --self-inflected injury, 84-539, 88-264, 88-707, 93-027
    --suspended, 88-707
   Pensioners, 2, 70, 333, 81-258, 81-329, 88-690
    --named beneficiary, 88-001
    --strike, 26, 270, 81-629

       ACCIDENTAL DEATH
   After Injury, 155, 84-693
   Bodily infirmity, 97, 145
   Driving while intoxicated, 84-032
   Heart attack, 217, 344, 84-693
   Homicide, 46, 95
   Self-inflicted injury, 88-264
   Strike, 289, 332

       DISMEMBERMENT
   Loss of hearing, 88-547
   Loss of member, 81-329
    --considerable period after injury, 316, 88-018
   Loss of use of member , 331
   Loss of vision, 57, 317, 81-119, 81-187, 81-483, 81-502, 81-623, 84-719, 88-572
    --less than total, 81-668, 84-719

       ARTICLE II C. DEATH BENEFITS
DEATHS PRIOR TO DECEMBER 6, 1977
 Responsibility for continuation of death benefits payments after effective date, 50, 137

DEATHS AFTER DECEMBER 5, 1977 AND PRIOR TO MARCH 27, 1978
 Disabled employee, 16


                                              19
       ARTICLE III D. GENERAL PROVISIONS

       ARTICLE III D. (1) CONTINUATION OF COVERAGE
   Accepts other employment, 24, 37, 81-276, 81-387, 81-579, 84-084, 84-088, 84-273,
    84-375, 84-452, 84-505, 84-606, 84-613, 88-346
    --notification of employer, 81-276, 81-537, 84-084, 84-088, 84-146, 84-273, 84-375, 84-528,
    84-552, 88-113
    --self-employment, 84-375, 84-606, 84-625
    --works briefly in nonclassified job during layoff, 6
   Back pay award, 81-422, 81-466, 84-403, 84-458
   Back pay grievance settlements, 84-588
   COBRA, 88-030, 88-446
    --reimbursement of COBRA premiums, 88-169, 88-178, 88-196, 88-327, 88-450, CA-074
   Contract mining agreement with another company, 81-027, 81-068, 84-451, 84-505
   Date last worked, 88-129
   Date of commencement, 312, 81-279, 81-283, 81-427, 81-445, 84-313, 84-357, 84-410,
    84-522, 84-596
    --employer determined NLIB, 81-077, 81-152, 81-170, 84-345
    --employer determined not NLIB, 219, 81-364, 81-368, 81-373, 81-497, 81-499, 84-318
   Disabled employee, 193, 262, 261, 262, 312, 81-314, 81-315, 81-327, 81-330, 81-349,
    81-382, 81-445, 81-499, 81-557, 84-090, 84-147, 84-252, 84-339, 84-356, 84-440, 84-444,
    84-498, 84-515, 84-610, 84-618, 88-020, 88-058, 88-244, 88-299, 88-381, 88-419, 88-555,
    88-657, 88-689
    --attends retraining class, 148, 84-305, 84-598, 88-661
    --coverage beyond expiration of Wage Agreement, 267, 81-327, 81-648, 88-798
    --coverage during strike, 262, 267, 272, 88-748, 93-014
    --disabled over one year, 64, 107, 135, 158, 261, 272, 298, 312, 323, 84-120, 84-663
    --injury during previous employment, 84-618
    --laid off during period of disability, 81-445, 84-444, 88-555
    --maximum continuation of coverage, 157, 312, 84-090, 84-190, 84-618, 88-381, 88-693,
    93-014
    --pregnant, 99
    --quit slip, 81-315
    --released to return to work, 84-444
    --S&A, 267
    --two periods of disability, 88-693, 93-014
   Discharge, 68, 150, 81-490, 81-516, 81-678, 84-111, 84-131, 84-721, 88-305, 88-379
   Employee returns to work, 84-108, 84-613
   Employer sells to, becomes or merges with another employer, 84-108, 84-613
    --alter ego, 81-199, 81-314, 81-327, 81-426, 81-537, 84-146, 84-444
    --merger, 84-146, 84-215, 84-324, 84-325, 84-326, 84-327
    --successor company’s responsibility to provide coverage, 22, 81-027, 81-068, 81-314,
    81-327, 81-613, 81-709, 84-294, 84-444, 84-470, 84-505, 84-545, 84-558, 88-477
    --transfer of ownership, 81-346, 84-444
   Employer’s responsibility to provide coverage, 81-416, 81-499, 81-509, 81-516, 81-556,
    81-579, 81-678, 81-682, 84-251, 84-300, 84-320, 84-364, 84-405, 84-409, 84-438, 84-451,
    84-452, 84-469, 84-489, 84-492, 84-498, 84-505, 84-506, 84-511, 84-515, 84-558, 84-613,
                                              20
    88-020, 88-058, 88-156, 88-188, 88-218, 88-279, 88-383, 88-431, 88-434, 88-473, 88-490,
    88-591, 88-649, 88-676, 88-747
   Hours worked, 81-101, 81-198, 81-231, 81-345, 81-400, 81-418, 81-420, 81-422, 81-579,
    88-419, 88-631, 88-653, CA-074
    --for alter-ego /successor employer, 81-426, 84-063, 88-143
    --for same employer at different mine sites, 88-091
    --for separate employers, 81-338, 81-613, 81-621, 84-146, 84-294, 84-365, 84-373, 88-013
    --for UMWA, 81-143, 81-386, 81-549
    --prior to effective date of contract, 81-396
    --schedules days, 81-418
    --sickness and accident benefits as hours worked, 55, 81-144, 81-148, 81-371, 81-587
    --temporary work, 81-400
    --vacation and sick leave as hour worked, 88-631, 88-653
   Insurance carrier, bankrupt/insolvent, 84-341, 84-422, 84-431, 84-495, 88-344
   Insurance plan
    --implementation of/method of payment, 88-235, 88-344
    --payment of claims in timely manner, 98-045
    --substandard plan, 81-426, 81-556, 84-215, 84-238, 84-324, 84-325, 88-278, 88-279,
    88-344
   Insurance premium
    --nonpayment of, 84-251, 84-438, 84-505, 88-017, 88-156, 88-188, 88-244
    --reimbursement of, 81-640, 88-383
   Laid-off employee, 263, 305, 81-068, 81-077, 81-101, 81-152, 81-170, 81-176, 81-199,
    81-207, 81-208, 81-231, 81-338, 81-345, 81-346, 81-364, 81-368, 81-373, 81-382, 81-387,
    81-392, 81-416, 81-418, 81-426, 81-427, 81-497, 81-499, 81-579, 81-613, 81-621, 84-063,
    84-089, 84-090, 84-108, 84-160, 84-175, 84-176, 84-197, 84-215, 84-238, 84-263, 84-279,
    84-325, 84-364, 84-438, 84-498, 84-515, 84-722, 88-020, 88-174, 88-175, 88-176, 88-278,
    88-279, 88-329, 88-344, 88-346, 88-383, 88-386, 88-431, 88-434, 88-477, 88-490, 88-634,
    88-649, 88-687, 98-038
   Leave of absence, 77, 81-296, 84-414
    --on layoff following UMWA employment, 79, 80, 120, 81-256
    --other than UMWA employment, 84-414
   Level of benefits coverage, 81-426, 81-556, 84-147, 84-215, 84-238, 84-325, 88-278,
    88-279, 88-344, 88-431, 88-591
   Maximum continuation of coverage, 239, 261, 269, 272, 312, 84-190, CA-074
   Multiple layoffs, 81-400, 84-175, 84-300, 84-326, 88-091
    --disabled employee, 4, 262
    --temporary recall, 81-418
    --UMWA employee, 80
   No longer in business (NLIB) determination under 1974 BP &T, 219, 81-077, 81-152,
    81-170, 81-364, 81-368, 81-373, 81-497, 81-499, 84-147, 84-174, 84-200, 84-238, 84-318,
    84-345, 84-613
   Nonclassified employment with employer, 84-384
   Other employment, 81-276, 81-387, 81-537, 84-084, 84-613
    --notice of other employment, 84-146, 84-528, 84-552
    --temporary , part-time, 84-088
   Panel form, timely, 81-061, 81-232, 81-243, 81-356, 81-678, 88-640
    --solvent out of business employer, 219

                                             21
   Quit, 51, 130, 150, 81-252, 81-315, 81-381, 81-477, 84-294, 88-262, 88-333
    --after period of date last worked, 84-267
    --employee retires, 88-206
    --reinstated under last chance agreement, 81-381
    --versus disability, 81-252, 81-315
   Re-training classes, 148, 84-305, 84-598, 84-239, 84-287
   Termination under Article III (j) of Wage Agreement, 81-570
   Wage Agreement
    --Coal Hauler’s Contract, coverage beyond expiration of, 81-564
    --continuing eligibility under subsequent Plan, 51, 56, 305, 81-327, 84-058, 88-058
    --contract extension, 81-564, 81-631
    --employer does not sign subsequent Wage Agreement, 81-525, 81-526, 81-530, 81-677,
    84-629, 84-681, 88-681, 88-746
    --expiration, lockout, 88-711
    --laid off prior to expiration of, 81-525, 81-526, 81-530, 81-586, 81-589, 84-599, 84-605,
    84-622, 84-629, 84-681, 84-683, 88-681, 88-798
    --laid off after expiration of, 84-470, 88-746
    --layoff prior to effective date of Wage Agreement, 81-613
    --letter of agreement/interim agreement, 81-682, 84-089, 84-108, 84-405, 88-011, 88-017,
    88-020
    --strike, 239, 244, 262, 267, 269, 289, 305, 306, 309, 327, 81-327, 81-564, 81-631, 81-677,
    81-680, 88-058, 88-748
    --strike-second strike period, 93-004
   Workers’ compensation/disability, 9, 148, 81-557, 81-570, 84-090, 84-305, 84-444, 88-527
   24 consecutive calendar month period defined, 81-292, 81-466, 81-613, 81-400, 84-373,
    88-091, 88-419


       ARTICLE III D. (2) ADVANCED INSURANCE PREMIUMS
   Amount of premiums, 276, 277, 284
   Disabled employee, 26, 272
   Extent of responsibility, 239, 306, 309, 327, 332, 81-631, 81-677
   Laid-off employee, 244, 239, 269, 305, 327, 81-677, 81-680
   Pensioners, 26
   Payment of premiums during work stoppage, 88-195
   Repayment of premiums, 306, 327

       ARTICLE III D. (3) CONVERSION PRIVILEGE
   Health benefits coverage, 81-567, 81-692, 84-089, 84-090, 84-440
    --dependent age 22, 88-030
   Level of coverage, 81-357, 81-362, 81-375
   Life insurance
    --accidental death benefits, 289, 332, 81-066, 84-539, 88-677, 88-674


       ARTICLE IV MANAGED CARE, COST CONTAINMENT
                                               22
   Maintenance drug mail order program, CA-066, 02-001
       Preferred Provider List (PPL), 93-035

       ARTICLE V ADMENDMENT AND TERMINATION
   Special Rule for Certain Pensioners, 93-112, 98-015, 98-018

       MISCELLANEOUS

   Dental plan benefits, 84-447, 84-564
   Medical necessity, 81-553, 84-240, 84-260, 84-268, 84-280, 84-380, 84-419, 84-420,
    84-434, 84-467, 84-530, 84-633, 84-656, 84-712, 88-043, 88-128, 88-223, 88-239, 88-311,
    88-314, 88-317, 88-319, 88-361, 88-363, 88-377, 88-520, 07-0010
   Scope of exemption, 157, 173, 175, 239, 254, 273, 276, 277, 284, 309, 321, 325, 326,
    81-196, 81-254, 81-387, 81-400, 81-418, 84-062, 88-181, 88-230




                                             23

								
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