No CRS summary available for this bill.
This section amends the Public Health Service Act and ERISA to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for outpatient and inpatient items and services related to the diagnosis and treatment of congenital anomalies or birth defects that primarily impact the appearance or function of the eyes, ears, teeth, mouth, or jaw, including reconstructive procedures, adjunctive dental or orthodontic support from birth until treatment completion, and related complications or secondary conditions, as determined medically necessary by the treating physician. Coverage is subject to cost-sharing requirements (e.g., coinsurance, copayments, deductibles) no more restrictive than those applied to substantially all other medical and surgical benefits under the plan or coverage but excludes cosmetic surgery to reshape normal body structures. Plans and issuers must provide notice of this coverage in documents describing services beginning not later than January 1, 2026.