Bill > S712

This bill aims to ensure comprehensive insurance coverage for medically necessary functional repair or restoration of genetic craniofacial conditions across various types of health insurance in Massachusetts. Specifically, the bill requires coverage for treatments that improve the function or appearance of abnormal structures caused by congenital diseases or anomalies, including specific conditions like ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. The legislation applies to multiple insurance providers, including the state group insurance commission, Medicaid (MassHealth), private insurance policies, hospital service plans, medical service agreements, health maintenance organizations, and preferred provider organizations. Importantly, the bill clarifies that the coverage does not include cosmetic surgery or dental/orthodontic treatments unrelated to the congenital condition, and mandates that these benefits cannot be subject to higher deductibles, copayments, or out-of-pocket limits compared to other medical benefits. The bill effectively standardizes and expands insurance coverage for individuals with genetic craniofacial conditions across different insurance platforms in the state, ensuring more consistent and accessible medical treatment for those with these specific health challenges.

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https://malegislature.gov/Bills/194/S712