Bill > H1257

This bill requires various types of health insurance providers in Massachusetts—including state employee group insurance, Medicaid, private insurance companies, hospital service plans, medical service agreements, health maintenance organizations, and preferred provider organizations—to provide coverage for medically necessary functional repair or restoration of craniofacial disorders caused by congenital diseases or anomalies. Specifically, the bill mandates coverage for treatments that improve function or approximate normal appearance for conditions like ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta, while explicitly excluding coverage for cosmetic surgery or dental/orthodontic treatments unrelated to the specific congenital condition. The bill is careful to note that existing coverage for cleft lip and cleft palate will remain unchanged, and importantly, requires that these new benefits be subject to the same deductibles, coinsurance, copayments, and out-of-pocket limits as other medical benefits. By amending multiple chapters of Massachusetts law, the bill ensures consistent coverage across different types of health insurance plans, ultimately providing more comprehensive treatment options for individuals with genetic craniofacial conditions.

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https://malegislature.gov/Bills/194/H1257