Bill > S1677

This bill, known as the "Ensuring Lasting Smiles Act," requires group health plans and health insurance issuers to provide comprehensive coverage for medical services related to congenital anomalies or birth defects that primarily affect the eyes, ears, teeth, mouth, or jaw. The bill mandates coverage for reconstructive and diagnostic services that are medically necessary to improve, repair, or restore body parts to achieve normal functioning or appearance, including reconstructive procedures, related complications, dental and orthodontic support from birth until treatment is complete, and follow-up treatments. Cost-sharing requirements for these services must be no more restrictive than those applied to other medical and surgical benefits. The bill explicitly excludes cosmetic surgeries performed solely to improve appearance or self-esteem. Starting January 1, 2026, health plans must provide notice to participants about these coverage requirements. The bill defines a congenital anomaly or birth defect broadly, encompassing structural or functional anomalies that can be caused by genetic disorders, environmental factors, or unknown causes, and which may manifest as physical, sensory, or cognitive disabilities. Additionally, the bill requires a study and report to Congress by December 31, 2027, evaluating the accessibility of provider networks and potential changes in patient out-of-pocket costs for these services.

Health and Social Services

https://www.congress.gov/bill/119th-congress/senate-bill/1677/all-info