Bill > H4206

This bill mandates that various types of insurance policies and health plans in Massachusetts, including those offered by the state's Medicaid program (referred to as "the division" in Chapter 118E), accident and sickness insurance, hospital service plans, medical service agreements, health maintenance organizations (HMOs), and preferred provider contracts, must provide coverage for medically necessary functional repair or restoration of craniofacial disorders. These disorders can stem from congenital defects, developmental deformities, trauma, tumors, infections, or disease, and the coverage aims to improve function or approximate normal appearance. While cleft lip and cleft palate coverage is addressed elsewhere in existing law, this bill specifically includes conditions like ectodermal dysplasia, dentinogenesis imperfecta, amelogenesis imperfecta, and other maxillofacial abnormalities. Importantly, the bill clarifies that this coverage will not extend to purely cosmetic surgery or dental/orthodontic treatments unrelated to the specified causes, and the benefits provided will not be subject to higher deductibles, coinsurance, copayments, or out-of-pocket limits than other benefits offered by the insurer. This legislation applies to policies, contracts, and certificates issued or renewed, with an exception for entities solely offering dental or vision care services.