I 

108TH CONGRESS 

1ST SESSION H. R. 1499

To require health insurance coverage for certain reconstructive surgery. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 27, 2003

Mr. ROSS introduced the following bill; which was referred to the Committee 

on Energy and Commerce, and in addition to the Committee on Education and the Workforce, for a period to be subsequently determined by 

the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL

To require health insurance coverage for certain 

reconstructive surgery.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Reconstructive Surgery 

5 Act of 2003’’. 

6 SEC. 2. COVERAGE OF RECONSTRUCTIVE SURGERY. 

7 (a) GROUP HEALTH PLANS.—

8 (1) PUBLIC HEALTH SERVICE ACT AMEND9 MENTS.—
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1 (A) IN GENERAL.—Section 2706 of the 

2 Public Health Service Act (42 U.S.C. 300gg–6) 

3 is amended to read as follows: 

4 ‘‘SEC. 2706. COVERAGE OF RECONSTRUCTIVE SURGERY. 

5 ‘‘(a) REQUIREMENT.—A group health plan and a 

6 health insurance issuer offering group health insurance 

7 coverage in connection with a group health plan that pro8 vides coverage for surgery shall provide coverage for re9 constructive surgery. 

10 ‘‘(b) DEFINITION.—In subsection (a), the term ‘re11 constructive surgery’ means any medically necessary and 

12 appropriate surgery performed to correct or repair abnor13 mal structures of the body caused by congenital defects, 

14 developmental abnormalities, trauma, infection, tumors, or 

15 disease to—

16 ‘‘(1) improve functions; or 

17 ‘‘(2) give the patient a normal appearance, to 

18 the extent possible, in the judgment of the physician 

19 performing the surgery. 

20 ‘‘(c) RULE OF CONSTRUCTION.—

21 ‘‘(1) IN GENERAL.—Nothing in this section 

22 shall be construed to require a group health plan or 

23 health insurance issuer in connection with a group 

24 health plan to provide coverage for cosmetic surgery. 
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1 ‘‘(2) DEFINITION.—In paragraph (1), the term 

2 ‘cosmetic surgery’ means surgery that is performed 

3 to alter or reshape normal structures of the body in 

4 order to improve appearance.’’. 

5 (B) CONFORMING AMENDMENT.—Section 

6 2723(c) of the Public Health Service Act (42 

7 U.S.C. 300gg–23(c)) is amended by striking 

8 ‘‘section 2704’’ and inserting ‘‘sections 2704 

9 and 2706’’. 

10 (2) ERISA AMENDMENTS.—

11 (A) IN GENERAL.—Section 713 of the Em12 ployee Retirement Income Security Act of 1974 

13 (29 U.S.C. 1185b) is amended to read as fol14 lows: 

15 ‘‘SEC. 713. COVERAGE FOR RECONSTRUCTIVE SURGERY. 

16 ‘‘(a) REQUIREMENT.—A group health plan and a 

17 health insurance issuer offering group health insurance 

18 coverage in connection with a group health plan that pro19 vides coverage for surgery shall provide coverage for re20 constructive surgery. 

21 ‘‘(b) DEFINITION.—In subsection (a), the term ‘re22 constructive surgery’ means any medically necessary and 

23 appropriate surgery performed to correct or repair abnor24 mal structures of the body caused by congenital defects,
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1 developmental abnormalities, trauma, infection, tumors, or 

2 disease to—

3 ‘‘(1) improve functions; or 

4 ‘‘(2) give the patient a normal appearance, to 

5 the extent possible, in the judgment of the physician 

6 performing the surgery. 

7 ‘‘(c) RULE OF CONSTRUCTION.—

8 ‘‘(1) IN GENERAL.—Nothing in this section 

9 shall be construed to require a group health plan or 

10 health insurance issuer in connection with a group 

11 health plan to provide coverage for cosmetic surgery. 

12 ‘‘(2) DEFINITION.—In paragraph (1), the term 

13 ‘cosmetic surgery’ means surgery that is performed 

14 to alter or reshape normal structures of the body in 

15 order to improve appearance.’’. 

16 (B) CONFORMING AMENDMENTS.—

17 (i) Section 731(c) of such Act (29 

18 U.S.C. 1191(c)) is amended by striking 

19 ‘‘section 711’’ and inserting ‘‘sections 711 

20 and 713’’. 

21 (ii) Section 732(a) of such Act (29 

22 U.S.C. 1191a(a)) is amended by striking 

23 ‘‘section 711’’ and inserting ‘‘sections 711 

24 and 713’’.
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1 (iii) The table of contents in section 1 

2 of such Act is amended by inserting after 

3 the item relating to section 712 the fol4 lowing new item:

‘‘Sec. 713. Coverage for reconstructive surgery.’’.

5 (b) INDIVIDUAL MARKET.—Section 2752 of the Pub6 lic Health Service Act (42 U.S.C. 300gg–52) is amended 

7 to read as follows: 

8 ‘‘SEC. 2752. COVERAGE FOR RECONSTRUCTIVE SURGERY. 

9 ‘‘The provisions of section 2706 shall apply to health 

10 insurance coverage offered by a health insurance issuer 

11 in the individual market in the same manner as they apply 

12 to health insurance coverage offered by a health insurance 

13 issuer in connection with a group health plan in the small 

14 or large group market.’’. 

15 (c) EFFECTIVE DATES.—

16 (1) GROUP HEALTH PLANS.—Subject to para17 graph (3), the amendments made by subsection (a) 

18 shall apply with respect to group health plans for 

19 plan years beginning on or after January 1, 2004. 

20 (2) HEALTH INSURANCE COVERAGE.—The 

21 amendment made by subsection (b) shall apply with 

22 respect to health insurance coverage offered, sold, 

23 issued, renewed, in effect, or operated in the indi24 vidual market on or after such date. 
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1 (3) COLLECTIVE BARGAINING AGREEMENTS.—

2 In the case of a group health plan maintained pur3 suant to 1 or more collective bargaining agreements 

4 between employee representatives and 1 or more em5 ployers ratified before the date of enactment of this 

6 Act, the amendments made by subsection (a) shall 

7 not apply to plan years beginning before the later 

8 of—

9 (A) the date on which the last collective 

10 bargaining agreements relating to the plan ter11 minates (determined without regard to any ex12 tension thereof agreed to after the date of en13 actment of this Act), or 

14 (B) January 1, 2004.

15 For purposes of subparagraph (A), any plan amend16 ment made pursuant to a collective bargaining 

17 agreement relating to the plan which amends the 

18 plan solely to conform to any requirement added by 

19 subsection (a) shall not be treated as a termination 

20 of such collective bargaining agreement. 

21 (d) COORDINATED REGULATIONS.—Section 104(1) 

22 of Health Insurance Portability and Accountability Act of 

23 1996 (Public Law 104–191) is amended by striking ‘‘this 

24 subtitle (and the amendments made by this subtitle and 

25 section 401)’’ and inserting ‘‘the provisions of part 7 of 
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1 subtitle B of title I of the Employee Retirement Income 

2 Security Act of 1974, and the provisions of parts A and 

3 C of title XXVII of the Public Health Service Act’’.

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