I 

108TH CONGRESS 

1ST SESSION H. R. 296

To amend the Public Health Service Act, the Employee Retirement Income 

Security Act of 1974, and the Internal Revenue Code of 1986 to require 

that group and individual health insurance coverage and group health 

plans provide coverage for treatment of a minor child’s congenital or 

developmental deformity or disorder due to trauma, infection, tumor, 

or disease. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 8, 2003

Mrs. KELLY introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Ways and Means and 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 amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal 

Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans 

provide coverage for treatment of a minor child’s congenital or developmental deformity or disorder due to 

trauma, infection, tumor, or disease.

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

2 This Act may be cited as the ‘‘Treatment of Chil3 dren’s Deformities Act of 2003’’. 

4 SEC. 2. COVERAGE OF MINOR CHILD’S CONGENITAL OR DE5 VELOPMENTAL DEFORMITY OR DISORDER. 

6 (a) GROUP HEALTH PLANS.—

7 (1) PUBLIC HEALTH SERVICE ACT AMEND8 MENTS.—(A) Subpart 2 of part A of title XXVII of 

9 the Public Health Service Act is amended by adding 

10 at the end the following new section: 

11 ‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR 

12 MINOR CHILD’S CONGENITAL OR DEVELOP13 MENTAL DEFORMITY OR DISORDER. 

14 ‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE SUR15 GERY.—

16 ‘‘(1) IN GENERAL.—A group health plan, and a 

17 health insurance issuer offering group health insur18 ance coverage, that provides coverage for surgical 

19 benefits shall provide coverage for outpatient and in20 patient diagnosis and treatment of a minor child’s 

21 congenital or developmental deformity, disease, or 

22 injury. A minor child shall include any individual 

23 through 21 years of age. 

24 ‘‘(2) REQUIREMENTS.—Any coverage provided 

25 under paragraph (1) shall be subject to pre-author26 ization or pre-certification as required by the plan or 
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1 issuer, and such coverage shall include any surgical 

2 treatment which, in the opinion of the treating phy3 sician, is medically necessary to approximate a nor4 mal appearance. 

5 ‘‘(3) TREATMENT DEFINED.—

6 ‘‘(A) IN GENERAL.—In this section, the 

7 term ‘treatment’ includes reconstructive sur8 gical procedures (procedures that are generally 

9 performed to improve function, but may also be 

10 performed to approximate a normal appear11 ance) that are performed on abnormal struc12 tures of the body caused by congenital defects, 

13 developmental abnormalities, trauma, infection, 

14 tumors, or disease, including—

15 ‘‘(i) procedures that do not materially 

16 affect the function of the body part being 

17 treated; and 

18 ‘‘(ii) procedures for secondary condi19 tions and follow-up treatment. 

20 ‘‘(B) EXCEPTION.—Such term does not in21 clude cosmetic surgery performed to reshape 

22 normal structures of the body to improve ap23 pearance or self-esteem. 

24 ‘‘(b) NOTICE.—A group health plan under this part 

25 shall comply with the notice requirement under section 
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1 714(b) of the Employee Retirement Income Security Act 

2 of 1974 with respect to the requirements of this section 

3 as if such section applied to such plan.’’. 

4 (B) Section 2723(c) of such Act (42 U.S.C. 

5 300gg–23(c)) is amended by striking ‘‘section 2704’’ 

6 and inserting ‘‘sections 2704 and 2707’’. 

7 (2) ERISA AMENDMENTS.—(A) Subpart B of 

8 part 7 of subtitle B of title I of the Employee Re9 tirement Income Security Act of 1974 is amended by 

10 adding at the end the following new section: 

11 ‘‘SEC. 714. STANDARDS RELATING TO BENEFITS FOR MINOR 

12 CHILD’S CONGENITAL OR DEVELOPMENTAL 

13 DEFORMITY OR DISORDER. 

14 ‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE SUR15 GERY.—

16 ‘‘(1) IN GENERAL.—A group health plan, and a 

17 health insurance issuer offering group health insur18 ance coverage, that provides coverage for surgical 

19 benefits shall provide coverage for outpatient and in20 patient diagnosis and treatment of a minor child’s 

21 congenital or developmental deformity, disease, or 

22 injury. A minor child shall include any individual 

23 through 21 years of age. 

24 ‘‘(2) REQUIREMENTS.—Any coverage provided 

25 under paragraph (1) shall be subject to pre-author-
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1 ization or pre-certification as required by the plan or 

2 issuer, and such coverage shall include any surgical 

3 treatment which, in the opinion of the treating phy4 sician, is medically necessary to approximate a nor5 mal appearance. 

6 ‘‘(3) TREATMENT DEFINED.—

7 ‘‘(A) IN GENERAL.—In this section, the 

8 term ‘treatment’ includes reconstructive sur9 gical procedures (procedures that are generally 

10 performed to improve function, but may also be 

11 performed to approximate a normal appear12 ance) that are performed on abnormal struc13 tures of the body caused by congenital defects, 

14 developmental abnormalities, trauma, infection, 

15 tumors, or disease, including—

16 ‘‘(i) procedures that do not materially 

17 affect the function of the body part being 

18 treated; and 

19 ‘‘(ii) procedures for secondary condi20 tions and follow-up treatment. 

21 ‘‘(B) EXCEPTION.—Such term does not in22 clude cosmetic surgery performed to reshape 

23 normal structures of the body to improve ap24 pearance or self-esteem.
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1 ‘‘(b) NOTICE UNDER GROUP HEALTH PLAN.—The 

2 imposition of the requirements of this section shall be 

3 treated as a material modification in the terms of the plan 

4 described in section 102(a)(1), for purposes of assuring 

5 notice of such requirements under the plan; except that 

6 the summary description required to be provided under the 

7 last sentence of section 104(b)(1) with respect to such 

8 modification shall be provided by not later than 60 days 

9 after the first day of the first plan year in which such 

10 requirements apply.’’. 

11 (B) Section 731(c) of such Act (29 U.S.C. 

12 1191(c)) is amended by striking ‘‘section 711’’ and 

13 inserting ‘‘sections 711 and 714’’. 

14 (C) Section 732(a) of such Act (29 U.S.C. 

15 1191a(a)) is amended by striking ‘‘section 711’’ and 

16 inserting ‘‘sections 711 and 714’’. 

17 (D) The table of contents in section 1 of such 

18 Act is amended by inserting after the item relating 

19 to section 712 the following new item:

‘‘Sec. 714. Standards relating to benefits for minor child’s congenital or developmental deformity or disorder.’’.

20 (3) INTERNAL REVENUE CODE AMEND21 MENTS.—Subchapter B of chapter 100 of the Inter22 nal Revenue Code of 1986 is amended—
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1 (A) in the table of sections, by inserting 

2 after the item relating to section 9812 the fol3 lowing new item:

‘‘Sec. 9813. Standards relating to benefits for minor child’s congenital or developmental deformity or disorder.’’;

4 and 

5 (B) by inserting after section 9812 the fol6 lowing: 

7 ‘‘SEC. 9813. STANDARDS RELATING TO BENEFITS FOR 

8 MINOR CHILD’S CONGENITAL OR DEVELOP9 MENTAL DEFORMITY OR DISORDER. 

10 ‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE SUR11 GERY.—

12 ‘‘(1) IN GENERAL.—A group health plan, and a 

13 health insurance issuer offering group health insur14 ance coverage, that provides coverage for surgical 

15 benefits shall provide coverage for outpatient and in16 patient diagnosis and treatment of a minor child’s 

17 congenital or developmental deformity, disease, or 

18 injury. A minor child shall include any individual 

19 through 21 years of age. 

20 ‘‘(2) REQUIREMENTS.—Any coverage provided 

21 under paragraph (1) shall be subject to pre-author22 ization or pre-certification as required by the plan or 

23 issuer, and such coverage shall include any surgical 

24 treatment which, in the opinion of the treating phy-
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1 sician, is medically necessary to approximate a nor2 mal appearance. 

3 ‘‘(3) TREATMENT DEFINED.—

4 ‘‘(A) IN GENERAL.—In this section, the 

5 term ‘treatment’ includes reconstructive sur6 gical procedures (procedures that are generally 

7 performed to improve function, but may also be 

8 performed to approximate a normal appear9 ance) that are performed on abnormal struc10 tures of the body caused by congenital defects, 

11 developmental abnormalities, trauma, infection, 

12 tumors, or disease, including—

13 ‘‘(i) procedures that do not materially 

14 affect the function of the body part being 

15 treated; and 

16 ‘‘(ii) procedures for secondary condi17 tions and follow-up treatment. 

18 ‘‘(B) EXCEPTION.—Such term does not in19 clude cosmetic surgery performed to reshape 

20 normal structures of the body to improve ap21 pearance or self-esteem.’’.

22 (b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B 

23 of title XXVII of the Public Health Service Act is amend24 ed by inserting after section 2752 the following new sec25 tion: 
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1 ‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR 

2 MINOR CHILD’S CONGENITAL OR DEVELOP3 MENTAL DEFORMITY OR DISORDER. 

4 ‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE SUR5 GERY.—

6 ‘‘(1) IN GENERAL.—A group health plan, and a 

7 health insurance issuer offering group health insur8 ance coverage, that provides coverage for surgical 

9 benefits shall provide coverage for outpatient and in10 patient diagnosis and treatment of a minor child’s 

11 congenital or developmental deformity, disease, or 

12 injury. A minor child shall include any individual 

13 through 21 years of age. 

14 ‘‘(2) REQUIREMENTS.—Any coverage provided 

15 under paragraph (1) shall be subject to pre-author16 ization or pre-certification as required by the plan or 

17 issuer, and such coverage shall include any surgical 

18 treatment which, in the opinion of the treating phy19 sician, is medically necessary to approximate a nor20 mal appearance. 

21 ‘‘(3) TREATMENT DEFINED.—

22 ‘‘(A) IN GENERAL.—In this section, the 

23 term ‘treatment’ includes reconstructive sur24 gical procedures (procedures that are generally 

25 performed to improve function, but may also be 

26 performed to approximate a normal appear-
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1 ance) that are performed on abnormal struc2 tures of the body caused by congenital defects, 

3 developmental abnormalities, trauma, infection, 

4 tumors, or disease, including—

5 ‘‘(i) procedures that do not materially 

6 affect the function of the body part being 

7 treated; and 

8 ‘‘(ii) procedures for secondary condi9 tions and follow-up treatment. 

10 ‘‘(B) EXCEPTION.—Such term does not in11 clude cosmetic surgery performed to reshape 

12 normal structures of the body to improve ap13 pearance or self-esteem. 

14 ‘‘(b) NOTICE.—A health insurance issuer under this 

15 part shall comply with the notice requirement under sec16 tion 714(b) of the Employee Retirement Income Security 

17 Act of 1974 with respect to the requirements referred to 

18 in subsection (a) as if such section applied to such issuer 

19 and such issuer were a group health plan.’’. 

20 (2) Section 2762(b)(2) of such Act (42 U.S.C. 

21 300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 

22 and inserting ‘‘sections 2751 and 2753’’. 

23 (c) EFFECTIVE DATES.—(1) The amendments made 

24 by subsection (a) shall apply with respect to group health 
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1 plans for plan years beginning on or after January 1, 

2 2004. 

3 (2) The amendment made by subsection (b) shall 

4 apply with respect to health insurance coverage offered, 

5 sold, issued, renewed, in effect, or operated in the indi6 vidual market on or after such date. 

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

8 of Health Insurance Portability and Accountability Act of 

9 1996 is amended by striking ‘‘this subtitle (and the 

10 amendments made by this subtitle and section 401)’’ and 

11 inserting ‘‘the provisions of part 7 of subtitle B of title 

12 I of the Employee Retirement Income Security Act of 

13 1974, the provisions of parts A and C of title XXVII of 

14 the Public Health Service Act, and chapter 100 of the In15 ternal Revenue Code of 1986’’.

Æ