(1) IN GENERAL.—Subpart B of part 7 of sub-
title B of title I of the Employee Retirement Income 
Security Act of 1974 is amended by adding at the 
end the following: 
‘‘SEC. 726. STANDARDS RELATING TO BENEFITS FOR CON-
GENITAL ANOMALY OR BIRTH DEFECT. 
‘‘(a) REQUIREMENTS FOR CARE AND RECONSTRUC-
TIVE TREATMENT.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insur-
ance coverage, shall provide coverage for outpatient 
and inpatient items and services related to the diag-
nosis and treatment of a congenital anomaly or birth 
defect. 
‘‘(2) REQUIREMENTS.— 
‘‘(A) IN
GENERAL.—Coverage provided 
under paragraph (1) shall include any medically 
necessary item or service to functionally im-
prove, repair, or restore any body part to 
achieve normal body functioning or appearance, 
as determined by the treating physician (as de-
fined in section 1861(r) of the Social Security 
Act), due to congenital anomaly or birth defect. 
‘‘(B) 
FINANCIAL
REQUIREMENTS
AND 
TREATMENT
REQUIREMENTS.—Any coverage 
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provided under paragraph (1) under a group 
health plan or group health insurance coverage 
offered by a health insurance issuer may be 
subject to coverage limits (such as medical ne-
cessity, pre-authorization, or pre-certification) 
and cost-sharing requirements (such as coinsur-
ance, copayments, and deductibles), as required 
by the plan or issuer, that are no more restric-
tive than the predominant coverage limits and 
cost-sharing requirements, respectively, applied 
to substantially all medical and surgical benefits 
covered by the plan (or coverage). 
‘‘(3) TREATMENT DEFINED.—In this section: 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘treatment’ in-
cludes, with respect to a group health plan or 
group health insurance coverage offered by a 
health insurance issuer, inpatient and out-
patient items and services performed to im-
prove, repair, or restore bodily function (or per-
formed to approximate a normal appearance), 
due to a congenital anomaly or birth defect, and 
includes treatment to any and all missing or ab-
normal body parts (including teeth, the oral 
cavity, and their associated structures) that 
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would otherwise be provided under the plan or 
coverage for any other injury or sickness, in-
cluding— 
‘‘(i) any items or services, including 
inpatient and outpatient care, reconstruc-
tive services and procedures, and complica-
tions thereof; 
‘‘(ii) adjunctive dental, orthodontic, or 
prosthodontic support from birth until the 
medical or surgical treatment of the defect 
or anomaly has been completed, including 
ongoing or subsequent treatment required 
to maintain function or approximate a nor-
mal appearance; 
‘‘(iii) procedures that materially im-
prove, repair, or restore bodily function; 
and 
‘‘(iv) procedures for secondary condi-
tions and follow-up treatment associated 
with the underlying congenital anomaly or 
birth defect. 
‘‘(B) EXCEPTION.—The term ‘treatment’ 
shall not include cosmetic surgery performed to 
reshape normal structures of the body to im-
prove appearance or self-esteem. 
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‘‘(b) NOTICE.—A group health plan under this part 
shall comply with the notice requirement under section 
714(c) with respect to the requirements of this section as 
if such section applied to such plan.’’. 
(2) TECHNICAL AMENDMENTS.— 
(A) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ 
and inserting ‘‘sections 711 and 726’’. 
(B) The table of contents in section 1 of 
such Act is amended by inserting after the item 
relating to section 725 the following new item: 
‘‘Sec. 726. Standards relating to benefits for congential anomaly or birth de-
fect.’’. 
(c) INTERNAL REVENUE CODE AMENDMENTS.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986 is amend-
ed by adding at the end the following: 
‘‘SEC. 9826. STANDARDS RELATING TO BENEFITS FOR CON-
GENITAL ANOMALY OR BIRTH DEFECT. 
‘‘(a) REQUIREMENTS FOR CARE AND RECONSTRUC-
TIVE TREATMENT.— 
‘‘(1) IN GENERAL.—A group health plan shall 
provide coverage for outpatient and inpatient items 
and services related to the diagnosis and treatment 
of a congenital anomaly or birth defect. 
‘‘(2) REQUIREMENTS.— 
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‘‘(A) IN
GENERAL.—Coverage provided 
under paragraph (1) shall include any medically 
necessary item or service to functionally im-
prove, repair, or restore any body part to 
achieve normal body functioning or appearance, 
as determined by the treating physician (as de-
fined in section 1861(r) of the Social Security 
Act), due to congenital anomaly or birth defect. 
‘‘(B) 
FINANCIAL
REQUIREMENTS
AND 
TREATMENT
REQUIREMENTS.—Any coverage 
provided under paragraph (1) under a group 
health plan may be subject to coverage limits 
(such as medical necessity, pre-authorization, or 
pre-certification) and cost-sharing requirements 
(such 
as 
coinsurance, 
copayments, 
and 
deductibles), as required by the plan, that are 
no more restrictive than the predominant cov-
erage limits and cost-sharing requirements, re-
spectively, applied to substantially all medical 
and surgical benefits covered by the plan. 
‘‘(3) TREATMENT DEFINED.—In this section: 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘treatment’ in-
cludes, with respect to a group health plan, in-
patient and outpatient items and services per-
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