‘‘(B) EXCEPTION.—Such term does not in-
clude cosmetic surgery performed to reshape
normal structures of the body to improve ap-
pearance or self-esteem.
‘‘(b) NOTICE.—A group health plan under this part
shall comply with the notice requirement under section
714(b) of the Employee Retirement Income Security Act
of 1974 with respect to the requirements of this section
as if such section applied to such plan.’’.
(B) Section 2723(c) of such Act (42 U.S.C.
300gg–23(c)) is amended by striking ‘‘section 2704’’
and inserting ‘‘sections 2704 and 2707’’.
(2) ERISA AMENDMENTS.—(A) Subpart B of
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974 is amended by
adding at the end the following new section:
‘‘SEC. 714. STANDARDS RELATING TO BENEFITS FOR MINOR
CHILD’S CONGENITAL OR DEVELOPMENTAL
DEFORMITY OR DISORDER.
‘‘(a) REQUIREMENTS
FOR RECONSTRUCTIVE SUR-
GERY.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insur-
ance coverage, that provides coverage for surgical
benefits shall provide coverage for outpatient and in-
patient diagnosis and treatment of a minor child’s
congenital or developmental deformity, disease, or
injury. A minor child shall include any individual
through 21 years of age.
‘‘(2) REQUIREMENTS.—Any coverage provided
under paragraph (1) shall be subject to pre-author-
ization or pre-certification as required by the plan or
issuer, and such coverage shall include any surgical
treatment which, in the opinion of the treating phy-
sician, is medically necessary to approximate a nor-
mal appearance.
‘‘(3) TREATMENT DEFINED.—
‘‘(A) IN
GENERAL.—In this section, the
term ‘treatment’ includes reconstructive sur-
gical procedures (procedures that are generally
performed to improve function, but may also be
performed to approximate a normal appear-
ance) that are performed on abnormal struc-
tures of the body caused by congenital defects,
developmental abnormalities, trauma, infection,
tumors, or disease, including—
‘‘(i) procedures that do not materially
affect the function of the body part being
treated; and
‘‘(ii) procedures for secondary condi-
tions and follow-up treatment.
‘‘(B) EXCEPTION.—Such term does not in-
clude cosmetic surgery performed to reshape
normal structures of the body to improve ap-
pearance or self-esteem.
‘‘(b) NOTICE UNDER GROUP HEALTH PLAN.—The
imposition of the requirements of this section shall be
treated as a material modification in the terms of the plan
described in section 102(a)(1), for purposes of assuring
notice of such requirements under the plan; except that
the summary description required to be provided under the
last sentence of section 104(b)(1) with respect to such
modification shall be provided by not later than 60 days
after the first day of the first plan year in which such
requirements apply.’’.
(B) Section 731(c) of such Act (29 U.S.C.
1191(c)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 712 the following new item:
‘‘Sec. 714. Standards relating to benefits for minor child’s congenital or develop-
mental deformity or disorder.’’.
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.—Subchapter B of chapter 100 of the Inter-
nal Revenue Code of 1986 is amended—
(A) in the table of sections, by inserting after
the item relating to section 9812 the following new
item:
‘‘Sec. 9813. Standards relating to benefits for minor child’s con-
genital or developmental deformity or disorder.’’;
and
(B) by inserting after section 9812 the fol-
lowing:
‘‘SEC. 9813. STANDARDS RELATING TO BENEFITS FOR
MINOR CHILD’S CONGENITAL OR DEVELOP-
MENTAL DEFORMITY OR DISORDER.
‘‘(a) REQUIREMENTS
FOR RECONSTRUCTIVE SUR-
GERY.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insur-
ance coverage, that provides coverage for surgical
benefits shall provide coverage for outpatient and in-
patient diagnosis and treatment of a minor child’s
congenital or developmental deformity, disease, or
injury. A minor child shall include any individual
through 21 years of age.
‘‘(2) REQUIREMENTS.—Any coverage provided
under paragraph (1) shall be subject to pre-author-
ization or pre-certification as required by the plan or
issuer, and such coverage shall include any surgical
treatment which, in the opinion of the treating phy-
sician, is medically necessary to approximate a nor-
mal appearance.
‘‘(3) TREATMENT DEFINED.—
‘‘(A) IN
GENERAL.—In this section, the
term ‘treatment’ includes reconstructive sur-
gical procedures (procedures that are generally
performed to improve function, but may also be
performed to approximate a normal appear-
ance) that are performed on abnormal struc-
tures of the body caused by congenital defects,
developmental abnormalities, trauma, infection,
tumors, or disease, including—
‘‘(i) procedures that do not materially
affect the function of the body part being
treated; and
‘‘(ii) procedures for secondary condi-
tions and follow-up treatment.
‘‘(B) EXCEPTION.—Such term does not in-
clude cosmetic surgery performed to reshape
normal structures of the body to improve ap-
pearance or self-esteem.’’.
(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act is amend-
ed by inserting after section 2752 the following new sec-
tion:
‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR
MINOR CHILD’S CONGENITAL OR DEVELOP-
MENTAL DEFORMITY OR DISORDER.
‘‘(a) REQUIREMENTS
FOR RECONSTRUCTIVE SUR-
GERY.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insur-
ance coverage, that provides coverage for surgical
benefits shall provide coverage for outpatient and in-
patient diagnosis and treatment of a minor child’s
congenital or developmental deformity, disease, or
injury. A minor child shall include any individual
through 21 years of age.
‘‘(2) REQUIREMENTS.—Any coverage provided
under paragraph (1) shall be subject to pre-author-
ization or pre-certification as required by the plan or
issuer, and such coverage shall include any surgical
treatment which, in the opinion of the treating phy-