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 do not materi-
ally restore or improve the function of the 
body part being treated; and 
‘‘(iv) procedures for secondary condi-
tions and follow-up treatment. 
‘‘(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. 
‘‘(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.’’. 
(2) TECHNICAL AMENDMENTS.— 
(A) Section 2724(c) of the Public Health 
Service Act (42 U.S.C. 300gg–23(c)) is amend-
ed by striking ‘‘section 2704’’ and inserting 
‘‘sections 2725 and 2729’’. 
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(B) Section 2762(b)(2) of the Public 
Health Service Act (42 U.S.C. 300gg–62(b)(2)) 
is amended by striking ‘‘section 2751’’ and in-
serting ‘‘sections 2729 and 2751’’. 
(b) ERISA AMENDMENTS.— 
(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. 716. STANDARDS RELATING TO BENEFITS FOR CON-
GENITAL ANOMALY OR BIRTH DEFECT. 
‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE TREAT-
MENT.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group or individual 
health insurance coverage, shall provide coverage for 
outpatient and inpatient services related to the diag-
nosis and treatment of a congenital anomaly or birth 
defect. 
‘‘(2) 
REQUIREMENTS.—Coverage 
provided 
under paragraph (1) shall include any service to 
functionally improve, repair, or restore any body 
part that is medically necessary to achieve normal 
body functioning or appearance, as determined by 
the treating physician (as defined in section 1861 of 
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the Social Security Act). Any coverage provided 
under such paragraph may be subject to coverage 
limits, such as pre-authorization or pre-certification, 
as required by the plan or issuer that are no more 
restrictive than the predominant treatment limita-
tions applied to substantially all medical and sur-
gical benefits covered by the plan (or coverage). 
‘‘(3) TREATMENT DEFINED.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), in this section, the term 
‘treatment’ includes patient and outpatient care 
and services performed to improve or restore 
body function (or performed to approximate a 
normal appearance), due to congenital anomaly 
or birth defect and shall include treatment to 
any and all missing or abnormal body parts, 
(including teeth, the oral cavity, and their asso-
ciated structures) that would otherwise be pro-
vided under the plan or coverage for any other 
injury and sickness, including— 
‘‘(i) inpatient and outpatient care, re-
constructive services and procedures, and 
complications thereof, including prosthetics 
and appliances; 
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‘‘(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 do not materi-
ally restore or improve the function of the 
body part being treated; and 
‘‘(iv) procedures for secondary condi-
tions and follow-up treatment. 
‘‘(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. 
‘‘(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 the last sentence of section 102(a), for pur-
poses of assuring notice of such requirements under the 
plan, except that the summary description required to be 
provided under the fourth sentence of section 104(b)(1) 
with respect to such modification shall be provided by not 
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later than 60 days after the first day of the first plan 
year in which such requirements apply.’’. 
(2) TECHNICAL AMENDMENTS.— 
(A) Section 731(c) of such Act (29 U.S.C. 
1191(c)) is amended by striking ‘‘section 711’’ 
and inserting ‘‘sections 711 and 716’’. 
(B) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ 
and inserting ‘‘sections 711 and 716’’. 
(C) The table of contents in section 1 of 
such Act is amended by inserting after the item 
relating to section 714 the following new items: 
‘‘Sec. 715. Additional market reforms. 
‘‘Sec. 716. Standards relating to benefits for congenital 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. 9816. STANDARDS RELATING TO BENEFITS FOR CON-
GENITAL ANOMALY OR BIRTH DEFECT. 
‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE TREAT-
MENT.—A group health plan, and a health insurance 
issuer offering group or individual health insurance cov-
erage, shall provide coverage for outpatient and inpatient 
services related to the diagnosis and treatment of a con-
genital anomaly or birth defect. 
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