patient diagnosis and treatment of a minor child’s 
congenital or developmental deformity, disease, or 
injury. A minor child shall include any individual 
who has not attained age 22. 
‘‘(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.—For purposes of this 
section, the term ‘treatment’ includes recon-
structive surgical procedures (procedures that 
are generally performed to improve function, 
but may also be performed to approximate a 
normal appearance) that are performed on ab-
normal structures of the body caused by con-
genital defects, developmental abnormalities, 
trauma, infection, tumors, or disease, includ-
ing— 
‘‘(i) procedures that do not materially 
affect the function of the body part being 
treated; and 
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‘‘(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 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 
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 713 the following new item: 
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‘‘Sec. 714. Standards relating to benefits for minor child’s congenital or devel-
opmental deformity or disorder.’’. 
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.— 
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986 
is amended by adding at the end the following 
new section: 
‘‘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 
who has not attained age 22. 
‘‘(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-
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sician, is medically necessary to approximate a nor-
mal appearance. 
‘‘(3) TREATMENT DEFINED.— 
‘‘(A) IN GENERAL.—For purposes of this 
section, the term ‘treatment’ includes recon-
structive surgical procedures (procedures that 
are generally performed to improve function, 
but may also be performed to approximate a 
normal appearance) that are performed on ab-
normal structures of the body caused by con-
genital defects, developmental abnormalities, 
trauma, infection, tumors, or disease, includ-
ing— 
‘‘(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) CLERICAL AMENDMENT.—The table of 
sections for such subchapter is amended by 
adding at the end the following new item: 
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‘‘Sec. 9813. Standards relating to benefits for minor child’s congenital or devel-
opmental deformity or disorder.’’. 
(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-
sician, is medically necessary to approximate a nor-
mal appearance. 
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‘‘(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.—A health insurance issuer under this 
part shall comply with the notice requirement under sec-
tion 714(b) of the Employee Retirement Income Security 
Act of 1974 with respect to the requirements referred to 
in subsection (a) as if such section applied to such issuer 
and such issuer were a group health plan.’’. 
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(2) Section 2762(b)(2) of such Act (42 U.S.C. 
300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 
and inserting ‘‘sections 2751 and 2753’’. 
(c) EFFECTIVE DATES.—(1) The amendments made 
by subsection (a) shall apply with respect to group health 
plans for plan years beginning on or after January 1, 
2008. 
(2) The amendment made by subsection (b) shall 
apply with respect to health insurance coverage offered, 
sold, issued, renewed, in effect, or operated in the indi-
vidual market on or after such date. 
(d) COORDINATED REGULATIONS.—Section 104(1) 
of Health Insurance Portability and Accountability Act of 
1996 is amended by striking ‘‘this subtitle (and the 
amendments made by this subtitle and section 401)’’ and 
inserting ‘‘the provisions of part 7 of subtitle B of title 
I of the Employee Retirement Income Security Act of 
1974, the provisions of parts A and C of title XXVII of 
the Public Health Service Act, and chapter 100 of the In-
ternal Revenue Code of 1986’’. 
Æ 
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