I 
111TH CONGRESS 
1ST SESSION H. R. 1339 
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 
MARCH 5, 2009 
Mrs. MCCARTHY of New York (for herself, Mr. TIBERI, Mr. GORDON of Ten-
nessee, Mr. MCDERMOTT, Mr. INSLEE, Mr. BARTLETT, Mr. BISHOP of 
Georgia, Mr. HINCHEY, Mr. ISRAEL, Ms. EDDIE BERNICE JOHNSON of 
Texas, Mr. KENNEDY, Mr. LEWIS of Georgia, Mr. MOORE of Kansas, Mr. 
MORAN of Virginia, Mr. PASCRELL, Mr. SMITH of New Jersey, Mr. 
TIERNEY, Mr. VAN HOLLEN, Mr. FILNER, Mr. MCHUGH, Mr. CARSON 
of Indiana, Ms. SUTTON, Mr. CUMMINGS, Mr. WOLF, Mr. BISHOP of New 
York, Mr. GENE GREEN of Texas, Ms. HIRONO, Ms. SLAUGHTER, Mr. 
HOLT, Mr. LINCOLN DIAZ-BALART of Florida, Mr. GRIJALVA, Mr. 
MCGOVERN, Ms. SCHAKOWSKY, Ms. KAPTUR, Mr. NADLER of New York, 
Mr. WEXLER, Ms. LEE of California, Mr. SCOTT of Virginia, Mr. 
PIERLUISI, Ms. BERKLEY, Mrs. EMERSON, Mr. TAYLOR, and Mrs. 
MALONEY) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Education and Labor and Ways and Means, for a period to be subse-
quently 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 Re-
tirement Income Security Act of 1974, and the Internal 
Revenue Code of 1986 to require that group and indi-
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vidual health insurance coverage and group health plans 
provide coverage for treatment of a minor child’s con-
genital or developmental deformity or disorder due to 
trauma, infection, tumor, or disease. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Children’s Access to 
Reconstructive Evaluation & Surgery (CARES) Act of 
2009’’. 
SEC. 2. COVERAGE OF MINOR CHILD’S CONGENITAL OR DE-
VELOPMENTAL DEFORMITY OR DISORDER. 
(a) GROUP HEALTH PLANS.— 
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—(A) Subpart 2 of part A of title XXVII of 
the Public Health Service Act is amended by adding 
at the end the following new section: 
‘‘SEC. 2708. 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-
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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 
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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.—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 2708’’. 
(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. 715. 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-
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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-
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— 
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‘‘(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 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 715’’. 
(C) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 715’’. 
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(D) The table of contents in section 1 of such 
Act is amended by inserting after the item relating 
to section 714 the following new item: 
‘‘Sec. 715. 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-
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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 
‘‘(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.’’. 
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