I 
109TH CONGRESS 
1ST SESSION H. R. 4022 
To require health insurance coverage for certain reconstructive surgery. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 7, 2005 
Mr. ROSS introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committee on Edu-
cation and the Workforce, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned 
A BILL 
To require health insurance coverage for certain 
reconstructive surgery. 
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 ‘‘Reconstructive Surgery 
Act of 2005’’. 
SEC. 2. COVERAGE OF RECONSTRUCTIVE SURGERY. 
(a) GROUP HEALTH PLANS.— 
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—
(A) IN
GENERAL.—Section 2706 of the 
Public Health Service Act (42 U.S.C. 300gg–6) 
is amended to read as follows: 
‘‘SEC. 2706. COVERAGE OF RECONSTRUCTIVE SURGERY. 
‘‘(a) REQUIREMENT.—A group health plan and a 
health insurance issuer offering group health insurance 
coverage in connection with a group health plan that pro-
vides coverage for surgery shall provide coverage for re-
constructive surgery, including medically-necessary treat-
ment for pre-operative and post-operative care deemed 
necessary by the treating physician or team of physicians. 
‘‘(b) DEFINITION.—In subsection (a), the term ‘re-
constructive surgery’ means any medically necessary and 
appropriate surgery performed to correct or repair abnor-
mal structures of the body caused by congenital defects, 
developmental abnormalities, trauma, infection, tumors, or 
disease to— 
‘‘(1) improve functions; or 
‘‘(2) give the patient a normal appearance, to 
the extent possible, in the judgment of the physician 
performing the surgery. 
‘‘(c) RULE OF CONSTRUCTION.— 
‘‘(1) IN
GENERAL.—Nothing in this section 
shall be construed to require a group health plan or
health insurance issuer in connection with a group 
health plan to provide coverage for cosmetic surgery. 
‘‘(2) DEFINITION.—In paragraph (1), the term 
‘cosmetic surgery’ means surgery that is performed 
to alter or reshape normal structures of the body in 
order to improve appearance.’’. 
(B) CONFORMING
AMENDMENT.—Section 
2723(c) of the Public Health Service Act (42 
U.S.C. 300gg–23(c)) is amended by striking 
‘‘section 2704’’ and inserting ‘‘sections 2704 
and 2706’’. 
(2) ERISA AMENDMENTS.— 
(A) IN GENERAL.—Section 713 of the Em-
ployee Retirement Income Security Act of 1974 
(29 U.S.C. 1185b) is amended to read as fol-
lows: 
‘‘SEC. 713. COVERAGE FOR RECONSTRUCTIVE SURGERY. 
‘‘(a) REQUIREMENT.—A group health plan and a 
health insurance issuer offering group health insurance 
coverage in connection with a group health plan that pro-
vides coverage for surgery shall provide coverage for re-
constructive surgery, including medically-necessary treat-
ment for pre-operative and post-operative care deemed 
necessary by the treating physician or team of physicians.
‘‘(b) DEFINITION.—In subsection (a), the term ‘re-
constructive surgery’ means any medically necessary and 
appropriate surgery performed to correct or repair abnor-
mal structures of the body caused by congenital defects, 
developmental abnormalities, trauma, infection, tumors, or 
disease to— 
‘‘(1) improve functions; or 
‘‘(2) give the patient a normal appearance, to 
the extent possible, in the judgment of the physician 
performing the surgery. 
‘‘(c) RULE OF CONSTRUCTION.— 
‘‘(1) IN
GENERAL.—Nothing in this section 
shall be construed to require a group health plan or 
health insurance issuer in connection with a group 
health plan to provide coverage for cosmetic surgery. 
‘‘(2) DEFINITION.—In paragraph (1), the term 
‘cosmetic surgery’ means surgery that is performed 
to alter or reshape normal structures of the body in 
order to improve appearance.’’. 
(B) CONFORMING AMENDMENTS.— 
(i) Section 731(c) of such Act (29 
U.S.C. 1191(c)) is amended by striking 
‘‘section 711’’ and inserting ‘‘sections 711 
and 713’’.
(ii) Section 732(a) of such Act (29 
U.S.C. 1191a(a)) is amended by striking 
‘‘section 711’’ and inserting ‘‘sections 711 
and 713’’. 
(iii) The table of contents in section 1 
of such Act is amended by inserting after 
the item relating to section 712 the fol-
lowing new item: 
‘‘Sec. 713. Coverage for reconstructive surgery.’’. 
(b) INDIVIDUAL MARKET.—Section 2752 of the Pub-
lic Health Service Act (42 U.S.C. 300gg–52) is amended 
to read as follows: 
‘‘SEC. 2752. COVERAGE FOR RECONSTRUCTIVE SURGERY. 
‘‘The provisions of section 2706 shall apply to health 
insurance coverage offered by a health insurance issuer 
in the individual market in the same manner as they apply 
to health insurance coverage offered by a health insurance 
issuer in connection with a group health plan in the small 
or large group market.’’. 
(c) EFFECTIVE DATES.— 
(1) GROUP HEALTH PLANS.—Subject to para-
graph (3), the amendments made by subsection (a) 
shall apply with respect to group health plans for 
plan years beginning on or after January 1, 2006. 
(2) 
HEALTH
INSURANCE
COVERAGE.—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. 
(3) COLLECTIVE BARGAINING AGREEMENTS.— 
In the case of a group health plan maintained pur-
suant to 1 or more collective bargaining agreements 
between employee representatives and 1 or more em-
ployers ratified before the date of enactment of this 
Act, the amendments made by subsection (a) shall 
not apply to plan years beginning before the later 
of— 
(A) the date on which the last collective 
bargaining agreements relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of en-
actment of this Act), or 
(B) January 1, 2006. 
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining 
agreement relating to the plan which amends the 
plan solely to conform to any requirement added by 
subsection (a) shall not be treated as a termination 
of such collective bargaining agreement. 
(d) COORDINATED REGULATIONS.—Section 104(1) 
of Health Insurance Portability and Accountability Act of