improve, repair, or restore bodily function (or 
performed to approximate a normal appear-
ance), due to a craniofacial, oral, or maxillo-
facial congenital anomaly or birth defect, and 
includes treatment to any and all missing or ab-
normal body parts (including teeth, the oral 
cavity, and their associated structures) that 
would otherwise be provided under the plan or 
coverage for any other injury or sickness, in-
cluding— 
‘‘(i) any items or services, including 
inpatient and outpatient care, reconstruc-
tive services and procedures, and complica-
tions thereof; 
‘‘(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 materially im-
prove, repair, or restore bodily function; 
and 
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‘‘(iv) procedures for secondary condi-
tions and follow-up treatment associated 
with the underlying craniofacial, oral, or 
maxillofacial congenital anomaly or birth 
defect. 
‘‘(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.—Not later than one year after the date 
of the enactment of this section and annually thereafter, 
a group health plan, and a health insurance issuer offering 
group or individual health insurance coverage, shall, in ac-
cordance with regulations or guidance issued by the Sec-
retary, provide to each enrollee under such plan or cov-
erage a written description of the terms of this section. 
Such description shall be in language which is understand-
able to the typical enrollee.’’. 
(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: 
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‘‘SEC. 726. STANDARDS RELATING TO BENEFITS FOR 
CRANIOFACIAL, ORAL, OR MAXILLOFACIAL 
CONGENITAL ANOMALY OR BIRTH DEFECT. 
‘‘(a) REQUIREMENTS FOR CARE AND RECONSTRUC-
TIVE TREATMENT.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insur-
ance coverage, shall provide coverage for outpatient 
and inpatient items and services related to the diag-
nosis and treatment of a craniofacial, oral, or maxil-
lofacial congenital anomaly or birth defect. 
‘‘(2) REQUIREMENTS.— 
‘‘(A) IN
GENERAL.—Coverage provided 
under paragraph (1) shall include any medically 
necessary item or service to functionally im-
prove, repair, or restore any body part to 
achieve normal body functioning or appearance, 
as determined by the treating physician (as de-
fined in section 1861(r) of the Social Security 
Act), due to craniofacial, oral, or maxillofacial 
congenital anomaly or birth defect. 
‘‘(B) 
FINANCIAL
REQUIREMENTS
AND 
TREATMENT
REQUIREMENTS.—Any coverage 
provided under paragraph (1) under a group 
health plan or group health insurance coverage 
offered by a health insurance issuer may be 
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subject to coverage limits (such as medical ne-
cessity, pre-authorization, or pre-certification) 
and cost-sharing requirements (such as coinsur-
ance, copayments, and deductibles), as required 
by the plan or issuer, that are no more restric-
tive than the predominant coverage limits and 
cost-sharing requirements, respectively, applied 
to substantially all medical and surgical benefits 
covered by the plan (or coverage). 
‘‘(3) TREATMENT DEFINED.—In this section: 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘treatment’ in-
cludes, with respect to a group health plan or 
group health insurance coverage offered by a 
health insurance issuer, inpatient and out-
patient items and services performed to im-
prove, repair, or restore bodily function (or per-
formed to approximate a normal appearance), 
due to a craniofacial, oral, or maxillofacial con-
genital anomaly or birth defect, and includes 
treatment to any and all missing or abnormal 
body parts (including teeth, the oral cavity, and 
their associated structures) that would other-
wise be provided under the plan or coverage for 
any other injury or sickness, including— 
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‘‘(i) any items or services, including 
inpatient and outpatient care, reconstruc-
tive services and procedures, and complica-
tions thereof; 
‘‘(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 materially im-
prove, repair, or restore bodily function; 
and 
‘‘(iv) procedures for secondary condi-
tions and follow-up treatment associated 
with the underlying craniofacial, oral, or 
maxillofacial congenital anomaly or birth 
defect. 
‘‘(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.—Not later than one year after the date 
of the enactment of this section and annually thereafter, 
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