Such description shall be in language which is understand-
able to the typical participant or beneficiary.’’. 
(2) TECHNICAL
AMENDMENT.—The table of 
contents in section 1 of such Act is amended by in-
serting after the item relating to section 725 the fol-
lowing new item: 
‘‘Sec. 726. Standards relating to benefits for congential 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. 9826. STANDARDS RELATING TO BENEFITS FOR CON-
GENITAL ANOMALY OR BIRTH DEFECT. 
‘‘(a) REQUIREMENTS FOR CARE AND RECONSTRUC-
TIVE TREATMENT.— 
‘‘(1) IN GENERAL.—A group health plan shall 
provide coverage for outpatient and inpatient items 
and services related to the diagnosis and treatment 
of a 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 congenital anomaly or birth defect. 
‘‘(B) 
FINANCIAL
REQUIREMENTS
AND 
TREATMENT
REQUIREMENTS.—Any coverage 
provided under paragraph (1) under a group 
health plan may be subject to coverage limits 
(such as medical necessity, pre-authorization, or 
pre-certification) and cost-sharing requirements 
(such 
as 
coinsurance, 
copayments, 
and 
deductibles), as required by the plan, that are 
no more restrictive than the predominant cov-
erage limits and cost-sharing requirements, re-
spectively, applied to substantially all medical 
and surgical benefits covered by the plan. 
‘‘(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, in-
patient and outpatient items and services per-
formed to improve, repair, or restore bodily 
function (or performed to approximate a normal 
appearance), due to a congenital 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 otherwise be provided 
under the plan for any other injury or sickness, 
including— 
‘‘(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 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 shall, in accordance with regulations 
or guidance issued by the Secretary, provide to each en-
rollee under such plan a written description of the terms 
of this section. Such description shall be in language which 
is understandable to the typical enrollee.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for such subchapter is amended by adding at 
the end the following new item: 
‘‘Sec. 9826. Standards relating to benefits for congenital anomaly or birth de-
fect.’’. 
(d) RULE OF CONSTRUCTION.—A group health plan 
or health insurance issuer shall provide the benefits de-
scribed in section 2799A–11 of the Public Health Service 
Act (as added by subsection (a)), section 726 of the Em-
ployee Retirement Income Security Act of 1974 (as added 
by subsection (b)), and section 9826 of the Internal Rev-
enue Code of 1986 (as added by subsection (c)) under the 
terms of such plan or health insurance coverage offered 
by such issuer. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning on or after January 1, 2024.
SEC. 3. DETERMINATION OF BUDGETARY EFFECTS. 
The budgetary effects of this Act, for the purpose of 
complying with the Statutory Pay-As-You-Go Act of 2010, 
shall be determined by reference to the latest statement 
titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this 
Act, submitted for printing in the Congressional Record 
by the Chairman of the House Budget Committee, pro-
vided that such statement has been submitted prior to the 
vote on passage. 
Passed the House of Representatives April 4, 2022. 
Attest: 
Clerk.
117TH CONGRESS 
2D SESSION 
H. R. 1916 
AN ACT 
To provide health insurance benefits for outpatient 
and inpatient items and services related to the 
diagnosis and treatment of a congenital anomaly 
or birth defect.