‘‘(b) NOTICE.—Beginning not later than January 1, 
2026, a group health plan or health insurance issuer offer-
ing group health insurance coverage shall provide notice 
to each participant and beneficiary under such plan or cov-
erage regarding the coverage required by this section, in 
any documents describing services, in accordance with any 
regulations promulgated by the Secretary. 
‘‘(c) DEFINITION.—In this section, the term ‘con-
genital anomaly or birth defect’ means a structural or 
functional anomaly that occurs during intrauterine life, 
develops prenatally, and may be identified before birth, at 
birth, or later in life, and which may— 
‘‘(1) be caused by genetic or chromosomal dis-
orders, embryotoxic or teratogenic environmental 
factors, nutrient deficiency, multifactorial inherit-
ance, or be of an unknown cause; 
‘‘(2) manifest as abnormal anatomical struc-
tures; 
‘‘(3) manifest as physical, sensory, or cognitive 
functional disabilities; 
‘‘(4) manifest as syndromes, diseases, or other 
health problems; and 
‘‘(5) manifest as singular anomalies or in com-
bination prenatally, at birth, or later in life.’’. 
(2) TECHNICAL AMENDMENTS.— 
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(A) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ 
and inserting ‘‘sections 711 and 726’’. 
(B) The table of contents in section 1 of 
such Act is amended by inserting after the item 
relating to section 725 the following new item: 
‘‘Sec. 726. Coverage of congenital anomaly or birth defect.’’. 
(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. COVERAGE OF CONGENITAL 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 that pri-
marily impacts the appearance or function of the 
eyes, ears, teeth, mouth, or jaw, consistent with 
paragraphs (2) and (3). 
‘‘(2) FINANCIAL
REQUIREMENTS.—Any cov-
erage provided under paragraph (1) under a group 
health plan may be subject to cost-sharing require-
ments (such as coinsurance, copayments, and 
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deductibles), as required by the plan, that are no 
more restrictive than the predominant cost-sharing 
requirements applied to substantially all other med-
ical and surgical benefits covered by the plan. 
‘‘(3) APPLICABLE ITEMS AND SERVICES.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the items and services re-
quired under paragraph (1) to be covered by a 
group health plan include— 
‘‘(i) any item or service to improve, 
repair, or restore any body part to achieve 
normal body functioning or appearance, or 
performed to approximate a normal ap-
pearance, as determined medically nec-
essary by the treating physician (as de-
fined in section 1861(r) of the Social Secu-
rity Act), on account of a congenital anom-
aly or birth defect that primarily impacts 
the appearance or function of the eyes, 
ears, teeth, mouth, or jaw; and 
‘‘(ii) any treatment or diagnostic serv-
ice with respect to any and all missing or 
abnormal body parts (including teeth, the 
oral cavity, and their associated struc-
tures), as determined medically necessary 
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by the treating physician (as defined in 
section 1861(r) of the Social Security Act), 
including— 
‘‘(I) reconstructive services and 
procedures, and items and services re-
lated to any complications arising 
from such services and procedures; 
‘‘(II) adjunctive dental, ortho-
dontic, 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 
normal appearance, notwithstanding 
any exclusions, limitations, or restric-
tions under the plan on coverage of 
dental, orthodontic, or prosthodontic 
items and services arising from other 
injuries or sicknesses; and 
‘‘(III) items and services related 
to secondary conditions and follow-up 
treatment associated with the under-
lying congenital anomaly or birth de-
fect. 
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‘‘(B) EXCEPTION.—The items and services 
required under this subsection to be covered by 
a group health plan shall not include cosmetic 
surgery performed to reshape normal structures 
of the body to improve appearance or self-es-
teem, if such items and services are not fur-
nished as a result of a medical determination of 
a congenital anomaly or birth defect. 
‘‘(b) NOTICE.—Beginning not later January 1, 2026, 
a group health plan shall provide notice to each partici-
pant and beneficiary under such plan or coverage regard-
ing the coverage required by this section in any documents 
describing services, in accordance with any regulations 
promulgated by the Secretary. 
‘‘(c) DEFINITION.—In this section, the term ‘con-
genital anomaly or birth defect’ means a structural or 
functional anomaly that occurs during intrauterine life, 
develops prenatally, and may be identified before birth, at 
birth, or later in life, and which may— 
‘‘(1) be caused by genetic or chromosomal dis-
orders, embryotoxic or teratogenic environmental 
factors, nutrient deficiency, multifactorial inherit-
ance, or be of an unknown cause; 
‘‘(2) manifest as abnormal anatomical struc-
tures; 
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