‘‘Sec. 713. Standards relating to benefits for minor child’s congenital or develop-
mental deformity or disorder.’’.
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.—Subchapter B of chapter 100 of the Inter-
nal Revenue Code of 1986 (as amended by section
1531(a) of the Taxpayer Relief Act of 1997) is
amended—
(A) in the table of sections, by inserting after
the item relating to section 9812 the following new
item:
‘‘Sec. 9813. Standards relating to benefits for minor child’s con-
genital or developmental deformity or disorder.’’;
and
(B) by inserting after section 9812 the follow-
ing:
‘‘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
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
‘‘(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) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act, as amend-
ed by section 605(a) of Public Law 104–204, is amended
by inserting after section 2751 the following new section:
‘‘SEC. 2752. 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
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
‘‘(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 health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 713(b) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements referred to
in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.’’.
(2) Section 2762(b)(2) of such Act (42 U.S.C.
300gg–62(b)(2)), as added by section 605(b)(3)(B) of
Public Law 104–204, is amended by striking ‘‘section
2751’’ and inserting ‘‘sections 2751 and 2752’’.
(c) EFFECTIVE DATES.—(1) The amendments made
by subsection (a) shall apply with respect to group health
plans for plan years beginning on or after January 1,
1999.
(2) The amendment made by subsection (b) shall
apply with respect to health insurance coverage offered,
sold, issued, renewed, in effect, or operated in the individ-
ual market on or after such date.
(d) COORDINATED REGULATIONS.—Section 104(1)
of Health Insurance Portability and Accountability Act of
1996 is amended by striking ‘‘this subtitle (and the
amendments made by this subtitle and section 401)’’ and
inserting ‘‘the provisions of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of
1974, the provisions of parts A and C of title XXVII of
the Public Health Service Act, and chapter 100 of the In-
ternal Revenue Code of 1986’’.
Æ