I
107TH CONGRESS
2D SESSION
H. R. 4959
To require health insurance coverage for certain reconstructive surgery.
IN THE HOUSE OF REPRESENTATIVES
JUNE 18, 2002
Mr. ROSS (for himself, Mr. SNYDER, and Mr. ANDREWS) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Education and the Work-
force, for a period to be subsequently determined by the Speaker, in each
case for consideration of such provisions as fall within 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 2002’’.
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.
‘‘(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.
‘‘(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, 2003.
(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, 2003.
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
1996 (Public Law 104–191) 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, and the provisions of parts A and
C of title XXVII of the Public Health Service Act’’.
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