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 
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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.—A group health plan under this part 
shall comply with the notice requirement under section 
714(c) of the Employee Retirement Income Security Act 
of 1974 with respect to the requirements of this section 
as if such section applied to such plan.’’. 
(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. 
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(e) CLARIFYING AMENDMENT REGARDING APPLICA-
TION
TO
GRANDFATHERED
PLANS.—Section 
1251(a)(4)(A) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18011(a)(4)(A)), is amended by add-
ing at the end the following: 
‘‘(v) Section 2799A–11 (relating to 
standards relating to benefits for con-
genital anomaly or birth defect), as added 
by section 2(a) of the Ensuring Lasting 
Smiles Act.’’. 
(f) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to group health plans 
for plan years beginning on or after January 1, 2022, and 
with respect to health insurance coverage offered, sold, 
issued, renewed, in effect, or operated in the individual 
market on or after such date. 
(g) COORDINATED REGULATIONS.—Section 104(1) 
of the 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, C, and D of title XXVII 
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of the Public Health Service Act, and chapter 100 of the 
Internal Revenue Code of 1986’’. 
Æ 
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