I
106TH CONGRESS
1ST SESSION
H. R. 49
To amend the Public Health Service Act, the Employee Retirement Income
Security Act of 1974, and the Internal Revenue Code of 1986 to require
that group and individual health insurance coverage and group health
plans provide coverage for treatment of a minor child’s congenital or
developmental deformity or disorder due to trauma, infection, tumor,
or disease.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 6, 1999
Mrs. KELLY (for herself, Mr. GANSKE, Mr. GILMAN, Mrs. MALONEY of New
York, and Mr. CONDIT) introduced the following bill; which was referred
to the Committee on Commerce, and in addition to the Committee on
Ways and Means, and Education and the Workforce, 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 con-
cerned
A BILL
To amend the Public Health Service Act, the Employee Re-
tirement Income Security Act of 1974, and the Internal
Revenue Code of 1986 to require that group and individ-
ual health insurance coverage and group health plans
provide coverage for treatment of a minor child’s con-
genital or developmental deformity or disorder due to
trauma, infection, tumor, or disease.
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 ‘‘Treatment of Chil-
dren’s Deformities Act of 1998’’.
SEC. 2. COVERAGE OF MINOR CHILD’S CONGENITAL OR DE-
VELOPMENTAL DEFORMITY OR DISORDER.
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—(A) Subpart 2 of part A of title XXVII of
the Public Health Service Act, as amended by sec-
tion 703(a) of Public Law 104–204, is amended by
adding at the end the following new section:
‘‘SEC. 2706. 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 group health plan under this part
shall comply with the notice requirement under section
713(b) 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.’’.
(B) Section 2723(c) of such Act (42 U.S.C.
300gg–23(c)), as amended by section 604(b)(2) of
Public Law 104–204, is amended by striking ‘‘sec-
tion 2704’’ and inserting ‘‘sections 2704 and 2706’’.
(2) ERISA AMENDMENTS.—(A) Subpart B of
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974, as amended
by section 702(a) of Public Law 104–204, is amend-
ed by adding at the end the following new section:
‘‘SEC. 713. STANDARDS RELATING TO BENEFITS FOR MINOR
CHILD’S CONGENITAL OR DEVELOPMENTAL
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 UNDER GROUP HEALTH PLAN.—The
imposition of the requirements of this section shall be
treated as a material modification in the terms of the plan
described in section 102(a)(1), for purposes of assuring
notice of such requirements under the plan; except that
the summary description required to be provided under the
last sentence of section 104(b)(1) with respect to such
modification shall be provided by not later than 60 days
after the first day of the first plan year in which such
requirements apply.’’.
(B) Section 731(c) of such Act (29 U.S.C.
1191(c)), as amended by section 603(b)(1) of Public
Law 104–204, is amended by striking ‘‘section 711’’
and inserting ‘‘sections 711 and 713’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)), as amended by section 603(b)(2) of Pub-
lic Law 104–204, is amended by striking ‘‘section
711’’ and inserting ‘‘sections 711 and 713’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 712 the following new item: