,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #efj  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #bf1 #bjai,ms4
 ,baldw9 7= h]self1 ,ms4 ,ern/1 ,ms4    
,murk[ski1 & ,mr4 ,br[n7 introduc$ !    
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,heal?1 ,education1  
,labor1 & ,p5sions  ,a ,,bill  ,to am5d 
! ,public ,heal? ,s]vice ,act1 !        
,employee ,retirem5t ,income ,security  
,act ( #aigd1 & ! ,int]nal ,rev5ue ,code
 ( #aihf to require t gr\p & individual 
heal? insurance cov]age & gr\p heal?    
plans provide cov]age = treatm5t ( a    
cong5ital anomaly or bir? defect4  #a4  
,%ort title ,?is ,act may be cit$ z !   
,ensur+ ,la/+ ,smiles ,act4  #b4        
,cov]age ( cong5ital anomaly or bir?    
defect  7a7 ,public ,heal? ,s]vice ,act 
,am5dm5ts  7#a7 ,9 g5]al ,title ,,xxvii 
( ! ,public ,heal? ,s]vice ,act is am5d$
 by ins]t+ aft] section #bgbi 7#db      
,u4,s4,c4 #cjj;gg-#ai;b71 ! foll[+3     
#bgcj4 ,/&>ds relat+ to b5efits =       
cong5ital anomaly or bir? defect  7a7   

,requirem5ts = c>e & ,recon/ructive     
,treatm5t  7#a7 ,9 g5]al ,a gr\p heal?  
plan1 & a heal? insurance issu] (f]+    
gr\p or individual heal? insurance      
cov]age1 %all provide cov]age =         
outpati5t & inpati5t s]vices relat$ to !
 diagnosis & treatm5t ( a cong5ital     
anomaly or bir? defect4  7#b7           
,requirem5ts ,cov]age provid$ "u        
p>agraph 7#a7 %all include any s]vice to
 functionally improve1 repair1 or re/ore
 any body "p t is m$ically necess>y to  
a*ieve normal body function+ or         
appe>ance1 z det]m9$ by ! treat+        
physician 7z def9$ 9 section #ahfa ( !  
,social ,security ,act74 ,any cov]age   
provid$ "u su* p>agraph may be subject  
to cov]age limits1 su* z                
pre-au?orization or pre-c]tification1 z 
requir$ by ! plan or issu] t are no m   
re/rictive ?an ! pr$om9ant treatm5t     
limitations appli$ to sub/antially all  
m$ical & surgical b5efits cov]$ by !    
plan 7or cov]age74  7#c7 ,treatm5t def9$
  7,a7 ,9 g5]al ,except z provid$ 9     

subp>agraph 7,b71 9 ?is section1 ! t]m  
treatm5t includes pati5t & outpati5t c>e
 & s]vices p]=m$ to improve or re/ore   
body function 7or p]=m$ to approximate a
 normal appe>ance71 due to cong5ital    
anomaly or bir? defect & %all include   
treatm5t to any & all miss+ or abnormal 
body p>ts1 7includ+ tee?1 ! oral cavity1
 & _! associat$ /ructures7 t w\ld       
o!rwise be provid$ "u ! plan or cov]age 
= any o!r injury & sickness1 includ+--  
7i7 inpati5t & outpati5t c>e1           
recon/ructive s]vices & proc$ures1 &    
complications !re(1 includ+ pro/hetics &
 appliances2  7ii7 adjunctive d5tal1    
or?odontic or pro/hodontic support f    
bir? until ! m$ical or surgical treatm5t
 ( ! defect or anomaly has be5 complet$1
 includ+ ongo+ or subsequ5t treatm5t    
requir$ to ma9ta9 function or           
approximate a normal appe>ance2  7iii7  
proc$ures t d n mat]ially re/ore or     
improve ! function ( ! body "p be+      
treat$2 &  7iv7 proc$ures = second>y    
conditions & foll[-up treatm5t4  7,b7   

,exception ,! t]m treatm5t %all n       
include cosmetic surg]y p]=m$ to re%ape 
normal /ructures ( ! body to improve    
appe>ance or self-e/eem4  7b7 ,notice ,a
 gr\p heal? plan "u ?is "p %all comply )
 ! notice requirem5t "u section #gad7;b7
 ( ! ,employee ,retirem5t ,income       
,security ,act ( #aigd ) respect to !   
requirem5ts ( ?is section z if su*      
section appli$ to su* plan4  4  7#b7    
,te*nical am5dm5ts  7,a7 ,section       
#bgbd7;c7 ( ! ,public ,heal? ,s]vice    
,act 7#db ,u4,s4,c4 #cjj;gg-#bc7;c77 is 
am5d$ by /rik+ section #bgjd & ins]t+   
sections #bgbe & #bgcj4  7,b7 ,section  
#bgfb7;b77#b7 ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4                    
#cjj;gg-#fb7;b77#b77 is am5d$ by /rik+  
section #bgea & ins]t+ sections #bgcj & 
#bgea4  7b7 ,,erisa am5dm5ts  7#a7 ,9   
g5]al ,subp>t ,b ( "p #g ( subtitle ,b (
 title ,i ( ! ,employee ,retirem5t      
,income ,security ,act ( #aigd is am5d$ 
by add+ at ! end ! foll[+3  #gaf4 ,/&>ds
 relat+ to b5efits = cong5ital anomaly  

or bir? defect  7a7 ,requirem5ts =      
,recon/ructive ,treatm5t  7#a7 ,9 g5]al 
,a gr\p heal? plan1 & a heal? insurance 
issu] (f]+ gr\p or individual heal?     
insurance cov]age1 %all provide cov]age 
= outpati5t & inpati5t s]vices relat$ to
 ! diagnosis & treatm5t ( a cong5ital   
anomaly or bir? defect4  7#b7           
,requirem5ts ,cov]age provid$ "u        
p>agraph 7#a7 %all include any s]vice to
 functionally improve1 repair1 or re/ore
 any body "p t is m$ically necess>y to  
a*ieve normal body function+ or         
appe>ance1 z det]m9$ by ! treat+        
physician 7z def9$ 9 section #ahfa ( !  
,social ,security ,act74 ,any cov]age   
provid$ "u su* p>agraph may be subject  
to cov]age limits1 su* z                
pre-au?orization or pre-c]tification1 z 
requir$ by ! plan or issu] t are no m   
re/rictive ?an ! pr$om9ant treatm5t     
limitations appli$ to sub/antially all  
m$ical & surgical b5efits cov]$ by !    
plan 7or cov]age74  7#c7 ,treatm5t def9$
  7,a7 ,9 g5]al ,except z provid$ 9     

subp>agraph 7,b71 9 ?is section1 ! t]m  
treatm5t includes pati5t & outpati5t c>e
 & s]vices p]=m$ to improve or re/ore   
body function 7or p]=m$ to approximate a
 normal appe>ance71 due to cong5ital    
anomaly or bir? defect & %all include   
treatm5t to any & all miss+ or abnormal 
body p>ts1 7includ+ tee?1 ! oral cavity1
 & _! associat$ /ructures7 t w\ld       
o!rwise be provid$ "u ! plan or cov]age 
= any o!r injury & sickness1 includ+--  
7i7 inpati5t & outpati5t c>e1           
recon/ructive s]vices & proc$ures1 &    
complications !re(1 includ+ pro/hetics &
 appliances2  7ii7 adjunctive d5tal1    
or?odontic or pro/hodontic support f    
bir? until ! m$ical or surgical treatm5t
 ( ! defect or anomaly has be5 complet$1
 includ+ ongo+ or subsequ5t treatm5t    
requir$ to ma9ta9 function or           
approximate a normal appe>ance2  7iii7  
proc$ures t d n mat]ially re/ore or     
improve ! function ( ! body "p be+      
treat$2 &  7iv7 proc$ures = second>y    
conditions & foll[-up treatm5t4  7,b7   

,exception ,! t]m treatm5t %all n       
include cosmetic surg]y p]=m$ to re%ape 
normal /ructures ( ! body to improve    
appe>ance or self-e/eem4  7b7 ,notice "u
 gr\p heal? plan ,! imposition ( !      
requirem5ts ( ?is section %all be treat$
 z a mat]ial modification 9 ! t]ms ( !  
plan describ$ 9 ! la/ s5t5ce ( section  
#ajb7;a71 = purposes ( assur+ notice (  
su* requirem5ts "u ! plan1 except t !   
summ>y description requir$ to be provid$
 "u ! f\r? s5t5ce ( section #ajd7;b77#a7
 ) respect to su* modification %all be  
provid$ by n lat] ?an #fj days aft] !   
fir/ day ( ! fir/ plan ye> 9 :i* su*    
requirem5ts apply4  4  7#b7 ,te*nical   
am5dm5ts  7,a7 ,section #gca7;c7 ( su*  
,act 7#bi ,u4,s4,c4 #aaia7;c77 is am5d$ 
by /rik+ section #gaa & ins]t+ sections 
#gaa & #gaf4  7,b7 ,section #gcb7;a7 (  
su* ,act 7#bi ,u4,s4,c4 #aaia;a7a77 is  
am5d$ by /rik+ section #gaa & ins]t+    
sections #gaa & #gaf4  7,c7 ,! table (  
cont5ts 9 section #a ( su* ,act is am5d$
 by ins]t+ aft] ! item relat+ to section

 #gad ! foll[+ new items3 ,sec4 #gae4   
,additional m>ket re=ms4,sec4 #gaf4     
,/&>ds relat+ to b5efits = cong5ital    
anomaly or bir? defect4  7c7 ,int]nal   
,rev5ue ,code am5dm5ts  7#a7 ,9 g5]al   
,sub*apt] ,b ( *apt] #ajj ( ! ,int]nal  
,rev5ue ,code ( #aihf1 z am5d$ by       
subsection 7f7 ( ! section #aefc 7relat+
 to con=m+ am5dm5ts7 ( ,public ,law     
#aaa-adh1 is am5d$ by add+ at ! end !   
foll[+3  #ihaf4 ,/&>ds relat+ to b5efits
 = cong5ital anomaly or bir? defect  7a7
 ,requirem5ts = ,recon/ructive ,treatm5t
 ,a gr\p heal? plan1 & a heal? insurance
 issu] (f]+ gr\p or individual heal?    
insurance cov]age1 %all provide cov]age 
= outpati5t & inpati5t s]vices relat$ to
 ! diagnosis & treatm5t ( a cong5ital   
anomaly or bir? defect4  7b7            
,requirem5ts ,cov]age provid$ "u        
subsection 7a7 %all include any s]vice  
to functionally improve1 repair1 or     
re/ore any body "p t is m$ically        
necess>y to a*ieve normal body function+
 or appe>ance1 z det]m9$ by ! treat+    

physician 7z def9$ 9 section #ahfa ( !  
,social ,security ,act74 ,any cov]age   
provid$ "u su* subsection may be subject
 to cov]age limits1 su* z               
pre-au?orization or pre-c]tification1 z 
requir$ by ! plan or issu] t are no m   
re/rictive ?an ! pr$om9ant treatm5t     
limitations appli$ to sub/antially all  
m$ical & surgical b5efits cov]$ by !    
plan 7or cov]age74  7c7 ,treatm5t def9$ 
7#a7 ,9 g5]al ,except z provid$ 9       
p>agraph 7#b71 9 ?is section1 ! t]m     
treatm5t includes pati5t & outpati5t c>e
 & s]vices p]=m$ to improve or re/ore   
body function 7or p]=m$ to approximate a
 normal appe>ance71 due to cong5ital    
anomaly or bir? defect & %all include   
treatm5t to any & all miss+ or abnormal 
body p>ts1 7includ+ tee?1 ! oral cavity1
 & _! associat$ /ructures7 t w\ld       
o!rwise be provid$ "u ! plan or cov]age 
= any o!r injury & sickness1 includ+--  
7,a7 inpati5t & outpati5t c>e1          
recon/ructive s]vices & proc$ures1 &    
complications !re(1 includ+ pro/hetics &

 appliances2  7,b7 adjunctive d5tal1    
or?odontic or pro/hodontic support f    
bir? until ! m$ical or surgical treatm5t
 ( ! defect or anomaly has be5 complet$1
 includ+ ongo+ or subsequ5t treatm5t    
requir$ to ma9ta9 function or           
approximate a normal appe>ance2  7,c7   
proc$ures t d n mat]ially re/ore or     
improve ! function ( ! body "p be+      
treat$2 &  7,d7 proc$ures = second>y    
conditions & foll[-up treatm5t4  7#b7   
,exception ,! t]m treatm5t %all n       
include cosmetic surg]y p]=m$ to re%ape 
normal /ructures ( ! body to improve    
appe>ance or self-e/eem4  4  7#b7       
,cl]ical am5dm5t ,! table ( sections =  
su* sub*apt] is am5d$ by add+ at ! end !
 foll[+ new items3  ,sec4 #ihae4        
,additional m>ket re=ms4,sec4 #ihaf4    
,/&>ds relat+ to b5efits = cong5ital    
anomaly or bir? defect4  4  7d7 ,cl>ify+
 am5dm5t reg>d+ application to gr&fa!r$ 
plans ,section #abea7;a77#d77;,a7 ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4                     

#ahjaa7;a77#d77;,a771 is am5d$ by add+  
at ! end ! foll[+3  7v7 ,section #bgcj  
7relat+ to /&>ds relat+ to b5efits =    
cong5ital anomaly or bir? defect71 z    
add$ by section #b7;a7 ( ! ,ensur+ ,la/+
 ,smiles ,act4  4  7e7 ,effective date  
,! am5dm5ts made by ?is section %all    
apply ) respect to gr\p heal? plans =   
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbj1 & ) respect to heal? insurance   
cov]age (f]$1 sold1 issu$1 r5ew$1 9     
effect1 or op]at$ 9 ! individual m>ket  
on or aft] su* date4  7f7 ,coord9at$    
regulations ,section #ajd7a7 ( ! ,heal? 
,insurance ,portability & ,acc\ntability
 ,act ( #aiif is am5d$ by /rik+ ?is     
subtitle 7& ! am5dm5ts made by ?is      
subtitle & section #dja7 & ins]t+ !     
provisions ( "p #g ( subtitle ,b ( title
 ,i ( ! ,employee ,retirem5t ,income    
,security ,act ( #aigd1 ! provisions (  
p>ts ,a & ,c ( title ,,xxvii ( ! ,public
 ,heal? ,s]vice ,act1 & *apt] #ajj ( !  
,int]nal ,rev5ue ,code ( #aihf4