,i  #aag? ,,congress  #b;d ,session  ,h4
 ,r4 #ggjb  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #aj1 #bjbb,mr4   
,dunn 7= himself & ,mr4 ,griffi?7       
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committees on ,education 
& ,labor1 & ,ways & ,means1 = a p]iod to
 be subsequ5tly det]m9$ by ! ,speak]1 9 
ea* case = consid]ation ( su* provisions
 z fall )9 ! jurisdiction ( ! committee 
conc]n$  ,a ,,bill  ,to provide heal?   
insurance b5efits = outpati5t & inpati5t
 items & s]vices relat$ to ! diagnosis &
 treatm5t ( a crani(acial1 oral1 or     
maxill(acial cong5ital anomaly or bir?  
defect4  #a4 ,%ort title ,?is ,act may  
be cit$ z ! ,ensur+ ,la/+ ,smiles ,act4 
#b4 ,cov]age ( crani(acial1 oral1 or    
maxill(acial cong5ital anomaly or bir?  
defect  7a7 ,public ,heal? ,s]vice ,act 
,am5dm5ts ,"p ,d ( title ,,xxvii ( !    
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#aaa et seq47 is am5d$
 by add+ at ! end ! foll[+ new section3 

#bgii;,a-#aa4 ,/&>ds relat+ to b5efits =
 crani(acial1 oral1 or maxill(acial     
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 items & s]vices    
relat$ to ! diagnosis & treatm5t ( a    
crani(acial1 oral1 or maxill(acial      
cong5ital anomaly or bir? defect4  7#b7 
,requirem5ts  7,a7 ,9 g5]al ,cov]age    
provid$ "u p>agraph 7#a7 %all include   
any m$ically necess>y item or s]vice to 
functionally improve1 repair1 or re/ore 
any body "p to a*ieve normal body       
function+ or appe>ance1 z det]m9$ by !  
treat+ physician 7z def9$ 9 section     
#ahfa7r7 ( ! ,social ,security ,act71   
due to crani(acial1 oral1 or            
maxill(acial cong5ital anomaly or bir?  
defect4  7,b7 ,f9ancial requirem5ts &   
treatm5t requirem5ts ,any cov]age       
provid$ "u p>agraph 7#a7 "u a gr\p heal?

 plan or individual or gr\p heal?       
insurance cov]age (f]$ by a heal?       
insurance issu] may be subject to       
cov]age limits 7su* z m$ical necessity1 
pre-au?orization1 or pre-c]tification7 &
 co/-%>+ requirem5ts 7su* z co9surance1 
copaym5ts1 & d$uctibles71 z requir$ by !
 plan or issu]1 t are no m re/rictive   
?an ! pr$om9ant cov]age limits & co/-%>+
 requirem5ts1 respectively1 appli$ to   
sub/antially all m$ical & surgical      
b5efits cov]$ by ! plan 7or cov]age74   
7#c7 ,treatm5t def9$ ,9 ?is section3    
7,a7 ,9 g5]al ,except z provid$ 9       
subp>agraph 7,b71 ! t]m treatm5t        
includes1 ) respect to a gr\p heal? plan
 or gr\p or individual heal? insurance  
cov]age (f]$ by a heal? insurance issu]1
 inpati5t & outpati5t items & s]vices   
p]=m$ to improve1 repair1 or re/ore     
bodily function 7or p]=m$ to approximate
 a normal appe>ance71 due to a          
crani(acial1 oral1 or maxill(acial      
cong5ital anomaly or bir? defect1 &     
includes treatm5t to any & all miss+ or 

abnormal body p>ts 7includ+ tee?1 ! oral
 cavity1 & _! associat$ /ructures7 t    
w\ld o!rwise be provid$ "u ! plan or    
cov]age = any o!r injury or sickness1   
includ+-- 7i7 any items or s]vices1     
includ+ inpati5t & outpati5t c>e1       
recon/ructive s]vices & proc$ures1 &    
complications !re(2  7ii7 adjunctive    
d5tal1 or?odontic1 or pro/hodontic      
support f bir? until ! m$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$ures t mat]ially 
improve1 repair1 or re/ore bodily       
function2 &  7iv7 proc$ures = second>y  
conditions & foll[-up treatm5t associat$
 ) ! und]ly+ crani(acial1 oral1 or      
maxill(acial cong5ital anomaly or bir?  
defect4  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 ,n lat] ?an "o ye> aft] ! date (

 ! enactm5t ( ?is section & annually    
!reaft]1 a gr\p heal? plan1 & a heal?   
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age1 %all1 9        
accordance ) regulations or guidance    
issu$ by ! ,secret>y1 provide to ea*    
enrollee "u su* plan or cov]age a writt5
 description ( ! t]ms ( ?is section4    
,su* description %all be 9 language :i* 
is und]/&able to ! typical enrollee4  4 
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  #gbf4 ,/&>ds relat+ 
to b5efits = crani(acial1 oral1 or      
maxill(acial 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 heal? insurance cov]age1
 %all provide cov]age = outpati5t &     
inpati5t items & s]vices relat$ to !    
diagnosis & treatm5t ( a crani(acial1   
oral1 or maxill(acial cong5ital anomaly 

or bir? defect4  7#b7 ,requirem5ts  7,a7
 ,9 g5]al ,cov]age provid$ "u p>agraph  
7#a7 %all include any m$ically necess>y 
item or s]vice to functionally improve1 
repair1 or re/ore any body "p to a*ieve 
normal body function+ or appe>ance1 z   
det]m9$ by ! treat+ physician 7z def9$ 9
 section #ahfa7r7 ( ! ,social ,security 
,act71 due to crani(acial1 oral1 or     
maxill(acial cong5ital anomaly or bir?  
defect4  7,b7 ,f9ancial requirem5ts &   
treatm5t requirem5ts ,any cov]age       
provid$ "u p>agraph 7#a7 "u a gr\p heal?
 plan or gr\p heal? insurance cov]age   
(f]$ by a heal? insurance issu] may be  
subject to cov]age limits 7su* z m$ical 
necessity1 pre-au?orization1 or         
pre-c]tification7 & co/-%>+ requirem5ts 
7su* z co9surance1 copaym5ts1 &         
d$uctibles71 z requir$ by ! plan or     
issu]1 t are no m re/rictive ?an !      
pr$om9ant cov]age limits & co/-%>+      
requirem5ts1 respectively1 appli$ to    
sub/antially all m$ical & surgical      
b5efits cov]$ by ! plan 7or cov]age74   

7#c7 ,treatm5t def9$ ,9 ?is section3    
7,a7 ,9 g5]al ,except z provid$ 9       
subp>agraph 7,b71 ! t]m treatm5t        
includes1 ) respect to a gr\p heal? plan
 or gr\p heal? insurance cov]age (f]$ by
 a heal? insurance issu]1 inpati5t &    
outpati5t items & s]vices p]=m$ to      
improve1 repair1 or re/ore bodily       
function 7or p]=m$ to approximate a     
normal appe>ance71 due to a crani(acial1
 oral1 or maxill(acial cong5ital anomaly
 or bir? defect1 & includes treatm5t to 
any & all miss+ or abnormal body p>ts   
7includ+ tee?1 ! oral cavity1 & _!      
associat$ /ructures7 t w\ld o!rwise be  
provid$ "u ! plan or cov]age = any o!r  
injury or sickness1 includ+-- 7i7 any   
items or s]vices1 includ+ inpati5t &    
outpati5t c>e1 recon/ructive s]vices &  
proc$ures1 & complications !re(2  7ii7  
adjunctive d5tal1 or?odontic1 or        
pro/hodontic support f bir? until !     
m$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$ures t mat]ially 
improve1 repair1 or re/ore bodily       
function2 &  7iv7 proc$ures = second>y  
conditions & foll[-up treatm5t associat$
 ) ! und]ly+ crani(acial1 oral1 or      
maxill(acial cong5ital anomaly or bir?  
defect4  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 ,n lat] ?an "o ye> aft] ! date (
 ! enactm5t ( ?is section & annually    
!reaft]1 a gr\p heal? plan1 & a heal?   
insurance issu] (f]+ gr\p heal?         
insurance cov]age1 %all1 9 accordance ) 
regulations or guidance issu$ by !      
,secret>y1 provide to ea* p>ticipant or 
b5efici>y "u su* plan or cov]age a      
writt5 description ( ! t]ms ( ?is       
section4 ,su* description %all be 9     
language :i* is und]/&able to ! typical 
p>ticipant or b5efici>y4  4  7#b7       
,te*nical am5dm5t ,! table ( cont5ts 9  
section #a ( su* ,act is am5d$ by ins]t+

 aft] ! item relat+ to section #gbe !   
foll[+ new item3  ,sec4 #gbf4 ,/&>ds    
relat+ to b5efits = crani(acial1 oral1  
or maxill(acial cong5ital anomaly or    
bir? defect4  4  7c7 ,int]nal ,rev5ue   
,code am5dm5ts  7#a7 ,9 g5]al ,sub*apt] 
,b ( *apt] #ajj ( ! ,int]nal ,rev5ue    
,code ( #aihf is am5d$ by add+ at ! end 
! foll[+3  #ihbf4 ,/&>ds relat+ to      
b5efits = crani(acial1 oral1 or         
maxill(acial cong5ital anomaly or bir?  
defect  7a7 ,requirem5ts = c>e &        
,recon/ructive ,treatm5t  7#a7 ,9 g5]al 
,a gr\p heal? plan %all provide cov]age 
= outpati5t & inpati5t items & s]vices  
relat$ to ! diagnosis & treatm5t ( a    
crani(acial1 oral1 or maxill(acial      
cong5ital anomaly or bir? defect4  7#b7 
,requirem5ts  7,a7 ,9 g5]al ,cov]age    
provid$ "u p>agraph 7#a7 %all include   
any m$ically necess>y item or s]vice to 
functionally improve1 repair1 or re/ore 
any body "p to a*ieve normal body       
function+ or appe>ance1 z det]m9$ by !  
treat+ physician 7z def9$ 9 section     

#ahfa7r7 ( ! ,social ,security ,act71   
due to crani(acial1 oral1 or            
maxill(acial cong5ital anomaly or bir?  
defect4  7,b7 ,f9ancial requirem5ts &   
treatm5t requirem5ts ,any cov]age       
provid$ "u p>agraph 7#a7 "u a gr\p heal?
 plan may be subject to cov]age limits  
7su* z m$ical necessity1                
pre-au?orization1 or pre-c]tification7 &
 co/-%>+ requirem5ts 7su* z co9surance1 
copaym5ts1 & d$uctibles71 z requir$ by !
 plan1 t are no m re/rictive ?an !      
pr$om9ant cov]age limits & co/-%>+      
requirem5ts1 respectively1 appli$ to    
sub/antially all m$ical & surgical      
b5efits cov]$ by ! plan4  7#c7 ,treatm5t
 def9$ ,9 ?is section3 7,a7 ,9 g5]al    
,except z provid$ 9 subp>agraph 7,b71 ! 
t]m treatm5t includes1 ) respect to a   
gr\p heal? plan1 inpati5t & outpati5t   
items & s]vices p]=m$ to improve1       
repair1 or re/ore bodily function 7or   
p]=m$ to approximate a normal           
appe>ance71 due to a crani(acial1 oral1 
or maxill(acial cong5ital anomaly or    

bir? defect1 & includes treatm5t to any 
& all miss+ or abnormal body p>ts       
7includ+ tee?1 ! oral cavity1 & _!      
associat$ /ructures7 t w\ld o!rwise be  
provid$ "u ! plan = any o!r injury or   
sickness1 includ+--  7i7 any items or   
s]vices1 includ+ inpati5t & outpati5t   
c>e1 recon/ructive s]vices & proc$ures1 
& complications !re(2  7ii7 adjunctive  
d5tal1 or?odontic1 or pro/hodontic      
support f bir? until ! m$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$ures t mat]ially 
improve1 repair1 or re/ore bodily       
function2 &  7iv7 proc$ures = second>y  
conditions & foll[-up treatm5t associat$
 ) ! und]ly+ crani(acial1 oral1 or      
maxill(acial cong5ital anomaly or bir?  
defect4  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 ,n lat] ?an "o ye> aft] ! date (
 ! enactm5t ( ?is section & annually    
!reaft]1 a gr\p heal? plan %all1 9      
accordance ) regulations or guidance    
issu$ by ! ,secret>y1 provide to ea*    
enrollee "u su* plan a writt5           
description ( ! t]ms ( ?is section4 ,su*
 description %all be 9 language :i* is  
und]/&able to ! typical enrollee4  4    
7#b7 ,cl]ical am5dm5t ,! table (        
sections = su* sub*apt] is am5d$ by add+
 at ! end ! foll[+ new item3  ,sec4     
#ihbf4 ,/&>ds relat+ to b5efits =       
crani(acial1 oral1 or maxill(acial      
cong5ital anomaly or bir? defect4  4    
7d7 ,rule ( con/ruction ,a gr\p heal?   
plan or heal? insurance issu] %all      
provide ! b5efits describ$ 9 section    
#bgii;,a-#aa ( ! ,public ,heal? ,s]vice 
,act 7z add$ by subsection 7a771 section
 #gbf ( ! ,employee ,retirem5t ,income  
,security ,act ( #aigd 7z add$ by       
subsection 7b771 & section #ihbf ( !    
,int]nal ,rev5ue ,code ( #aihf 7z add$  
by subsection 7c77 "u ! t]ms ( su* plan 

or heal? insurance cov]age (f]$ by su*  
issu]4  7e7 ,effective date ,! am5dm5ts 
made by ?is section %all apply ) respect
 to plan ye>s beg9n+ on or aft] ,janu>y 
#a1 #bjbd4