,,ii  #aag? ,,congress  #a/ ,session    
,s4 #ged  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #af1 #bjba,ms4    
,baldw9 7= h]self1 ,ms4 ,ern/1 ,mr4     
,br[n1 ,ms4 ,murk[ski1 ,ms4 ,klobu*>1   
,mr4 ,m>%all1 ,mrs4 ,%ahe51 ,mr4 ,wick]1
 ,mr4 ,:iteh\se1 ,mr4 ,tillis1 ,ms4     
,/ab5[1 ,mr4 ,cram]1 ,mr4 ,van ,holl51  
,mr4 ,boozman1 ,mr4 ,pet]s1 ,ms4        
,coll9s1 ,mr4 ,m>key1 ,mrs4 ,capito1    
,mr4 ,book]1 ,mr4 ,graham1 ,ms4 ,smi?1  
,mr4 ,grassley1 ,ms4 ,s9ema1 ,mr4       
,moran1 ,mr4 ,murphy1 ,mr4 ,da9es1 ,mr4 
,blum5?al1 ,mr4 ,braun1 & ,mr4 ,re$7    
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to provide heal? insurance  
b5efits = outpati5t & inpati5t items &  
s]vices relat$ to ! diagnosis & 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 ,"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 =
 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    
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 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 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+ 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 ,a gr\p heal? plan "u ?is "p    
%all comply ) ! notice requirem5t "u    
section #gad7;c7 ( ! ,employee          

,retirem5t ,income ,security ,act (     
#aigd ) respect to ! requirem5ts ( ?is  
section z if su* section appli$ to su*  
plan4  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 = 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    
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 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 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+ 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 ,a gr\p heal? plan "u ?is "p    

%all comply ) ! notice requirem5t "u    
section #gad7;c7 ) respect to !         
requirem5ts ( ?is section z if su*      
section appli$ to su* plan4  4  7#b7    
,te*nical am5dm5ts  7,a7 ,section       
#gcb7;a7 ( su* ,act 7#bi ,u4,s4,c4      
#aaia;a7a77 is am5d$ by /rik+ section   
#gaa & ins]t+ sections #gaa & #gbf4     
7,b7 ,! 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 = 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 ( 
#aihf is am5d$ by add+ at ! end !       
foll[+3  #ihbf4 ,/&>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?  
plan %all provide cov]age = outpati5t & 
inpati5t items & s]vices relat$ to !    
diagnosis & treatm5t ( a 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 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 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+ 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 ,a gr\p heal? plan "u ?is "p    
%all comply ) ! notice requirem5t "u    
section #gad7;c7 ( ! ,employee          
,retirem5t ,income ,security ,act (     
#aigd ) respect to ! requirem5ts ( ?is  
section z if su* section appli$ to su*  
plan4  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 =       
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 ,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 #bgii;,a-#aa 7relat+ to /&>ds  
relat+ to b5efits = cong5ital anomaly or
 bir? defect71 z add$ by section #b7;a7 
( ! ,ensur+ ,la/+ ,smiles ,act4  4  7f7 
,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 #bjbb1 & ) 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   
7g7 ,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 ,a1   
,c1 & ,d ( title ,,xxvii ( ! ,public    
,heal? ,s]vice ,act1 & *apt] #ajj ( !   
,int]nal ,rev5ue ,code ( #aihf4