Ensuring Lasting Smiles Act

IntroducedN/A

Introduced7 months ago

Intro

Senate

House

Pres

Committee on Health, Education, Labor, and Pensions. Hearings held.

HealthBirth defectsChild healthDental careGovernment studies and investigationsHealth care costs and insuranceHealth care coverage and accessHome and outpatient careHospital careSurgery and anesthesia

Why This Matters

The Ensuring Lasting Smiles Act requires health plans to cover treatment and related services for congenital anomalies or birth defects that affect the eyes, ears, teeth, mouth, or jaw. It sets rules for cost-sharing and requires plans to notify participants by January 1, 2026.

Who this affects

employer-sponsored health plans · individual health insurance plans · individuals with congenital anomalies

What changes is this bill making?

1Group and individual health plans must cover outpatient and inpatient services for diagnosis and treatment of congenital anomalies or birth defects impacting appearance or function of the eyes, ears, teeth, mouth, or jaw.
2Covered services include reconstructive surgery, dental, orthodontic, and prosthodontic support from birth until treatment is complete, plus follow-up care for related secondary conditions.
3Cost-sharing requirements such as coinsurance, copayments, and deductibles must be no more restrictive than those for other medical and surgical benefits.
4Cosmetic surgery on normal structures to improve appearance or self-esteem is not covered unless medically necessary for a congenital anomaly or birth defect.
5Plans must send notice to participants and beneficiaries about the new coverage requirements by January 1, 2026.
6The Secretary of Health and Human Services will study provider network adequacy and patient out-of-pocket costs and report to Congress by December 31, 2027.
7These requirements apply to plan years beginning on or after January 1, 2026.

Read full document

Last changed 1 month ago · checked hourly

Ensuring Lasting Smiles Act

IntroducedN/A

Introduced7 months ago

Intro

Senate

House

Pres

Committee on Health, Education, Labor, and Pensions. Hearings held.

Why This Matters

Who this affects

employer-sponsored health plans · individual health insurance plans · individuals with congenital anomalies

What changes is this bill making?

1Group and individual health plans must cover outpatient and inpatient services for diagnosis and treatment of congenital anomalies or birth defects impacting appearance or function of the eyes, ears, teeth, mouth, or jaw.
2Covered services include reconstructive surgery, dental, orthodontic, and prosthodontic support from birth until treatment is complete, plus follow-up care for related secondary conditions.
3Cost-sharing requirements such as coinsurance, copayments, and deductibles must be no more restrictive than those for other medical and surgical benefits.
4Cosmetic surgery on normal structures to improve appearance or self-esteem is not covered unless medically necessary for a congenital anomaly or birth defect.
5Plans must send notice to participants and beneficiaries about the new coverage requirements by January 1, 2026.
6The Secretary of Health and Human Services will study provider network adequacy and patient out-of-pocket costs and report to Congress by December 31, 2027.
7These requirements apply to plan years beginning on or after January 1, 2026.

Read full document

Last changed 1 month ago · checked hourly