Health Insurance: Mandatory Coverage for Craniofacial Birth Defects
This act mandates that health insurance plans cover the diagnosis and treatment of craniofacial, oral, or maxillofacial congenital anomalies. This means individuals with these conditions will have access to necessary procedures, including dental and orthodontic support, aimed at improving function or appearance, without fear of denial by their insurer.
Key points
Health insurers must cover diagnosis and treatment for craniofacial, oral, or maxillofacial birth defects.
Coverage includes medically necessary items and services to improve function or restore normal appearance, including dental, orthodontic, and prosthodontic support.
Cost-sharing and coverage limits for these treatments cannot be more restrictive than for other medical benefits.
The act specifically excludes cosmetic surgery performed solely to improve appearance or self-esteem, unrelated to a birth defect.
Health plans will be required to provide clear information to enrollees about these new coverage terms.
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