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Birth Defect Insurance: New Coverage Rules for Treatment Costs

This act aims to ensure that health insurance plans cover the costs of treating congenital anomalies that affect the appearance or function of the eyes, ears, teeth, mouth, or jaw. This means individuals with such conditions will have easier access to necessary medical procedures, including reconstructive and dental treatments, without fear of their insurer not covering the costs. The act is set to take effect on January 1, 2026.
Key points
Health insurers must cover the costs of treating congenital anomalies affecting eyes, ears, teeth, mouth, or jaw.
This includes reconstructive, dental, orthodontic, and prosthodontic procedures if medically necessary.
Patient out-of-pocket costs (e.g., co-pays) cannot be higher than for other medical benefits.
Insurers must provide notice of this new coverage by January 1, 2026.
The act does not cover cosmetic surgery performed solely for appearance improvement if not due to a birth defect.
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Introduced
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Additional Information
Print number: 119_HR_3277
Sponsor: Rep. Dunn, Neal P. [R-FL-2]
Process start date: 2025-05-08
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Summarized by: gemini-2.5-flash-preview-05-20
Source data: api.congress.gov
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OFFICIAL LEGAL TITLE

Ensuring Lasting Smiles Act

FREQUENTLY ASKED QUESTIONS

What is the official ID of this bill?

The official print number for this legislation is 119_HR_3277.

Which chamber initiated this legislation?

This legislation was initiated in the House of Representatives.

When did the legislative process begin?

The process officially started on 2025-05-08.

What are the main provisions?

Key points include:

  • Health insurers must cover the costs of treating congenital anomalies affecting eyes, ears, teeth, mouth, or jaw.
  • This includes reconstructive, dental, orthodontic, and prosthodontic procedures if medically necessary.
  • Patient out-of-pocket costs (e.g., co-pays) cannot be higher than for other medical benefits.
  • Insurers must provide notice of this new coverage by January 1, 2026.
  • The act does not cover cosmetic surgery performed solely for appearance improvement if not due to a birth defect.
What is the specific legal status?

The current status is Introduced.

Where can I read the full text of this legislation?

The full official text is available at: View full text

Who is the primary sponsor?

The primary sponsor is Rep. Dunn, Neal P. [R-FL-2].

What is the latest detailed status?

The latest detailed status is: Introduced in House

Is this summary verified?

Yes. This content was analyzed by AI and verified by the Lustra Judge System on 2025-12-22.

CATEGORIES

Health