Health Insurance: Mandatory Coverage for Congenital Anomalies
New regulations mandate health insurers to cover the diagnosis and treatment of congenital anomalies affecting the eyes, ears, teeth, mouth, or jaw. This means families with children born with such conditions will have better access to necessary medical procedures, including reconstructive and dental treatments, potentially easing their financial burden.
Key points
Health insurers must cover diagnosis and treatment of congenital anomalies impacting eyes, ears, teeth, mouth, or jaw.
This includes reconstructive, dental, orthodontic, and prosthodontic services if medically necessary.
Patient out-of-pocket costs (e.g., co-pays) cannot be more restrictive than for other medical benefits.
Insurers must provide notice of this new coverage starting January 1, 2026.
The act does not cover cosmetic surgery performed solely for appearance or self-esteem, if not due to a birth defect.
Introduced
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