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Adds new section 2799A–11 to Part D of title XXVII of the Public Health Service Act establishing coverage requirements for diagnosis and treatment of certain congenital anomalies or birth defects affecting the eyes, ears, teeth, mouth, or jaw.
Adds new section 726 to Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 establishing coverage requirements for certain congenital anomalies or birth defects.
Amends 29 U.S.C. 1191a(a) (section 732(a) of ERISA) by striking 'section 711' and inserting 'sections 711 and 726', thereby adding a citation to the newly added section 726.
Requires group health plans and health insurance issuers to cover outpatient and inpatient diagnosis and treatment for congenital anomalies or birth defects that primarily affect the appearance or function of the eyes, ears, teeth, mouth, or jaw, including reconstructive and related dental/orthodontic care. Plans must follow specified cost‑sharing rules, notify participants about the new coverage, and HHS must study network access and cost impacts. The coverage and notice requirements apply for plan years beginning on or after 2026‑01‑01; HHS must report by 2027‑12‑31.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced May 8, 2025 by Neal Patrick Dunn · Last progress May 8, 2025
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House