Ensuring Lasting Smiles Act
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed House
- Passed Senate
- To President
- Became Law
Overview
The Ensuring Lasting Smiles Act aims to expand health insurance coverage for individuals affected by congenital anomalies or birth defects. Specifically, it mandates that group health plans and health insurance issuers cover outpatient and inpatient services related to the diagnosis and treatment of conditions primarily impacting the eyes, ears, teeth, mouth, or jaw. The act also includes provisions for reconstructive treatments, adjunctive dental care, and follow-up treatment, while excluding coverage for purely cosmetic surgery not linked to a medical determination of the anomaly.
Key provisions
- Requires group health plans and health insurance issuers to cover outpatient and inpatient services for congenital anomalies or birth defects impacting the eyes, ears, teeth, mouth, or jaw.
- Covers reconstructive services, adjunctive dental, orthodontic, or prosthodontic support, and related complications.
- Excludes coverage for purely cosmetic surgery not resulting from a medical determination of the anomaly.
- Establishes a notice requirement for plans and issuers to inform participants and beneficiaries about the expanded coverage.
- Defines ‘congenital anomaly or birth defect’ broadly, encompassing various causes and manifestations.
- Includes amendments to the Public Health Service Act, ERISA, and the Internal Revenue Code to implement the coverage changes.
- Requires a study and report on network adequacy and potential cost changes related to the new coverage.
Who is affected
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