Ensuring Lasting Smiles Act

This bill would require group health plans and health insurers selling group or individual coverage to cover outpatient and inpatient care for diagnosing and treating birth defects that mainly affect the eyes, ears, teeth, mouth, or jaw. Covered care would include reconstructive procedures, related dental, orthodontic, and prosthodontic support, and follow-up treatment, when a treating physician finds it medically necessary. Cost-sharing for this care could not be more restrictive than for most other medical and surgical benefits, and cosmetic surgery on normal body structures would not be covered. Plans would have to notify members of this coverage, and the Department of Health and Human Services would report to Congress by the end of 2027 on provider networks and patient costs. The rules would apply to plan years starting on or after January 1, 2026.

Full text and official record on Congress.gov

Sponsors

• Tammy Baldwin Democrat sponsor
• 54 cosponsors