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The Ensuring Lasting Smiles Act requires group health plans and health insurance issuers to cover outpatient and inpatient services for diagnosing and treating congenital anomalies or birth defects affecting the eyes, ears, teeth, mouth, or jaw. Coverage includes reconstructive procedures, dental and orthodontic support, and follow-up treatment to restore normal function or appearance, as determined medically necessary by a treating physician. Cost-sharing for these services cannot be more restrictive than cost-sharing for other medical and surgical benefits. The bill excludes purely cosmetic surgery unrelated to a congenital anomaly or birth defect.
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