Ensuring Lasting Smiles Act
Bipartisan Bill Requires Insurance to Cover Reconstructive Surgery and Dental Work for Birth Defects
Legislative Progress
Key Points
- This bill requires health insurance companies to cover treatments for birth defects that affect how a person looks or how their body functions. It specifically targets issues with the eyes, ears, teeth, mouth, or jaw, such as a cleft lip or palate.
- Insurance plans would have to pay for reconstructive surgery, dental work, and braces if a doctor determines they are medically necessary to fix a birth defect. This prevents insurance companies from denying claims by calling these procedures "cosmetic."
- The policy makes sure families do not face unfair costs. Insurance companies cannot charge higher copays or deductibles for these treatments than they do for other standard medical or surgical services.
- These requirements would apply to most private and employer-sponsored health plans starting January 1, 2026. Plans would also be required to notify their members about these new coverage rules so they know what benefits are available.
- The government would study how well these rules are working by the end of 2027. This study will look at whether patients can find enough doctors to perform the surgeries and how much money families are saving on out-of-pocket costs.
Impact Analysis
Personal Impact
Life & Work
Small businesses that offer group health plans would be required to include coverage for congenital anomaly treatments. While this benefits employees and their families, it could slightly increase premiums for small employers, though the affected population is relatively small so premium impacts are expected to be modest.
Programs
Disabilities
Milestones
Committee on Health, Education, Labor, and Pensions. Hearings held.
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in Senate
The bill was officially filed and given a number. It now enters the legislative queue.
Votes
No votes have been recorded for this legislation yet.
Related News
3 articles
Bill would ensure health insurance covers needed treatment
Reports on the reintroduction of the Ensuring Lasting Smiles Act (ELSA) in the 119th Congress. The bill requires private health plans to cover reconstructive services and adjunctive dental or orthodontic support for individuals born with congenital anomalies or birth defects.
Ensuring Lasting Smiles Act Seeks to Ensure Coverage for Children Born with Congenital Anomalies or Birth Defects
Details the bipartisan legislation reintroduced by Senators Baldwin and Ernst. It explains that ELSA aims to ensure coverage for outpatient and inpatient services related to congenital anomalies affecting the eyes, ears, teeth, mouth, or jaw, specifically targeting insurance denials.
AAOMS seeks insurance coverage for congenital craniofacial anomalies
Discusses the advocacy efforts for the Ensuring Lasting Smiles Act, explaining that the bill would address delays and denials in coverage for patients with birth defects, including those covered by ERISA-regulated plans.
Source Information
Document Type
Congressional Bill
Official Title
Ensuring Lasting Smiles Act
Data Sources
Sponsor
Cosponsors
(46)Analysis generated by AI. Always verify with official sources.