Ensuring Lasting Smiles Act

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.