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Congress·In Committee

Bipartisan Bill Requires Insurance to Cover Reconstructive Surgery and Dental Work for Birth Defects

Ensuring Lasting Smiles Act

Also known as: Ensuring Lasting Smiles Act

10 months ago·View on Congress.gov

Legislative Progress

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Senate
House
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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.
Healthcare

Impact Analysis

Scores: 1 = low, 5 = highSentiment: -5 to +5 (net benefit)

Milestones

2 milestones2 actions
May 8, 2025Senate

Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

May 8, 2025

Introduced in Senate

What Happens Next

Projected impacts based on AI analysis

2026-01-01

New coverage requirements take effect for health plans

If enacted, group and individual health insurance plans must begin covering diagnosis and treatment of congenital anomalies affecting the eyes, ears, teeth, mouth, or jaw starting with plan years beginning on or after January 1, 2026. Insurers must also notify members about these new benefits.

Related News

3 articles
American Dental Association News·10 months ago

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.

C=
Academy of General Dentistry·10 months ago

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.

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Dental Tribune·10 months ago

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.

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Source Information

Document Type

Congressional Bill

Official Title

Ensuring Lasting Smiles Act

Bill NumberS 1677
Congress119th Congress
ChamberSenate
Latest ActionRead twice and referred to the Committee on Health, Education, Labor, and Pensions.

Sponsor

Cosponsors

(42)
D: 27R: 14I: 1

Analysis generated by AI. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.