A bill to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans provide coverage for treatment of a minor child's congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease.
Treatment of Children's Deformities Act of 2005 - Amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code to require a group health plan, and a health issuer offering group health insurance coverage, that cover surgical benefits to also cover outpatient and inpatient diagnosis and treatment of a child's congenital or developmental deformity, disease, or injury. Requires that such coverage: (1) be subject to pre-authorization or pre-certification requirements of the plan or issuer; and (2) include any surgical treatment deemed by the treating physician to be medically necessary to approximate a normal appearance. Defines "treatment" to include reconstructive surgical procedures that are performed on abnormal structures of the body caused by congenital defects, abnormalities, trauma, infection, tumors, or disease, including: (1) procedures that do not materially affect the function of the body part being treated; and (2) procedures for secondary conditions and follow-up treatment. Excludes cosmetic surgery performed to reshape normal structures of the body to improve appearance or self-esteem.
Referred to the Subcommittee on Employer-Employee Relations.
Introduced in Senate
Sponsor introductory remarks on measure. (CR S6028)
Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR S6028-6029)
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