The Ensuring Lasting Smiles Act requires health insurance plans to cover diagnosis and treatment services for congenital anomalies and birth defects that affect the eyes, ears, teeth, mouth, or jaw. This includes reconstructive surgeries, dental work, orthodontic care, and follow-up treatment needed to restore normal function or appearance, as determined by a physician. The coverage applies to both group and individual health insurance plans, though insurers can still impose standard cost-sharing like copayments and deductibles similar to other medical services. The bill excludes purely cosmetic surgery on normal body structures. Insurance companies must notify beneficiaries about this coverage by January 1, 2026, and the requirements take effect for plan years beginning January 1, 2026. The Department of Health and Human Services must study whether there are enough qualified providers available under these plans and report to Congress by the end of 2027 on patient costs and accessibility.
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