Senate BillS 1677Health care coverage and accessSurgery and anesthesia
Ensuring Lasting Smiles Act
INTRO MAY 8· LAST ACTION MAR 19
READING
12MIN
COSPONSORS
52BIPARTISAN
READER REACTIONS0 TOTAL
NO VOTES YET · BE THE FIRST
Introduced only
LEGISLATIVE PROGRESS
STEP 2 / 8
Introduced
In Committee
Reported
Passed Senate
Passed House
Conference
To President
Became Law
WHAT THE BILL DOES
AI-written
This bill matters because it addresses a significant gap in health insurance coverage that many families currently face. Often, treatments for severe congenital anomalies, especially those involving dental and oral structures, are deemed "cosmetic" by insurers, leaving families with substantial out-of-pocket costs for essential care. If this bill becomes law, it would ensure that medically necessary procedures to improve function and approximate a normal appearance for these birth defects are covered, reducing financial hardship for families.
Without this bill, many individuals with these conditions struggle to access comprehensive, affordable care throughout their lives, impacting their ability to eat, speak, and live with dignity. By mandating coverage, the bill aims to improve the quality of life, long-term health, and overall well-being for affected Americans, ensuring they receive the full scope of treatment needed from childhood into adulthood without financial ruin.
KEY PROVISIONS
5AI-extracted
PROVISION 01
Requires group and individual health insurance plans to cover diagnosis and treatment of congenital anomalies or birth defects affecting the eyes, ears, teeth, mouth, or jaw.
This ensures that essential medical care for specific birth defects is covered, addressing a common gap in insurance policies.
PROVISION 02
Mandates that patient cost-sharing for these treatments, such as deductibles or copayments, cannot be more restrictive than for other medical and surgical benefits.
This prevents insurance companies from placing disproportionately high financial burdens on families seeking care for these conditions.
PROVISION 03
Includes coverage for reconstructive services, procedures to restore normal function or appearance, and related adjunctive dental, orthodontic, or prosthodontic support.
This comprehensive coverage ensures that all necessary aspects of treatment, including often-excluded dental care, are provided for the entire duration of treatment.
PROVISION 04
Excludes purely cosmetic surgery not resulting from a medical determination of a congenital anomaly or birth defect.
This clarifies that the bill's intent is to cover medically necessary care, not elective cosmetic procedures.
PROVISION 05
Requires health plans to provide notice to participants and beneficiaries about this new coverage beginning January 1, 2026.
This ensures that affected individuals and families are aware of their new insurance benefits.
This bill matters because it addresses a significant gap in health insurance coverage that many families currently face. Often, treatments for severe congenital anomalies, especially those involving dental and oral structures, are deemed "cosmetic" by insurers, leaving families with substantial out-of-pocket costs for essential care. If this bill becomes law, it would ensure that medically necessary procedures to improve function and approximate a normal appearance for these birth defects are covered, reducing financial hardship for families.
Without this bill, many individuals with these conditions struggle to access comprehensive, affordable care throughout their lives, impacting their ability to eat, speak, and live with dignity. By mandating coverage, the bill aims to improve the quality of life, long-term health, and overall well-being for affected Americans, ensuring they receive the full scope of treatment needed from childhood into adulthood without financial ruin.
KEY PROVISIONS
AI-extracted
high
Requires group and individual health insurance plans to cover diagnosis and treatment of congenital anomalies or birth defects affecting the eyes, ears, teeth, mouth, or jaw.
This ensures that essential medical care for specific birth defects is covered, addressing a common gap in insurance policies.
high
Mandates that patient cost-sharing for these treatments, such as deductibles or copayments, cannot be more restrictive than for other medical and surgical benefits.
This prevents insurance companies from placing disproportionately high financial burdens on families seeking care for these conditions.
high
Includes coverage for reconstructive services, procedures to restore normal function or appearance, and related adjunctive dental, orthodontic, or prosthodontic support.
This comprehensive coverage ensures that all necessary aspects of treatment, including often-excluded dental care, are provided for the entire duration of treatment.
med
Excludes purely cosmetic surgery not resulting from a medical determination of a congenital anomaly or birth defect.
This clarifies that the bill's intent is to cover medically necessary care, not elective cosmetic procedures.
low
Requires health plans to provide notice to participants and beneficiaries about this new coverage beginning January 1, 2026.
This ensures that affected individuals and families are aware of their new insurance benefits.
Health plans must begin providing notice to participants and beneficiaries about the required coverage.
GLOSSARY
AI-written
Congenital anomaly or birth defect
A structural or functional problem that develops before birth, which can be identified at birth or later in life, and may affect physical, sensory, or cognitive abilities.
Group health plan
A health benefit package offered by an employer or employee organization to its employees or members.
Health insurance issuer
A company that offers health insurance policies to individuals or groups.
Outpatient services
Medical care received by a patient who is not admitted to a hospital for an overnight stay.
Inpatient services
Medical care received by a patient who is admitted to a hospital for at least one overnight stay.
Cost-sharing requirements
The portion of healthcare costs that a patient is responsible for, such as copayments, deductibles, or coinsurance.
Reconstructive treatment
Surgery or procedures performed to improve, repair, or restore a body part to achieve normal function or appearance, or to approximate a normal appearance.
ACTION TIMELINE
3 EVENTS
MAR 19
Committee on Health, Education, Labor, and Pensions. Hearings held.
COMMITTEE
MAY 8, 25
Introduced in Senate
INTROREFERRAL
MAY 8, 25
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Adjunctive dental, orthodontic, or prosthodontic support
Supportive dental care, teeth straightening, or artificial tooth replacement services that are necessary alongside medical or surgical treatment for a birth defect.
