# Ensuring Lasting Smiles Act - Plain Language Summary

## What This Bill Does

The "Ensuring Lasting Smiles Act" requires health insurance companies to cover medical and surgical treatments for birth defects and congenital anomalies (conditions present from birth) that affect the eyes, ears, teeth, mouth, or jaw. Currently, many insurance plans exclude or limit coverage for these treatments, particularly dental and reconstructive procedures. This bill would mandate that insurers cover diagnostic services, surgical repairs, reconstructive procedures, and follow-up care needed to restore normal function or appearance—as long as a doctor determines the treatment is medically necessary.

## Who Benefits

The primary beneficiaries are children and adults born with conditions like cleft palate, cleft lip, missing teeth, jaw abnormalities, and other structural birth defects affecting facial features or function. This bill would ensure they can access necessary treatments without insurance companies denying coverage based on exclusions for "cosmetic" or "dental" services. Families would no longer face the burden of paying out-of-pocket for treatments that restore normal function and appearance.

## Key Provisions

- **Coverage requirement**: Insurance plans must cover treatment and diagnosis of birth defects affecting the eyes, ears, teeth, mouth, or jaw
- **Scope includes**: Reconstructive surgery, dental work, orthodontics, and ongoing care to maintain function—even if the plan normally excludes dental coverage
- **Cost-sharing**: Insurance companies can still charge copays and deductibles, but at the same rates as other medical procedures
- **Exclusion**: The bill does NOT cover cosmetic surgery on normal body structures performed solely for appearance or self-esteem
- **Implementation**: Insurance companies must notify patients about this coverage by January 1, 2026