[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4022 Introduced in House (IH)]







109th CONGRESS
  1st Session
                                H. R. 4022

    To require health insurance coverage for certain reconstructive 
                                surgery.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 7, 2005

   Mr. Ross introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
Education and the Workforce, for a period to be subsequently determined 
 by the Speaker, in each case for consideration of such provisions as 
        fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
    To require health insurance coverage for certain reconstructive 
                                surgery.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Reconstructive Surgery Act of 
2005''.

SEC. 2. COVERAGE OF RECONSTRUCTIVE SURGERY.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--
                    (A) In general.--Section 2706 of the Public Health 
                Service Act (42 U.S.C. 300gg-6) is amended to read as 
                follows:

``SEC. 2706. COVERAGE OF RECONSTRUCTIVE SURGERY.

    ``(a) Requirement.--A group health plan and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan that provides coverage for surgery shall provide 
coverage for reconstructive surgery, including medically-necessary 
treatment for pre-operative and post-operative care deemed necessary by 
the treating physician or team of physicians.
    ``(b) Definition.--In subsection (a), the term `reconstructive 
surgery' means any medically necessary and appropriate surgery 
performed to correct or repair abnormal structures of the body caused 
by congenital defects, developmental abnormalities, trauma, infection, 
tumors, or disease to--
            ``(1) improve functions; or
            ``(2) give the patient a normal appearance, to the extent 
        possible, in the judgment of the physician performing the 
        surgery.
    ``(c) Rule of Construction.--
            ``(1) In general.--Nothing in this section shall be 
        construed to require a group health plan or health insurance 
        issuer in connection with a group health plan to provide 
        coverage for cosmetic surgery.
            ``(2) Definition.--In paragraph (1), the term `cosmetic 
        surgery' means surgery that is performed to alter or reshape 
        normal structures of the body in order to improve 
        appearance.''.
                    (B) Conforming amendment.--Section 2723(c) of the 
                Public Health Service Act (42 U.S.C. 300gg-23(c)) is 
                amended by striking ``section 2704'' and inserting 
                ``sections 2704 and 2706''.
            (2) ERISA amendments.--
                    (A) In general.--Section 713 of the Employee 
                Retirement Income Security Act of 1974 (29 U.S.C. 
                1185b) is amended to read as follows:

``SEC. 713. COVERAGE FOR RECONSTRUCTIVE SURGERY.

    ``(a) Requirement.--A group health plan and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan that provides coverage for surgery shall provide 
coverage for reconstructive surgery, including medically-necessary 
treatment for pre-operative and post-operative care deemed necessary by 
the treating physician or team of physicians.
    ``(b) Definition.--In subsection (a), the term `reconstructive 
surgery' means any medically necessary and appropriate surgery 
performed to correct or repair abnormal structures of the body caused 
by congenital defects, developmental abnormalities, trauma, infection, 
tumors, or disease to--
            ``(1) improve functions; or
            ``(2) give the patient a normal appearance, to the extent 
        possible, in the judgment of the physician performing the 
        surgery.
    ``(c) Rule of Construction.--
            ``(1) In general.--Nothing in this section shall be 
        construed to require a group health plan or health insurance 
        issuer in connection with a group health plan to provide 
        coverage for cosmetic surgery.
            ``(2) Definition.--In paragraph (1), the term `cosmetic 
        surgery' means surgery that is performed to alter or reshape 
        normal structures of the body in order to improve 
        appearance.''.
                    (B) Conforming amendments.--
                            (i) Section 731(c) of such Act (29 U.S.C. 
                        1191(c)) is amended by striking ``section 711'' 
                        and inserting ``sections 711 and 713''.
                            (ii) Section 732(a) of such Act (29 U.S.C. 
                        1191a(a)) is amended by striking ``section 
                        711'' and inserting ``sections 711 and 713''.
                            (iii) The table of contents in section 1 of 
                        such Act is amended by inserting after the item 
                        relating to section 712 the following new item:

``Sec. 713. Coverage for reconstructive surgery.''.
    (b) Individual Market.--Section 2752 of the Public Health Service 
Act (42 U.S.C. 300gg-52) is amended to read as follows:

``SEC. 2752. COVERAGE FOR RECONSTRUCTIVE SURGERY.

    ``The provisions of section 2706 shall apply to health insurance 
coverage offered by a health insurance issuer in the individual market 
in the same manner as they apply to health insurance coverage offered 
by a health insurance issuer in connection with a group health plan in 
the small or large group market.''.
    (c) Effective Dates.--
            (1) Group health plans.--Subject to paragraph (3), the 
        amendments made by subsection (a) shall apply with respect to 
        group health plans for plan years beginning on or after January 
        1, 2006.
            (2) Health insurance coverage.--The amendment made by 
        subsection (b) shall apply with respect to health insurance 
        coverage offered, sold, issued, renewed, in effect, or operated 
        in the individual market on or after such date.
            (3) Collective bargaining agreements.--In the case of a 
        group health plan maintained pursuant to 1 or more collective 
        bargaining agreements between employee representatives and 1 or 
        more employers ratified before the date of enactment of this 
        Act, the amendments made by subsection (a) shall not apply to 
        plan years beginning before the later of--
                    (A) the date on which the last collective 
                bargaining agreements relating to the plan terminates 
                (determined without regard to any extension thereof 
                agreed to after the date of enactment of this Act), or
                    (B) January 1, 2006.
        For purposes of subparagraph (A), any plan amendment made 
        pursuant to a collective bargaining agreement relating to the 
        plan which amends the plan solely to conform to any requirement 
        added by subsection (a) shall not be treated as a termination 
        of such collective bargaining agreement.
    (d) Coordinated Regulations.--Section 104(1) of Health Insurance 
Portability and Accountability Act of 1996 (Public Law 104-191) is 
amended by striking ``this subtitle (and the amendments made by this 
subtitle and section 401)'' and inserting ``the provisions of part 7 of 
subtitle B of title I of the Employee Retirement Income Security Act of 
1974, and the provisions of parts A and C of title XXVII of the Public 
Health Service Act''.
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