An Act relative to ensuring treatment for genetic craniofacial conditions

This bill (H 5041) requires all health insurance plans covering specific groups in Massachusetts to provide coverage for medically necessary treatment of three genetic craniofacial conditions: ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. It mandates coverage for functional repair or restoration of craniofacial disorders caused by congenital conditions, excluding cosmetic procedures, unrelated dental work, and cleft lip/palate (which is covered under separate provisions). The coverage must not impose higher deductibles, copays, or out-of-pocket limits than other benefits in the plan. It applies to group insurance for state employees, state health division programs, private health insurance policies, hospital service plans, and health maintenance organizations. The bill does not create new benefits but ensures existing plans cover these specific conditions equally with other medical treatments.