MA H5041

Mandates health insurance coverage for medically necessary functional repair or restoration of craniofacial disorders caused by congenital disease or anomaly, including ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta

Applies to multiple insurance types: Group Insurance Commission plans for state employees, MassHealth, commercial insurers, hospital service plans (Blue Cross), medical service plans (Blue Shield), HMOs, and preferred provider organizations

Excludes coverage for cleft lip and cleft palate (already covered under existing law), purely cosmetic surgery, and dental or orthodontic treatment unrelated to the congenital condition

Prohibits insurers from imposing higher deductibles, coinsurance, copayments, or out-of-pocket limits for these benefits compared to other covered services

Amends seven chapters of Massachusetts General Laws (32A, 118E, 175, 176A, 176B, 176G, and 176I) to ensure comprehensive coverage across all regulated insurance markets