Bill would mandate Washington health plans to cover costs of fertility services

Senators discussed a bill that would mandate Washington health plans to cover the costs of fertility services during a Senate Health & Long Term Care Committee meeting on Friday.

 

 

Committee staffer Greg Attanasio said Senate Bill 5204 would mandate coverage for the diagnosis of infertility, treatment for infertility, and standard fertility preservation services beginning on Jan. 1st, 2025.

“The coverage must include four complete oocyte retrievals and unlimited embryo transfers,” Attanasio said.

The Department of Health completed a mandated benefit sunrise review for a proposal mandating coverage for fertility services in 2021. The proposal required health plans, including plans offered to public employees, to provide coverage for the diagnosis of infertility, treatment for infertility, and standard fertility preservation services. 

“DOH found that health plans generally did not include coverage for these treatments, and out-of-pocket costs for these services were generally very expensive,” Attanasio said. “The (mandated benefit) would likely increase the cost to the state, health carriers, and enrollees, but may decrease out-of-pocket costs for patients, and allow for better quality of care and informed decision making.”

Dr. Lori Marshall, medical director at Pacific Northwest Fertility, testified in support of SB 5204.

“Every leading healthcare organization now recognizes infertility as a disease, and does not consider it to be elective,” Marshall said. “Diseases should be covered by insurance. Despite this, millions of Washingtonians pay insurance premiums for plans that cover neither the diagnosis nor the standard treatment of this disease.”

Five new states have passed legislation mandating fertility coverage in the past five years, while others have had mandates in place for decades, Marshall said. 

Marshall said most of her clinic’s patients do not need in vitro fertilization (IVF), a complex series of procedures used to help with fertility, prevent genetic problems, and assist with the conception of a child. 

“But many delay seeing a doctor because they don’t have fertility coverage,” she said. “And that delay results in a greater likelihood that they will need more invasive treatments. When IVF is needed, outcomes are better for insured patients because they are more likely to choose a single embryo transfer. This lowers the number of twins and triplets, which results in huge savings for insurance carriers, as well as healthier mothers and babies.”

Without a state mandate in place, a patient’s ability to build a family depends on their ability to pay for services, Marshall said. 

“On a daily basis, I witness this inequality,” she said. “Teachers and nurses can’t have children because they don’t have fertility coverage. I’ve waited 30 years for a bill like this to help my patients.”

Jennifer Ziegler, a lobbyist for the Association of Washington Healthcare Plans, testified in opposition to SB 5204. 

“Our opposition to this bill is based on our request for you to not evaluate any individual proposal in isolation, but really look at them together to determine the cumulative impact,” Ziegler said.

The 2022 supplemental operating budget included a provision that required the insurance commissioner, in consultation with the Health Care Authority, to complete an analysis of the cost to implement a fertility treatment benefit. That report is due to lawmakers on June 30th.

“The only other thing we would ask, on this particular piece of legislation, is that you all did pass a budget last year that required additional analysis related to this process, in particular potential premium impacts,” Ziegler said. “That analysis is due back to you on June 30th. So we’d ask you to wait for that complete analysis from the insurance commissioner’s office before making a statutory decision.”

A total of 641 people signed into the meeting to record their stance on the issue without testifying, with 606 supporting the bill and 35 opposing it. No action was taken on the bill, and it remains in committee.