A group of Democrats in the House and Senate sent a letter to Office of Personnel Management director Kiran Ahuja urging the Federal Employees Health Benefits Program (FEHB) to include coverage for infertility diagnosis and treatment.
According to the lawmakers, adding this coverage to the FEHB is “in our national interest” because it will allow “the Federal Government to recruit and retain the most effective Federal workforce.”
The letter cites a study which found that employees without infertility treatment coverage “often express dissatisfaction with employer-sponsored [health] coverage.”
They also said that “the choice to build a family is a fundamental right for all Americans” and consequently, “people should not have to take on substantial medical debt to grow a family.”
The letter also states that adding infertility coverage to the FEHB would help improve mental health of federal employees. “Evidence also indicates that coverage for such medical services also alleviates certain health conditions associated with fertility challenges, including depression, stress, and anxiety,” wrote the lawmakers.
OPM previously expressed interest in adding infertility treatment coverage to the FEHB earlier this year. OPM wrote in its annual benefit and rate proposals letter for 2023 from FEHB program carriers:
One in three workers aged 18 to 34 believe that fertility treatment should be included as a part of their employee benefits package, with almost half citing the high out-of-pocket cost of treatment as the main reason. Additionally, over the past five years there has been an upward trend for prevalence of infertility coverage among employers and increased activity at the state level, with the adoption of infertility insurance laws in nineteen states.
OPM is interested in supporting family building efforts for covered FEHB enrollees and their eligible family members. FEHB Carriers currently cover the diagnosis and treatment of infertility; however, more could be done to assist with the financial burden of ART [Assisted Reproductive Technology] treatment for those who may require it.
When more procedures are required to be covered under an insurance plan, this generally means that costs for providing the insurance will rise as well to pay for those procedures. As federal employees are undoubtedly aware, the cost of health insurance continues to rise at a steady pace every year. The table below shows the average premium increases that federal employees and retirees have to pay as well as the overall cost increases under FEHB for the last five years.
|Increase of Employees’ Share of Premiums
|Overall Average FEHB Cost Increase
The federal government pays for around 72% of the total cost of providing health insurance to federal employees and retirees, so that helps to minimize the costs borne by the individuals and their families covered by FEHB plans. According to OPM:
For most employees and annuitants, the Government contribution equals the lesser of: (1) 72 percent of amounts OPM determines are the program-wide weighted average of premiums in effect each year, for Self Only, Self Plus One and Self and Family enrollments, respectively, or (2) 75 percent of the total premium for the particular plan an enrollee selects.
The 2023 FEHB premiums will be announced in the fall in advance of the 2023 federal benefits open enrollment period.
Text of Letter Urging OPM to Add Infertility Coverage to FEHB
August 26, 2022
Dear Director Ahuja:
We write to express our support for the U.S. Office of Personnel Management’s (OPM) stated interest in expanding Federal medical coverage to include infertility diagnosis and treatment, which includes accessing assistive reproductive technology (ART), such as in vitro fertilization (IVF). It is in our national interest for the Federal Government to recruit and retain the most effective Federal workforce, and to do so, we must ensure federal health benefits cover the needs of working families. Providing medical coverage for ART services is critical to ensure Federal agencies can compete with the private sector for top talent and promote optimal health outcomes among their employees.
A survey commissioned by RESOLVE: The National Infertility Association found that one in every eight couples face challenges while conceiving, and that does not even include the many LGBTQ+ couples who may wish to utilize ART to start and grow families. The survey findings indicate that employees without infertility treatment coverage often express dissatisfaction with such employer-sponsored coverage. Moreover, in certain cases, this deficient health insurance coverage is a causal factor in individuals seeking new employment from organizations that do provide family-friendly coverage of infertility services, such as comprehensive access to ART.
The choice to build a family is a fundamental right for all Americans. People should not have to take on substantial medical debt to grow a family. Yet, despite the prevalence of infertility and diversity of family structures, the Federal Employee Health Benefits (FEHB) program – our Nation’s largest employer-sponsored group health insurance program – currently only offers limited infertility treatment, and it is often prohibitively expensive. We agree with your program call letter that, “more could be done to assist with the financial burden of ART treatment for those who may require it.” If negotiations for the 2023 cycle have completed, we urge you to ensure coverage of ART remains an FEHB benefit going forward.
The benefits of modernizing insurance coverage for employees seeking fertility treatment are not limited to retention. Evidence also indicates that coverage for such medical services also alleviates certain health conditions associated with fertility challenges, including depression, stress, and anxiety. In addition, employees may feel more valued by their employers, recommend the company to others based on such satisfaction, and boost productivity. Currently, 20 states require that state-regulated commercial plans cover infertility treatments. These productivity benefits help explain why many states and the private sector are leading in expanding availability of coverage for medical services addressing infertility.
Federal employees provide essential, often underappreciated, work that is necessary to keep our government functioning, and they should be provided access to affordable family planning services. OPM’s proposed modernization of the FEHB Program to urge insurance plans cover comprehensive ART services will ensure that our best civil servants will stay in public service and create and build their families. It will also empower the United States Government to lead by example and demonstrate the importance and benefits of family-friendly workplaces.
Providing all Federal Government employees with access to ART treatment, irrespective of an infertility diagnosis, would make family building more affordable and ensure the Federal Government remains a competitive employer. We strongly support the coverage of ART services in federal health care benefits and urge OPM to build on its efforts to ensure Federal employees can afford fertility treatments by requiring every FEHB program carrier to provide ART treatment coverage going forward.