The Federal Employees Health Benefits (FEHB) program would be required to cover in-vitro fertilization (IVF) and other assisted reproductive technology (ART) under new legislation introduced in Congress.
The Family Building FEHB Fairness Act was introduced in the Senate (S. 1262) by Senator Tammy Duckworth (D-IL) and in the House (H.R. 2828) by Congressman Gerry Connolly (D-VA).
If either bill were to become law as currently written, the Office of Personnel Management would be required to ensure that health insurance companies participating in the FEHB begin covering the infertility procedures within one year.
Connolly and Duckworth are among the group of lawmakers who sent a letter to OPM last year pushing OPM to mandate infertility treatment coverage for federal employees under the FEHB. The agency apparently isn’t making it happen quickly enough for their liking, so they felt the legislation was necessary to move the process forward. A press release about the bill states, “OPM has made incremental progress since then [August 2022], but much more remains to be done. Only 19 FEHB plans currently offer some level ART coverage, and these plans vary greatly in terms of which specific services and treatments are included.”
In what seems like a paradox, Duckworth is a self-described “fierce advocate” for not only infertility services but also abortion. Her press release states:
Duckworth is a fierce advocate in protecting women’s right to access the reproductive healthcare they need, including IVF and other forms of ART. Recently, Duckworth re-introduced the Equal Access to Abortion Coverage in Health Insurance (EACH) Act, a bicameral bill that would help end the Hyde Amendment and lifts unjust abortion coverage restrictions for those who depend on Medicaid and other government-sponsored plans or programs. Duckworth also helped introduce the Women’s Health Protection Act of 2023, federal legislation to guarantee access to abortion everywhere across the country and restore the right to comprehensive reproductive healthcare for millions of Americans.
For reference on the Hyde Amendment, according to the Congressional Research Service, “A significant effect of the Hyde Amendment is that it restricts federally funded abortions under major federal health care programs, such as Medicaid, a cooperative federal-state program that provides medical benefits assistance to low-income individuals, and Medicare, which provides health coverage not only for certain elderly individuals, but also certain disabled individuals under 65.”
However, in addition to the new bill that would require infertility treatments under the FEHB, the press release also touts a similar bill that would apply to all Americans:
Last year, Duckworth also introduced the Right to Build Families Act of 2022, which would protect every American’s right to access IVF and other ART —regardless of their zip code.
Duckworth affirmed her support for both abortion and infertility treatments in a statement about the new legislation in which she said they both fall under the heading of “basic reproductive freedoms”:
With Roe v. Wade thrown out by the Supreme Court and Republicans actively working to roll back basic reproductive freedoms, many Americans—including those who may have trouble getting pregnant—are understandably worried about their access to IVF and other assisted reproductive technology that they need to start or grow their families. Without the miracle of IVF, I wouldn’t have my two beautiful baby girls. And so, today, I’m proud to introduce bipartisan legislation with Congressman Connolly that would help make sure others like me have access to IVF and other assisted reproductive technology through the Federal Employees Health Benefits (FEHB) Program—the largest employer-sponsored health insurance plan in the world—so they can have the chance to experience all the joys of parenthood if and when they want to.
FEHB Premiums On the Rise
FEHB premium increases have been going up substantially as evidenced by the 7.2% overall average increase in FEHB premiums for 2023. The employees’ share of premiums increased even more, rising an average of 8.7% for 2023.
OPM blamed the increases on COVID-19, but with the list of services and procedures that FEHB carriers have to provide growing longer all the time, this no doubt also puts an upward strain on premiums.
In 2023 for example, OPM touted a number of “enhanced benefits services” available under FEHB such as treatment for gender dysphoria, gender-affirming care and services, ART services, and anti-obesity medications.
For 2024, OPM says that it “is continuing to emphasize the importance of Gender Affirming Care and Services, Maternal Health, Prevention and Treatment of Obesity, and Mental Health and Substance Use Disorders.”
In fact, the agency is stepping up its push to expand infertility coverage under the FEHB by going from encouraging to requiring procedures in some cases. OPM lists these requirements for FEHB carriers in 2024:
- Carriers are required to provide coverage of artificial insemination (intrauterine insemination, intracervical insemination, and intravaginal insemination). This requirement to cover artificial insemination does not include a requirement to cover donor sperm.
- Carriers are required to cover drugs associated with artificial insemination procedures.
- Carriers are required to cover the cost of IVF-related drugs for three cycles annually to defray the overall cost of IVF cycles for FEHB enrollees.
- The 2015 Call Letter and supporting 2015 Technical Guidance stated that brochures should include a definition of infertility and clearly describe how members qualify for any available diagnostic and therapeutic infertility benefits. Currently, many brochures do not make the plan’s definition of infertility and qualifications for these benefits easily apparent. Carriers must provide a definition of infertility and qualifications for these benefits in an easily accessible manner in their brochure, website, and other consumer-facing materials.
- Applicable medical policy related to infertility coverage must also be easily accessible to members on each Carrier’s website.
The table below lists the average total annual FEHB premium increases since 2009:
|Year||Average Increase (%)|
The federal government pays for about 70% of the total cost of providing health insurance while federal employees pay the other 30%, so even with premiums steadily increasing, it remains a valuable benefit that helps to minimize the costs borne by the individuals.