FEHB enrollees will see more choices for comprehensive IVF coverage in 2025

Federal employees looking to grow their families will soon see more options in the Federal Employees Health Benefits (FEHB) program to help cover the costs of fertility treatments.

Beginning in plan year 2025, two FEHB carriers — Blue Cross Blue Shield and GEHA — will offer a nationwide plan option with “comprehensive” coverage of in vitro fertilization (IVF), the Office of Personnel Management announced Wednesday.

“The Biden-Harris administration believes that every woman should have the right to make the decision to have a child,” Jennifer Klein, director of the White House Gender Policy Council, told reporters on a press call Wednesday morning. “We know that about one in five American women struggle with infertility, and many rely on IVF. The right to access fertility treatment is a basic issue of reproductive freedom.”

Specifically, Blue Cross Blue Shield and GEHA will each have a plan option available in 2025 that will include $25,000 to cover the costs of IVF. Blue Cross Blue Shield began offering the $25,000 IVF benefit for the 2024 plan year, while GEHA’s will be new for plan year 2025. The addition of a second nationwide option means federal employees looking to grow their family now have a choice in their plan, if they are seeking that more comprehensive coverage.

“Critically, every FEHB enrollee, regardless of where they live, the agency for which they work or the job they hold, will now have a choice of multiple nationwide plans that offer comprehensive IVF coverage,” OPM Acting Director Rob Shriver told reporters Wednesday.

The $25,000 benefit comes on top of the baseline coverage for artificial insemination and related drugs, as well as IVF medications for three cycles of treatment, which OPM began requiring carriers to offer earlier this year. OPM additionally set higher requirements for carriers to provide mental health support, gender-affirming care and obesity treatments in FEHB plans for 2024.

Beginning in 2025, feds working or living in a combined total of 13 states, regions and territories will also see more options for higher IVF coverage: California, Colorado, Hawaii, Illinois, Maryland, Michigan, New Mexico, New York, Pennsylvania, Texas, Utah, Virginia, Washington, D.C., Guam, Puerto Rico and the U.S. Virgin Islands.

In all, there will be 45 plan options, across 25 different plans, offering IVF coverage above OPM’s baseline requirements for carriers for plan year 2025. A senior administration official told reporters that the expanded IVF coverage through FEHB is in part the result of OPM negotiating with carriers over the last year and encouraging them to go above and beyond OPM’s baseline coverage requirements for fertility treatments.

The expanded fertility coverage options in FEHB will also extend to new Postal enrollees in the Postal Service Health Benefits (PSHB) program. On top of the two nationwide FEHB plans, Postal enrollees will have an additional nationwide option through Rural Letter Carriers that will offer “enhanced” IVF coverage, OPM said.

Younger generations of feds

Access to fertility treatments appears to be especially important for younger generations of federal employees, and may have influence over their recruitment and retention, according to the results of OPM’s latest Federal Employee Benefits Survey (FEBS). In the 2023 FEBS, two-thirds of survey respondents agreed that fertility benefits should be available through FEHB.

“That number increases to 76% of people when you focus on those who were born after 1981, who would be most likely to use fertility benefits,” Shriver said. “For those of you who have experienced the pain and heartbreak of fertility challenges, just as my wife and I have, these survey results are not surprising. We want to be sure that people who are considering working for the federal government know that we are on your side, and we can help make your dreams come true of becoming parents.”

Democratic lawmakers have also been pushing to codify further coverage of IVF in FEHB through the Right to IVF Act, introduced earlier this month. Rep. Gerry Connolly (D-Va.), one of the co-sponsors of the legislation, called OPM’s announcement a “monumental improvement” to IVF coverage.

“Providing federal employees with options to start and grow their families will in turn help the government recruit and retain the federal workforce of the future,” Connolly said in a statement Wednesday. “Federal employees, like every American, must have the right to start and build a family on their own terms.”

IVF costs

Over the past year, organizations including the Department of Justice Gender Equality Network (DOJ GEN) have called for further coverage of fertility treatments through FEHB. While OPM’s baseline requirements do help with the cost of medications, individuals looking to start a family will often spend tens of thousands of dollars out of pocket on IVF procedures and other related costs. The medications related to IVF account for just about a third of the overall cost of the treatment.

In testimonials that DOJ GEN collected earlier this year, some federal employees said they paid $30,000 or $40,000 out of pocket on IVF, while others said they spent up to $70,000 or even more. Due to the financial challenges, several employees said they either left or thought about leaving a federal job to try to get better IVF coverage in the private sector or elsewhere.

“We applaud President Biden, Vice President Harris and OPM for being leaders on IVF by significantly expanding federal employees’ access to it,” Stacey Young, president of DOJ GEN, said in a statement to Federal News Network. “DOJ GEN and its members — many of whom have used IVF or may need to in the future — will continue pushing Congress to create a permanent mandate requiring all FEHB plans to cover IVF treatments by passing the Right to IVF Act.”

Federal employees interested in changing their health plan options for 2025 will be able to do so during Open Season this fall. This year’s open enrollment period runs from Nov. 11 to Dec. 9.

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