Lawmakers seek OPM update on plans to expand infertility coverage for federal employees

Democratic lawmakers are urging the Office of Personnel Management to follow through on its plans to expand federal employees’ medical coverage to cover infer...

Democratic lawmakers are urging the Office of Personnel Management to follow through on its plans to expand federal employees’ medical coverage to cover infertility diagnoses and treatments.

Sen. Tammy Duckworth (D-Ill.) and Government Operations Subcommittee Chairman Gerry Connolly (D-Va.) urged OPM in a letter last week to ensure all Federal Employee Health Benefits (FEHB) program carriers provide coverage for assistive reproductive technology (ART), which includes in vitro fertilization (IVF), starting in 2023.

The lawmakers’ letter to OPM follows up on the agency’s goal to expand fertility benefits earlier this year, as part of a broader campaign of advancing diversity, equity and inclusion goals across the federal workforce.

The lawmakers said the FEHB program currently offers limited infertility treatment, and it is often “prohibitively expensive.”

“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,” lawmakers wrote in their letter to OPM Director Kiran Ahuja. “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.”

Duckworth and Connolly led the letter, which was also signed by Sens. Chris Van Hollen (D-Md.), Kirsten Gillibrand (D-N.Y.), Cory Booker (D-N.J.) and Mazie Hirono (D-Hawaii).

The letter was also signed by Reps. Nydia Velazquez (D-N.Y.), Susan Wild (D-Pa.), Donald Payne Jr. (D-N.J.), Troy Carter (D-La.), Karen Bass (D-Calif.), Eleanor Holmes Norton (D-D.C.), Mike Doyle (D-Pa.), Stephen Lynch (D-Mass.), David Trone (D-Md.), Emanuel Cleaver (D-Mo.), Jamie Raskin (D-Md.), Derek Kilmer (D-Wash.), Jennifer Wexton (D-Va.), Chrissy Houlahan (D-Pa.), Colin Allred (D-Texas), John Larson (D-Conn), Judy Chu (D-Calif.) and David Cicilline (D-R.I.)

The lawmakers cited a survey from RESOLVE: The National Infertility Association, which found one in every eight couples faces challenges while conceiving. They said those figures don’t include many LGBTQ couples who may seek fertility treatments to start a family.

“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,” lawmakers wrote.

The congressional letter follows up on health coverage priorities that OPM outlined for the federal workforce earlier this year.

OPM, in an annual call for benefit and rate proposals from FEHB providers, said in February it was “interested in supporting family-building efforts for covered FEHB enrollees and their eligible family members.”

“It is imperative that we offer competitive, comprehensive health insurance options to meet consumer demand and address evolving medical evidence,” OPM wrote. “We must continuously reevaluate our standards to ensure we are doing so, and when necessary encourage FEHB carriers to make new offerings and expand coverage as the market shifts and expectations from consumers change.”

FEHB providers currently cover the diagnosis and treatment of infertility, but OPM said “more could be done to assist with the financial burden of ART treatment for those who may require it.”

“If ART treatments, medications, and procedures are not covered by FEHB carriers, and carriers choose not to propose added benefits with corresponding premium increases, carriers should attempt to negotiate discounted rates that members can access for non-covered ART procedures,” OPM wrote.

OPM said more employers have increased their coverage of infertility treatment for employees over the past five years. Lawmakers note that 20 states have now passed infertility insurance laws.

OPM also cites a 2017 maternity, family and fertility survey conducted by the insurance advisor company Willis Towers Watson that found one in three workers between ages 18-34 believe that fertility treatment should be included as part of their employee benefits package.

Nearly half cited high out-of-pocket costs of treatment as their main reason for their response.

OPM said it expected to complete benefit negotiations by July 31 and rate negotiations by mid-August to ensure a timely Open Season. Lawmakers urged OPM to ensure coverage of ART remains an FEHB benefit, if negotiations for the 2023 cycle are already complete.

OPM is requiring all FEHB carriers in 2023 to provide coverage for standard fertility preservation procedures for persons facing the possibility of “iatrogenic infertility,” or infertility caused by a necessary medical intervention.

OPM said it also urged FEHB carriers to manage specialty prescription drugs costs, which the agency said has seen a “high-cost growth rate across the industry.”

OPM said it would focus on advancing “health equity” for 2023 medical benefits, and ensure that the federal government expands coverage for maternal health, gender-affirming care and obesity.

OPM said it planned to focus on expanding coverage to assisted reproductive technology as part of its plan to offer “competitive, comprehensive health insurance benefits” to federal employees, annuitants, their families, and other eligible individuals.

OPM said its health equity goals align with the Biden administration’s two executive orders promoting diversity, equity, inclusion and accessibility across the federal workforce, as well as across public-facing federal programs.

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