Lawmakers are asking the Office of Personnel Management (OPM) to follow through on its promise to expand federal employees’ medical coverage to include infertility diagnoses and treatments.
Sen. Tammy Duckworth (D-Ill.) and Government Operations Subcommittee Chairman Gerry Connolly (D-Va.) urged OPM on Monday to make sure that all Federal Employee Health Benefits (FEHB) program carriers provide coverage for assistive reproductive technology (ART), including in vitro fertilization (IVF). This would begin in 2023.
The Democratic lawmakers’ letter to OPM comes just after the agency’s prioritization of expanding fertility benefits earlier this year, as part of a larger campaign of advancing diversity, equity and inclusion goals for the entire federal workforce.
The FEHB program currently only offers limited infertility treatment, and it is typically “prohibitively expensive.”, according to lawmakers.
“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,” Connolly and Duckworth 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 spearheaded the letter, which was 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 additionally 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 Cicilline (D-R.I.)
These Senators cited a survey from RESOLVE: The National Infertility Association, which discovered one in every eight couples face challenges while conceiving.
Duckworth and Connolly also noted that 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,” they wrote.
OPM outlined health coverage priorities for the federal workforce earlier this year.
In an annual call for benefit and rate proposals from FEHB providers, OPM wrote 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 said. “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 stated that more employers have increased their coverage of infertility treatment for employees in the past five years. Lawmakers note that 20 states have now passed infertility insurance laws.
“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,” OPM wrote.
OPM also cites a 2017 maternity, family and fertility survey conducted by Willis Towers Watson that found one in three workers between ages 18-34 believe that fertility treatment should be added as part of their employee benefits package.
Nearly half cited high out-of-pocket costs of treatment as their primary reason for their response.
OPM said it expected to complete benefit negotiations by July 31st and judge negotiations by mid-August to ensure a timely Open Season.
OPM is mandating that all FEHB carriers in 2023 to provide coverage for standard fertility preservation procedures for persons facing the chance of “iatrogenic infertility,” or infertility caused by a necessary medical intervention. Also, OPM said it encouraged 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, as well as to focus on increasing 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.
The agencies health equity goals match with the Biden administration’s two executive orders supporting diversity, equity, inclusion and accessibility across the federal workforce, and well as across public-facing federal programs.
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