Earlier this year, U.S. Senator Tammy Duckworth (D-Ill.) and U.S. Representative Gerry Connolly (D-Va.-11) introduced the Family Building FEHB Fairness Act.
The bipartisan bill would “expand and protect access to in-vitro fertilization (IVF) and other assisted reproductive technology (ART) that millions of Americans need to have children, including Senator Duckworth, who relied on IVF to have her two daughters,” read a statement from Duckworth’s office announcing the legislation’s introduction.
The legislation would oblige the Federal Employees Health Benefit Program (FEHB)—the largest employer-sponsored health insurance program in the world—to cover IVF and ART, and would give the U.S. Office of Personnel Management (OPM) one year from the date of the bill’s enactment to implement its requirements.
The Act’s fate remains to be seen. In the meantime, Duckworth and Connolly are among a group of 30 American lawmakers who wrote a recent letter calling on OPM to update the definition of infertility used by health insurance carriers participating in the FEHB program to be more inclusive of the LGBTQ+ community.
The current definition of infertility used by FEHB providers precludes members of the LGBTQ+ community from utilizing full health benefits, including access to assisted reproductive technology, according to the Aug. 17 letter addressed to OPM Director Kiran Ahuja.
“We are writing to request that OPM take immediate action to update the definition of infertility within the FEHB program guidance,” the lawmakers wrote, requesting that OPM works closely with medical professionals and advocacy organizations as well as members of the LGBTQ+ community “to revise the definition in a manner that is inclusive, evidence-based and reflective of contemporary medical guidelines.”
Increasing Access to Care
OPM last updated its definition of infertility within the scope of the FEHB program in 2015, as Government Executive’s Erich Wagner recently noted.
In March of this year, the agency’s annual letter to insurance carriers taking part in the program voiced OPM’s support for “the provision of benefits that will help enrollees build their families. The same letter informed participating insurers that they will be required to expand fertility coverage to include assisted reproductive technologies such as artificial insemination, in vitro fertilization (IVF) and the cost of IVF-related drugs for three cycles.
Duckworth, Connelly and their colleagues who authored the recent letter to OPM, however, maintain that these changes “don’t do enough to fill gaps in existing coverage related to the diagnosis of infertility, and could leave LGBTQ+ federal workers behind,” Wagner wrote.
“At issue is the fact that, under the current OPM definition of infertility, women without male partners or otherwise ‘exposure to sperm,’ patients must undergo six unsuccessful cycles of artificial or intrauterine insemination in order to receive a diagnosis,” Wagner pointed out.
Those procedures aren’t covered by FEHB, though, unless the employee has already been diagnosed with infertility, “creating a catch-22 for federal workers trying to get pregnant,” he continued, noting that OPM is slated to finalize changes to the FEHB for 2024 this fall, upon announcing the annual open season.
A growing number of states are recognizing the importance of inclusive family building policies, the lawmakers wrote. For example, Illinois has updated its definition of infertility to encompass a broader range of patients, including those unable to reproduce either as a single individual or with a partner without medical intervention. Meanwhile, Maine defines a fertility patient as an individual or couple at increased risk of transmitting a serious inheritable genetic or chromosomal abnormality to a child or an individual unable to conceive as an individual or with a partner because the individual or couple does not have the necessary gametes for conception.
The letter has received endorsements from a number of organizations, including RESOLVE: The National Infertility Association, the National Center for Lesbian Rights and GLBTQ+ Legal Advocates & Defenders (GLAD).
In a statement, Barbara Collura, president and CEO of RESOLVE, implored OPM to take steps to ensure that FEHB keeps up with advancements at the state level.
“Our community tells us over and over that the biggest barrier to family building is a lack of adequate insurance coverage for medical care,” said Collura. “Too often, it is the definition of infertility in the insurance plan that restricts access and dictates who can, and who can’t, access the medical care offered. … We urge OPM to align their definition with the current standard of care that many forward-thinking employers are using today.”
11 September 2023
HR News Article