Washington State Infertility Insurance Mandate

Exciting news, Washington coalition applauds legislation requiring health plans to cover fertility services! Mandate applies to health plans for groups, individuals, and state and school employees.

Washington State House Bill 1730 was filed this week on January 3rd! This is the proposed bill by the Washington State Family Building Coalition that would require health insurers to provide benefits for fertility and fertility preservation services in Washington State starting 01/01/2024.  The bill is championed by Representative Stonier and there are already other legislators signing onto the bill. Subsequently, the companion Senate Bill 5647 was filed the next day by Senator June Robinson.

If you feel strongly that everyone should have equitable access to fertility services, this would be the right time to have a conversation, increase awareness, and even consider reaching out to your representative, and participating. To find the representatives for your district, more details here.

For ongoing updates, check out SRM’s Advocacy webpage.

 

Fertility Coverage News Release

Jan. 10, 2021—A grassroots coalition of patient advocates, physicians and nurses, fertility clinics and health care providers across Washington state is applauding legislation requiring insurers to cover infertility treatment and fertility preservation services for Washingtonians enrolled in group health plans, individual health plans, and the state’s Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs.

State Rep. Monica Stonier, D-Vancouver,  prefiled the Washington Building Families Act, HB 1730, in the House on Jan. 3. State Sen. June Robinson, D-Everett, prefiled a companion bill, SB 5647, in the Senate on Jan. 4.

Nationally, one in eight couples have trouble getting pregnant or sustaining a pregnancy, yet only one in four of those can access the care they need to treat infertility. Although infertility is a recognized medical condition with widely accepted standards for diagnosis and treatment, many insurance plans in Washington state do not cover fertility services such as in vitro fertilization (IVF). For many people, the cost of paying out of pocket is a major barrier to pursuing infertility treatment.

Millions of Washingtonians pay monthly premiums for insurance coverage that does not cover the standard of care for infertility. The Washington Building Families Act expands access and removes economic barriers to infertility treatment, offering hope to more Washingtonians with dreams of growing their family. Supporters say that passing this legislation is a matter of equity in access to care.

Nineteen states have already passed fertility insurance coverage laws. Thirteen of those laws include coverage of IVF and eleven states require coverage for fertility preservation for patients undergoing treatment for cancer and other medical conditions that can lead to infertility.

Passing the Washington Building Families Act will reduce the financial strain on Washingtonians while only minimally impacting insurance premiums, if at all. Comprehensive reviews of states with mandated infertility benefits show that the cost of infertility coverage averages less than one percent of the total premium cost.

Additionally, a 2021 Mercer survey of over 450 employers nationwide found that 97% of employers offering infertility treatment, even those that include IVF, have not experienced increases in their medical costs.

The legislation also generates significant cost savings – and healthier outcomes – from a reduction in multiple births. In states with mandated coverage, patients are more likely to choose single embryo transfer, resulting in fewer high-risk multiple births. A 2014 study estimated that the national savings from fewer multiple births at $6 billion each year.

Covering the spectrum of fertility services also enables patients to pursue the most effective treatment options; some patients may benefit from medication only, while others may need IVF to become pregnant, and still others may have success with intrauterine insemination (IUI) that is less invasive and less costly than IVF. Insurance coverage leads to healthier and more cost-effective outcomes.

Coalition members issued the following statements in support of the legislation:

Dr. Lynn B. Davis, Reproductive Endocrinologist and Infertility Specialist at SRM Seattle:

Everyone deserves equal access to care to build their families. Unfortunately, many people in Washington state who struggle with infertility cannot get the care they need due to lack of reliable insurance coverage. This needs to change. Passing the Washington Building Families Act will help people across the state access these medically necessary services. Whether it is treatment for infertility, or fertility preservation like egg or sperm freezing before cancer treatment, providing the standard of care to all is the right thing to do for patients and their families.

Dr. Christopher Herndon, Medical Director of Division of Reproductive Endocrinology at University of Washington:

As a physician, I love to provide care for patients and help them overcome the challenges of infertility. Yet the lack of insurance coverage prevents so many in our state from being able to access effective, standard of care treatments and realize their dreams of building a family. Insurance coverage is transformative for improving patient care. In its absence, the right to build a family in the face of infertility is reserved only for those who can afford the out-of-pocket treatment costs. This legislative bill is, at its heart, a call for equity in Washington state.

Dr. Lori Marshall, Co-founder and Medical Director at Pacific NW Fertility, Clinical Professor at University of Washington:

As a reproductive endocrinologist who has enjoyed a long career in Washington state, I have been committed for many years to improving access to treatment for infertility – a treatable disease that affects one in eight couples with dreams of building a family. It has always troubled me that lack of insurance coverage for fertility services puts an enormous financial burden on patients and can even prevent patients from seeking treatment at all. Many Washingtonians will benefit from passing legislation that requires health plans to cover treatment for infertility just as they cover treatment for other medical conditions.

Dr. Tyler Ketterl, Medical Director of Adolescent and Young Adult Oncology at Seattle Children’s Hospital, Medical Director of the Comprehensive Fertility Preservation Program at Seattle Children’s Hospital, Division of Pediatric Hematology/Oncology, University of Washington:

As a physician who cares for children and young adults with blood and cancer disorders, infertility risk and fertility preservation are one of the most important aspects I discuss with patients and families. Many patients expect to grow into adulthood and eventually have kids of their own. Fortunately, we have more tools than ever to intervene before, during or after patients’ medical treatment to preserve their healthy ovarian tissue, eggs, sperm or embryos for a future pregnancy. It can be devastating to come to terms with the fact that they will never be able to build a biological family; especially when this possibility is limited by a patient or family’s lack of insurance coverage and inability to afford fertility preservation. We must treat the risk of infertility like any other side effect of cancer-directed therapy or treatment of blood conditions like sickle cell disease. This bill would help ALL children and young adults in Washington have access to standard of care fertility preservation options which can be instrumental to coping during and after life-saving therapy.

Dr. Shannel Adams, OB-GYN and Reproductive Endocrinology and Infertility Specialist, Vios Fertility Institute, Vancouver:

Patients who struggle with infertility deserve access to the standard of care and should not be limited by insurance coverage that excludes fertility treatments. I see many patients who could likely get pregnant with in vitro fertilization but can’t because their health plan does not cover fertility services and they can’t afford to pay the entire cost themselves. We need this legislation so that Washingtonians don’t have to take on enormous debt to be able to pay for fertility treatments. We need this legislation so that Washingtonians don’t have to make the difficult choice between having a home or having a family.

Amanda Hathaway, Lacey patient:

My husband and I are both state employees with health insurance that does not cover infertility treatment. We decided to pursue in vitro fertilization, which was our only option to conceive, even though it meant paying all of the costs of treatment out of pocket. After five rounds of IVF, we now have two young children. Altogether, we paid more than $50,000 for treatment that was not covered by our state employee health plan. I am advocating for this legislation because other couples who are struggling with infertility should not have to bear the heavy financial burden that we endured.

Brittney Hoelzel, Granite Falls patient:

As my husband and I have gone through infertility treatment, there has been a lot of additional stress from trying to come up with tens of thousands of dollars to pay all the costs ourselves because our employer-provided health plan does not include fertility coverage. We used up our savings and maxed out our credit cards, then sold our house to pay off the debt and continue treatment. Having now spent around $50,000, we are continuing with the IVF process in the hopes of building a family. Infertility it not a choice. It is a medical condition and should be covered by insurance like other medical conditions.

Rebecca Donaway, Spokane Valley patient:

Thanks to the fertility coverage provided through my husband’s employer, we were able to afford in vitro fertilization, which was our only option to conceive. The coverage was a gift, and our two children would not be here without it. But we have friends who do not have coverage and have had to cash out their 401k or take out a second mortgage to pay thousands of dollars for infertility treatment. No one should be saddled with such a heavy financial burden on top of the emotional burden of dealing with fertility issues.

Nicole Schroeder, Edmonds patient:

No one plans for a life-altering disease or its impact on fertility. My husband and I had been trying to get pregnant when I was diagnosed with breast cancer. Fortunately, I had access to fertility preservation before going through chemotherapy and my insurance covered most of the cost. But many people don’t have access because their health plan doesn’t include fertility coverage. That has to change. Patients need access to fertility preservation, and insurance plans should cover the cost.

Joyce Reinecke, Executive Director, Alliance for Fertility Preservation:

We are thrilled to see the inclusion of fertility preservation services in the Washington Building Families Act. Providing this coverage will allow newly diagnosed Washingtonians to focus on their cancer treatment, while knowing that their ability to one day have a family is being valued and protected.

January 11, 2022

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