Editor’s note: This story was updated at 9 a.m. ET on July 20 to include a statement from Blue Cross Blue Shield.
Reproductive health advocacy groups and Democratic lawmakers are pressing the Office of Personnel Management on why some insurers offer fewer infertility treatments than they’re required to in federal employee health plans.
In a letter to OPM Director Kiran Ahuja obtained by Federal Times, Rep. Gerry Connolly (D-Va.) and Sen. Tammy Duckworth (D-Ill.) said certain providers under the Federal Employee Benefits Program — which serves 8 million beneficiaries — are denying coverage of standard fertility preservation treatments.
Benefits are provided by insurance companies but coordinated and overseen by OPM.
“This denial not only violates the coverage directive set by OPM but also undermines the intent to support fertility benefits for federal employees struggling with infertility,” the lawmakers said in the July 18 letter.
For the 2023 plan year, OPM announced it was requiring all FEHB carriers to “provide coverage for standard fertility preservation procedures for ... iatrogenic infertility.”
In the past, carriers have been encouraged to cover these kinds of procedures, but in recognizing that “more could be done to assist with the financial burden” of infertility treatments, OPM made these recommendations mandatory.
However, some patients are being denied claims for what should be covered benefits based on communications with clinicians and hospitals, according to another letter sent to OPM in May by the Alliance for Fertility Preservation, the American Society for Reproductive Medicine and Resolve: The National Infertility Association.
Now, as OPM seeks to further expand coverage in 2024, the question, reproductive health advocates say, is whether such requirements carry any teeth if carriers are able to defy them. It’s unclear what authorities OPM has to enforce these requirements, and a spokesperson for the office did not immediately respond to questions about that.
“I don’t understand the point of saying something is a requirement if you’re gonna let them get away with not meeting the alleged requirements,” said Sean Tipton, a spokesperson for the American Society for Reproductive Medicine, in an interview.
Employees interviewed by Federal Times have said that navigating the more than 200 plans available to them to find the one that offers the treatment they qualify for is difficult and cumbersome. And prior to the coverage expansions promised in the last few years, employees have had to go out of pocket because their government-sponsored plan won’t cover the type of infertility treatments they need.
These concerns have been heard by OPM, members of Congress and outside groups that say expanded infertility coverage can play into a federal benefits program that will retain employees with diverse health needs and recruit those who see the government as supportive of employees’ families.
Blue Cross Blue Shield’s FEP Blue plan was called out specifically in the letters for covering one year of sperm and egg storage but not any of the actual procedures or medications to retrieve cells from each partner.
“They are correctly quoting our benefit, and we are in compliance with Office of Personnel Management benefit mandates,” a spokesperson for the company said.
Other plans, the letter alleges, also exclude certain elements of these coverages.
“This extremely limited scope of coverage clearly does not reflect OPM’s coverage directive for these services,” said the health advocacy organizations in a May letter. “Since FEP Blue is the largest plan within the FEHB system — covering 5.3 million enrollees — effectively two-thirds of FEHB insureds currently lack coverage for fertility preservation procedures that they are now entitled to receive.”
For plan year 2024, carriers will be required to provide coverage of artificial insemination procedures and associated drugs and three cycles of in vitro fertilization per year.
Barbara Collura, president and CEO of Resolve, said recent progress has made a positive difference already, but it’s still inadequate. For one, offering enhanced coverage for only iatrogenic infertility — which is infertility caused by a medical intervention, like surgery or medication — doesn’t apply to single women, same-sex couples or those who were diagnosed with natural infertility.
“A lot of benefits oftentimes [center] around a very strict definition of infertility that excludes them,” Collura told Federal Times. “Certainly we are concerned if this is what happened with fertility preservation, what’s going to happen with the new items added to the list for coverage for 2024 and beyond?”
Tipton said that certainly there are implementation challenges any time there’s a policy change or new requirement coming from an agency. However, he cautioned that not being able to ensure that each plan adheres to OPM’s expectations borders on a “bait and switch” for employees who are planning their lives and finances around seeking such treatments.
“And that’s unacceptable,” he said. “Clearly, OPM has some work to do in terms of oversight of its requirements.”
Molly Weisner is a staff reporter for Federal Times where she covers labor, policy and contracting pertaining to the government workforce. She made previous stops at USA Today and McClatchy as a digital producer, and worked at The New York Times as a copy editor. Molly majored in journalism at the University of North Carolina at Chapel Hill.