Members of Congress are urging the Office of Personnel Management to ensure providers of its health insurance program do not exclude same-sex couples and single individuals from seeking the same artificial reproductive procedures that other federal employees do.
The current working definition of infertility for the Federal Employee Health Benefits plan “is outdated and lacks inclusivity, particularly for the LGBTQ community,” Rep. Gerry Connolly of Virginia and 30 other Democratic lawmakers wrote in a Aug. 17 letter to OPM Director Kiran Ahuja that was obtained by Federal Times.
It’s one of several letters lawmakers have sent OPM in the last two years to address long-standing discrepancies in insurance coverage of infertility treatments. In vitro fertilization, a common by expensive treatment, has only just been a covered benefit in the private sector in recent years. Carriers under the federal health program only this year were required to covering medications associated with it.
Roughly 8 million people get health insurance through the FEHB program, a government-run marketplace of more than 270 plans overseen by the OPM. Federal employees, health advocacy groups and lawmakers have pointed to the federal government’s slow adoption of more comprehensive reproductive health care coverage, which has driven some educated, stable employees with full-time work to consider picking up an side service job just to get better benefits.
LGBTQ individuals make up an estimated 6% of the federal workforce.
“States and employers across the country are recognizing the importance of inclusive policies and the Federal Employees Health Benefit program must keep pace with these advancements,” said Connolly’s letter. “This definition [of infertility] does not consider the evolving landscape of family building and the diverse needs of individuals who require fertility health care to build their families.”
In guidance issued this spring in preparation of the 2024 plan year, OPM referred to previous memos that said plans which do offer benefits must ensure that descriptions and definitions of infertility and treatments are “relationship neutral.”
OPM has also acknowledged that it may be difficult for patients to find, let alone discern, their carrier’s infertility eligibility and has told providers to ensure this information is front-and-center online and in brochures. The agency has offered examples in past guidance on how to define infertility based on what other government and private sector plans use .
For example, it highlights that for women without male partners or exposure to sperm, “infertility is the inability to conceive after six cycles of artificial or intrauterine insemination performed by a qualified specialist.”
In that case, coverage may not kick in until a diagnosis is reached after the completion of six failed cycles, any one of which could cost between $500 and $4,000 out-of-pocket, which is why Connolly said that requirement is “both arbitrary and unnecessarily restrictive.”
“Furthermore, this policy creates unnecessary barriers and costs for LGBTQ people by excluding consideration of at-home inseminations,” he wrote.
A spokesperson for OPM did not respond to requests for comment by the time of publication.
‘Locked out’ of coverage
In a June study by Progyny, a fertility benefits company, 68% of LGBTQ patients said they were “locked out” of coverage because a diagnosis of infertility was a prerequisite, and that diagnosis assumed heterosexuality.
Lisa Campo-Engelstein, a bioethicist specializing in reproductive and sexual ethics at the University of Texas Medical Branch, said coverage requirements like these do not consider infertility that goes beyond a traditional male-female couple. Meanwhile, other states like Maine, Maryland and Illinois have adopted definitions of infertility that expands eligibility to couples that do not have both reproductive gametes.
“There have been stories of lesbian couples having to prove their infertility by paying for IUI out-of-pocket for a year before they’re eligible, whereas their straight counterparts can just jump right in,” she said in an interview with Federal Times last year.
While federal employees can expect more coverage of drugs associated with infertility treatments going into next fiscal year, some may also see the D.C. government mandate infertility coverage for those enrolled in Medicaid and the D.C. Healthcare Alliance.
That bill is awaiting Congressional review.
For 2024, FEHB carriers will be required to cover for artificial insemination procedures and associated drugs. That does not include a requirement to cover donor sperm. To help cover costs associated with IVF, OPM is also requiring carriers to cover medications for three cycles per year.
“As OPM continues to prioritize inclusive, family building policies in the FEHB program, it is imperative that all federal employees have equal access to this suite of services,” the letter said.
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.