Fertility Benefits: 2023 Federal Health Insurance Plans
A helpful summary outlining fertility benefits under different federal employee health insurance plans.
As I mentioned in the last DOJ GEN update, the awesome Abigail Farthing from our Fertility Benefits Working Group for studying the different policies and creating the summary below that outlines what fertility benefits national FEHB plan options will and won’t offer in 2023. Some points before we get to the summaries:
They provide a snapshot of only what national FEHB plans will offer in the way of reproductive services. There are a few plans only available in certain regions that will offer more options, including Artificial Reproductive Technology (ART) services. You can read about those in this Federal Times article. However, most national plans will limit their coverage to one year per beneficiary’s lifetime of egg or sperm storage.
If you’re looking to change your plan during open season (which ends December 12, 2022!), please don’t rely on these summaries as your exclusive source of information. We hope the summaries will be useful to some as starting point when researching options, but keep in mind that and we’re not health insurance experts and we’re not OPM.
As for OPM, it hasn’t replied to our request to issue guidance explaining what those interested in fertility coverage should know about this year’s changes. We’re sending OPM these summaries and urging it again to help feds navigate their choices.
Although very few FEHB plans will cover ART, they will all cover fertility preservation for cancer patients and others at risk of medically induced infertility, including for those who undergo forms of gender-affirming care.
As we mentioned last time, we think the overall offerings are far too limited. Over the next year, we plan to lobby OPM and Congress to ensure that benefit options are more robust in FY 2024. If you want to get involved in that effort, let us know.
APWU Health Plan - 47
Nationwide
[1] Family planning not covered: reversal of voluntary surgical sterilization, genetic testing and counseling// Covered: contraceptive counseling, voluntary family planning services (limited to some services), [p.42]
[2] Diagnosis and treatment of infertility, except as shown in 'Not covered'—which includes ART procedures has limited benefits: PPO: 15% of the Plan allowance and all charges after we pay $2,500 in a calendar year and Non-PPO: 40% of the Plan allowance and all charges after we pay $2,500 in a calendar year
[3] Iatrogenic fertility preservation procedures (retrieval of and freezing of eggs or sperm) caused by chemotherapy, pelvic radiotherapy, ovary or testicle removal and other gonadotoxic therapies for the treatment of disease and gender reassignment with a $12,000 lifetime maximum//PPO: 15% of the Plan allowance and Non-PPO: 40% of the Plan allowance (p. 40)
Blue Cross and Blue Shield Service Benefit Plan Basic Option - 11 and Standard Option 10
Nationwide
Both Standard and Basic: covers one year of sperm and egg storage for individuals facing iatrogenic infertility, once per lifetime. (See pages 22, 50 and 154.) Both provide the benefits seen here when billed by a facility. See page 22 for prior approval requirements. See Section 10 for our definition of iatrogenic infertility. **Note, while the reproductive services lists diagnosis and treatment of infertility, it is limited and DOES NOT include ART.
Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - 13
Nationwide
Covers one year of sperm and egg storage for individuals facing iatrogenic infertility, once per lifetime. Provides the benefits outlined when billed by a facility. See page 21 for prior approval requirements. See Section 10 for definition of iatrogenic infertility.
GEHA Benefit Plan - 31 (High and Standard Options plan with PPO plan)
Nationwide
Covers iatrogenic infertility, to include collection and storage (up to 12 months) of eggs, sperm and embryos. See Section 3. How You Get Care; Section 5(a), Infertility services; and Section 10. Definitions. **Also includes infertility associated with medical and surgical gender reassignment.
GEHA HDHP - 34
Nationwide
Covers iatrogenic infertility, to include collection and storage (up to 12 months) of eggs, sperm and embryos. See Section 3. How You Get Care; Section 5(a), Infertility services; and Section 10. Definitions. **Also includes infertility associated with medical and surgical gender reassignment.
GEHA Indemnity Benefit Plan - 25
Nationwide
The Plan will add standard fertility preservation coverage including collection and up to 12 months of storage of oocyte, sperm, and embryos for members diagnosed with iatrogenic infertility, including infertility associated with medical and surgical gender reassignment. See Section 3, How You Get Care, Section 5(a), Medical Services and Supplies, Section 5(b), Surgical and Anesthesia Services and Section 10. Definitions of Terms, pages 18, 35, 57, and 115.
MHBP Consumer Option - 48
Nationwide
Covers fertility preservation procedures (retrieval of and freezing of eggs or sperm with initial storage) for members facing the possibility of infertility caused by chemotherapy, pelvic radiotherapy, other gonadotoxic therapies, or ovary or testicle removal for treatment of disease.
MHBP Standard Option - 45 and Value Plan -41
Nationwide
Covers fertility preservation procedures (retrieval of and freezing of eggs or sperm with initial storage) for members facing the possibility of infertility caused by chemotherapy, pelvic radiotherapy, other gonadotoxic therapies, or ovary or testicle removal for treatment of disease.
NALC Health Benefit Plan - 32 and KM
Nationwide
Benefits are available for fertility preservation for medical reasons that cause irreversible infertility such as chemotherapy or radiation treatment. Services include the following procedures, when provided by or under the care or supervision of a Physician: • Cryopreservation of sperm • Embryo cryopreservation • Cryopreservation of reproductive tissue, testicular or ovarian • Mature oocyte cryopreservation • Storage costs up to one year Note: These services are only covered while you are enrolled in the Plan. Prescription drugs are covered for the treatment of infertility, limited to a maximum Plan payment of $2,500 each calendar year per person. (p.116) **NOTE, this plan states that ART is not covered, including services and supplies related to ART—it appears the drugs are related to fertility preservation for medical reasons that cause irreversible fertility.
SAMBA Health Benefit Plan - 44
Nationwide
From Section 2: added coverage for standard fertility preservation procedures for individuals facing anticipated infertility resulting from chemotherapy or other covered medical procedures, including gender affirming care, expected to result in permanent infertility. Benefits are limited to $1,000 per person, per calendar year/$5,000 per lifetime under the High Option and $800 per person, per calendar year/$3,500 per lifetime under the Standard Option. Prior authorization is required. See Infertility services in Section 5(a), page 39.