New "infertility" definition could broaden coverage in Pennsylvania
A new, more expansive definition of "infertility" could result in more help for hopeful LGBTQ+ and single parents.
Why it matters: Broader insurance coverage of fertility services, like egg freezing, for all people could be in the offing after a recent decision by an influential group of reproductive health care providers to redefine the condition.
State of play: The American Society for Reproductive Medicine (ASRM) redefined infertility to include everyone — not just heterosexual couples — who need medical intervention to achieve pregnancy.
- It's no longer limited to when a man and a woman can't get pregnant after a year of unprotected intercourse or through intrauterine insemination (IUI) — or after six months of IUI for women over 35.
- The updated language applies to anyone who needs help having children, regardless of relationship status, gender identity or sexual orientation.
State of play: Pennsylvania currently doesn't require any insurance coverage for fertility services, per infertility advocacy group Resolve.
- That's unlike 21 other states plus Washington, D.C., which require some workplace health plans to cover at least some form of fertility coverage, per Resolve.
Zoom in: Despite the growing interest in this care — and more Philly employers like Comcast, Vanguard, and Temple Health offering fertility benefits to stay competitive in the labor market — insurance coverage of the often-pricey services remains limited.
- The average cost of one cycle of IVF is $12,400, according to ASRM.
- Still, several studies suggest fertility insurance coverage does not significantly increase the cost of medical plans.
What we're watching: While the new "infertility" definition creates one avenue for more inclusive coverage, Pennsylvania legislators are pursuing others.
- State lawmakers are considering a handful of bills that would require health insurance plans to cover the diagnosis and treatment of infertility and fertility services.
- Some bills would expand the definition of infertility to include coverage for LGBTQ+ individuals and surrogates.
Yes, but: Previous legislative attempts to expand these services have stalled.
What they're saying: A more inclusive definition of infertility is "a game-changer" because a number of insurance plans rely on the ASRM definition of "disease" to determine coverage, infertility specialist Lucky Sekhon told Axios.
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