Proposed Mandated Health Insurance Benefits
JLARC staff evaluate proposed health insurance mandates in support of the Special Advisory Commission on Mandated Health Insurance Benefits.
JLARC Report In Brief
Evaluation of SB 631: Mandated Coverage of Treatment for Infertility
Senate Bill 631 would require health insurance coverage for the treatment of infertility for individuals less than 50 years old. Treatment includes, but is not limited to, artificial insemination and assisted reproductive technology techniques, such as in vitro fertilization (IVF). Coverage is only required if an individual has not undergone four complete oocyte (or egg) retrievals, except that if a live birth follows a complete oocyte retrieval, then two more oocyte retrievals shall be covered. SB 631 would not cover the reversal of a vasectomy or a tubal ligation.
Medical Efficacy and Effectiveness
According to the U.S. Department of Health and Human Services, about two-thirds of couples who are treated for infertility are able to have a baby with treatment. The efficacy and effectiveness of specific infertility treatments varies by the type of treatment and factors that are specific to the couple, in particular the age of the woman and the cause of the couple's infertility. In general, IVF procedures have the highest success rates of all infertility procedures, with live birth rates of more than 50 percent in some situations. However, many couples pursue other infertility treatments first, and frequently experience success, before turning to IVF.
Social Impact
Approximately 12 percent of U.S. women of childbearing age have used some type of infertility service. Few insurance companies appear to provide comprehensive coverage of infertility treatment as part of their standard benefit, but one-third of plans indicated they offer such coverage as an option to group policyholders. Some oral medications to stimulate ovulation are low cost and generally available without insurance coverage. However, costs for IVF (which is used by a minority of women) could range to more than a third of median annual household income per treatment cycle. Pregnancies achieved through infertility treatment have led to increasing numbers of multiple-birth pregnancies, which adversely impacts public health. Minimizing the use of procedures with a high risk for multiple births would help mitigate this negative public health effect, but individuals may be unwilling to do this if financial constraints limit their options for achieving a live birth.
Financial Impact
The proposed mandate would likely increase access to infertility treatment and reduce the cost of that treatment. However, a Bureau of Insurance survey of insurance companies indicates that SB 631 could also increase insurance premiums. Median estimates based on all insurers responding to the survey indicate that the premium impact of SB 631 would be greater than that of any existing Virginia mandates. However, median estimates reported by those companies already providing infertility coverage are substantially lower, as are the premium impacts reported from other sources. Options to reduce the premium impact of SB 631 include lowering the age limit in the bill, reducing the number of covered treatment cycles, and capping coverage amounts.
Balancing Medical, Social, and Financial Considerations
The need for mandated coverage of infertility treatment may be a policy decision. Many couples would benefit from increased access to infertility treatment and, depending how a benefit is structured, there could be positive impacts on public health through reduced multiple births. However, to the extent that increased premiums could affect some individuals' and employers' ability to purchase health insurance, it is important to recognize that treatment of infertility is not life sustaining nor is it required for individuals to undertake normal activities of daily living (though many medical experts point out that reproduction is a normal life activity.) While this is true for many other covered treatments, it is an important consideration when determining whether to require insurance coverage of a benefit.
| Report No. 375: Oct 2008, 40 pages | Report (pdf) | Briefing (pdf) |