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Lawmakers and patients press to add infertility and IVF to California’s essential health benefits
Summary
Stakeholders urged inclusion of infertility diagnosis and in‑vitro fertilization in the EHB benchmark. Wakely and CHBRP presented differing price ranges; advocates urged pathway aligned with SB 729. Lawmakers asked for clearer unit costs and covered services.
Assembly and Senate health committee members spent substantial time at the informational hearing on whether to include infertility services — including in‑vitro fertilization (IVF) — in California’s EHB benchmark package.
Why it matters: Infertility services are expensive and, if adopted as part of the EHB, would become required benefits in individual and small group plans. The choice affects access and out‑of‑pocket costs for people who need fertility care and has measurable premium implications across the individual market.
Actuarial viewpoints: Wakely actuary Matt Slaughter explained the firm priced multiple IVF benefit packages, reporting broad ranges driven by benefit design. Slaughter said the three illustrative IVF pathways Wakely priced produced marginal allowed‑cost impacts in a per‑allowed‑cost percentage range (examples shown…
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