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Board hears Aon analysis of infertility benefits, member says denials disproportionately affect some groups
Summary
Aon presented a first‑look review of infertility benefits showing no immediate cost surge after 2017 changes; a city employee told the board she faced multiple denials and urged staff to verify unequal access, and the board asked staff to return with standardized denial/count data in August.
Ann Thompson of benefits consultant Aon presented the Health Service System board with a preliminary analysis of infertility benefit utilization and coverage design on June 13, saying changes made in 2017 (two cycles of IVF coverage, expanded egg and embryo storage and adoption/surrogacy assistance) have not produced a sharp rise in plan costs or utilization.
Thompson told the board that initial sampling and plan carrier conversations show total plan payments for infertility pharmacy components trending downward and that average out‑of‑pocket exposure under the typical 50% cost share sample would be roughly $12,000 on a $25,000 case. She said the team will continue mining all‑payers claims and carrier data to standardize reporting and to evaluate carve‑out or third‑party administration options.
"We worked together with SFHSS staff and Aon, as well as subject‑matter experts and the health plans, to make sure current infertility benefits support best‑practice approaches for the membership," Thompson said during the presentation.
Public commenter Erica Maybaum, who identified herself as a city employee, told the board she had received three denials in the mail and said the plan’s current definition and coverage rules appear to disadvantage lesbians and people without partners. "If I were in a heterosexual relationship none of this would be happening," Maybaum said, asking whether provider or plan data on denials had been shared with HSS.
Maybaum pressed the board to consider pausing contract approvals until staff could verify equitable access. Executive Director Abby Yant and Aon staff responded that they have some data but lack standardized reporting across carriers and that some of the data fields (orientation, partnership status) are not captured in current claims systems. Yant said staff plan to continue data mining, standardize reporting codes, and return with more analysis.
Board members repeatedly asked for specific counts and reasons for denials. "We need more time to do the analysis of the data that we have because we have, at this point, more questions than we do data analysis," Yant said. Commissioners asked the health plans to provide whatever denial statistics are available and requested that staff provide an update at the August meeting.
What’s next: Aon and SFHSS staff will continue data collection and claims‑level analysis, looking at appeals and denial reasons and evaluating third‑party administration or carve‑out options. The board requested staff report back with standardized denial counts and the planned timeline (staff said they expect to return in August).
