HSS board broadens infertility coverage, renames benefit to include assisted reproductive technology

The San Francisco Health Service System on Tuesday unanimously approved a package of enhancements to what will be renamed the "infertility and assisted reproductive technology" benefit. Director Catherine Dodd said the aim is "to provide services that result in a healthy live birth" and to bring plan language into alignment with state law and current clinical practice.

Key changes the board approved include eliminating a spousal opposite‑sex intercourse requirement that barred some same‑sex couples, removing an upper age barrier, adding assisted hatching and intracytoplasmic sperm injection (ICSI) to the covered procedure list, extending egg-storage coverage to 12 months, and harmonizing coverage features across Blue Shield, Kaiser and UnitedHealthcare plans. Staff said pre‑implantation genetic diagnosis (PGD) is covered where medically indicated and that pre‑implantation genetic screening (PGS) would be considered once it is the standard of care.

Staff reviewed HSS claims data and reported utilization increases: in 2015 Blue Shield recorded 15 treatments and Kaiser 57; in 2016 Blue Shield recorded 35 and Kaiser 108, with total infertility-related procedures rising substantially year over year. Cost examples provided during the presentation included assisted hatching (~$750) and ICSI (~$1,800) as incremental laboratory costs, while staff noted broader maternal/newborn care costs can be substantially higher when multiple-embryo implantation leads to preterm births. The board accepted the recommendations to create a uniform, updated benefit for the 2018 benefit cycle.