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Board briefed on assisted‑reproductive benefits; staff to revisit eligibility and coverage
Summary
Aon presented infertility (assisted reproductive technology) benefit options and costs; current plan coverage is generally 50% after deductible, costs per cycle were estimated at $30k–$60k, and staff said the benefit hasn’t been reviewed in five years and will return for policy consideration.
An Aon consultant walked the board through the Health Service System’s current infertility (assisted reproductive technology) benefits and emerging clinical techniques that affect effectiveness and cost.
The presenter stated that, across the three plans, infertility procedures are generally covered at 50% after deductible (UHC noted to have a deductible; Blue Shield and Kaiser reported no deductibles for those plan designs). She summarized clinical approaches (IVF/ICSI, assisted hatching, pre‑implantation genetic screening) and gave an approximate cost range for treatment cycles: $30,000–$60,000 per cycle with an illustrative ~31% chance of live birth, noting higher downstream perinatal costs for multiple births.
Deputy Director Mitchell Griggs and staff confirmed that benefits had not been reviewed in at least five years and recommended the board examine eligibility barriers (including how documentation requirements affect same‑sex couples and others) and new treatment options that could improve live‑birth rates while managing risk and cost. “Our goals are to make sure that the services we're providing…are those that will result in a live, healthy birth,” the presenter said.
The board asked staff to bring a policy review back to a future meeting so the benefits and eligibility rules can be updated and aligned with current medical practice and member needs.
