HSS outlines $15,000 adoption, surrogacy reimbursement; board weighs eligibility and funding limits

The San Francisco Health Service System (HSS) on Aug. 4 described a proposed one-time reimbursement benefit of up to $15,000 for eligible employees who incur qualified expenses for adoption or surrogacy, with the benefit scheduled to take effect Jan. 1, 2017.

HSS Chief Operating Officer Mitchell Griggs said the draft plan sets eligibility for employees who are members of HSS and who have at least one year of employment; an eligible child must be under 18. The plan would allow one claim per eligible employee or family and requires documentation of qualified expenses. Griggs said surrogacy expenses incurred outside the United States would be ineligible under the proposed rules.

Board members asked detailed questions about scope and limits. Several commissioners urged staff to consider whether retirees should be eligible and whether age limits should apply to surrogacy or adoption coverage. Commissioner questions focused on whether surrogates or members must be U.S. residents and on how the plan would treat cross-border services.

Griggs told the board the immediate funding source would be HSS performance-guarantee funds and similar reserves, not premiums collected from employees. Pamela Levin, HSS chief financial officer, confirmed there was roughly $500,000 in performance-guarantee money and that, at the full $15,000 reimbursement amount, that sum would cover about 34 claims in a year — a built-in limit on near-term payouts.

Supporters at the meeting emphasized the modest scale of the benefit compared with total surrogacy costs. A public commenter representing retirees noted that surrogacy and adoption costs can exceed $150,000 and urged the board to consider retirees’ different family structures if the policy is extended beyond active employees.

The plan document lists eligible and ineligible expenses, application and reimbursement procedures, and an appeals process aligned with other HSS rules. Several commissioners suggested adding clarifying language that the enumerated eligible expenses are illustrative rather than exhaustive and asked staff to return with options that explicitly address whether retirees are included and whether to adopt an age limit for certain services.

Next steps: staff will revise the plan language to address the governance questions raised — residency/documentation for surrogates, retiree eligibility, and potential age limits — and return the item for board action at the next meeting. The board did not take a final vote on the plan at this session.

Outcome/next step: Draft plan to return as an action item at the next board meeting after staff provides clarified eligibility language, funding projections and options requested by commissioners.