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Health Service System to review infertility coverage after supervisors raise access concerns
Summary
The city employee Health Service System told the Budget & Finance Committee it is investigating whether infertility benefit design disadvantages lesbians, single women or unpartnered members and will report back to its board in August; any expansion to cover assisted reproductive technology would be taxable.
At the Budget & Finance Committee's June 14 hearing, Abby Yant, executive director of the city's Health Service System (HSS), said the administration is conducting a utilization review of the infertility benefit after supervisors raised concerns that the plan's current design may functionally favor members who can demonstrate medical infertility diagnoses tied to heterosexual couples.
President Norman Yee pressed HSS staff about "a discrepancy in access in fertility coverage for heterosexual couples versus lesbians or those who are single or unpartnered," and asked whether single women and same-sex couples face barriers to coverage. Yant said the infertility benefit is keyed to a medical diagnosis: "The benefit is offered … it's a medical … based on a medical diagnosis. So if a male or female has a condition that is diagnosed by a licensed medical practitioner as infertility, then they can access the services under that" benefit.
Yant and staff told supervisors they are examining utilization, vendor practices and whether the design should be broadened to include assisted reproductive technology for people without a medical infertility diagnosis — an option that would be treated as a taxable benefit under federal/state rules because it is not tied to a medical diagnosis. HSS will report findings to its board in August; any design change would take effect in a future plan year and likely be taxable if classified as assisted reproductive technology coverage.
Supervisors also questioned disparities in fertility drug pricing and whether retirees have reported care denials under new plan vendors. HSS officials said they are investigating outlier pharmacy pricing and vendor practices and are in follow-up discussions with plans to improve transparency and negotiated pricing.
Provenance: HSS presentation and the sustained Q&A on infertility coverage took place in the department presentation segment of the June 14 committee hearing.
