Capital Blue Cross – HB 1383 Infertility Care Coverage amendment to The Insurance Company Law of 1921

HB 1383, sponsored by Representative Steven Malagari (D-Montgomery), would require insurers to cover infertility care and would also waive cost share requirements related to that coverage.

The rationale for the legislation as noted in the co-sponsor memo circulated by Rep. Malagari is:

One in ten U.S. women 15-44 years of age have difficulty getting or staying pregnant and face medical challenges in having children. Infertility affects men and women equally, with one-third of infertility cases caused by male reproductive issues, one-third by female reproductive issues, and one-third by both male and female reproductive issues or by unknown factors. In addition to heterosexual couples, other populations may face barriers to family building and require medical assistance to have children.

While there are several forms of fertility assistance, many services are out of reach for most people due to cost. Infertility treatments typically cost patients thousands of dollars, ranging anywhere from $18,433 to $85,563. As such, insurance coverage for infertility services is a fundamental requirement to nurturing families and communities in Pennsylvania.

Unfortunately, insurance laws protecting a person’s right to procreate are non-existent in Pennsylvania. This disheartening circumstance is made worse by the fact that every single one of our border states has an infertility insurance coverage mandate. The lack of an insurance mandate for infertility services means that the right to build a family in the face of infertility appears to be reserved only for those who can afford it. This reality is socially unjust and incompatible with Pennsylvania’s strong community values.

To address this, we are introducing legislation requiring insurance coverage for infertility services. The ability to start and cherish a family is a foundational element for strong communities and provides future generations with a pathway to fulfill their potential. We hope you are encouraged to join this small measure to protect the rights of Pennsylvanians to raise loving families.

Capital Blue Cross will likely oppose the legislation primarily on cost concerns. This mandate would cost members in our fully insured products – mostly small employer groups and individuals – approximately $14 million and if it were applied to the self-insured products we manage, those costs could balloon to approximately $55 million.

Consideration of the legislation will certainly be influenced by the election. Democrat VP candidate Walz has openly noted how he and his wife used the IVF procedure to get pregnant. This differentiates the Democrats with Republicans who in some cases have opposed IVF procedures as conflicting with their pro-life positions. I can see the PA House Democrats pushing the bill this fall to try and force an uncomfortable vote for many Republicans.