Lawmakers urge OPM to expand FEHBP infertility coverage for LGBTQ+ feds

A group of 30 congressional Democrats last week urged the Office of Personnel Management to update federal workers’ health insurance program to fill gaps in its infertility coverage and make it more inclusive for LGBTQ+ employees.

OPM last updated its definitions of infertility within the Federal Employees Health Benefits Program in 2015. And in its annual letter to insurance carriers who participate in the program last spring, the agency announced that it will require insurers to expand their fertility coverage to include assisted reproductive technologies like in vitro fertilization, artificial insemination and drugs associated with those procedures.

But a group of Democrats led by Rep. Gerry Connolly, D-Va., and Sen. Tammy Duckworth, D-Ill., said in a letter to OPM Director Kiran Ahuja that the recently announced changes don’t do enough to fill gaps in existing coverage related to the diagnosis of infertility, and could leave LGBTQ+ federal workers behind.

“It has come to our attention that the current definition, as outlined in the 2015 technical guidance, is outdated and lacks inclusivity, particularly for the LGBTQ community,” they wrote. “As members of Congress invested in recruiting and retaining the most effective federal workforce, we would like to thank you for the Office of Personnel Management’s continued commitment to expanding coverage of fertility health care, including assisted reproduction for federal employees. By modernizing FEHB policies to make family building more affordable and inclusive, we ensure the federal government remains a competitive employer.”

At issue is the fact that under the current OPM definition of infertility, women without male partners or otherwise “exposure to sperm,” patients must undergo six unsuccessful cycles of artificial or intrauterine insemination in order to receive a diagnosis. But those procedures, which can cost anywhere between $500 and $4,000 per cycle, not including the cost of donor sperm, aren’t actually covered by FEHBP unless they have already been diagnosed with infertility, creating a catch-22 for federal workers trying to get pregnant.

“This definition does not consider the evolving landscape of family building and the diverse needs of individuals who require fertility health care to build their families,” the lawmakers wrote. “States and employers across the country are recognizing the importance of inclusive policies and the Federal Employees Health Benefits Program must keep pace with these advancements.”

The lawmakers noted that Illinois, Maine and a number of major private sector employers have updated their own definitions of infertility for the purposes of insurance coverage in recent years to better cover the diagnosis process and to be more inclusive of same-sex and other LGBTQ+ couples.

“The number of cycles required in the definition does not take into account an infertility diagnosis that may occur when a patient is evaluated, leading to inconsistent and unequal coverage for individuals seeking alternative methods of conception,” they wrote. “Furthermore, this policy creates unnecessary barriers and costs for LGBTQ people by excluding consideration of at-home inseminations. Second, the definition fails to account for same-sex couples and single individuals. By limiting coverage to these individuals only after six cycles of insemination with donor sperm, we are effectively denying them access to necessary fertility treatments, placing an undue burden on their path to parenthood.”

OPM is slated to finalize changes to the FEHBP for 2024 this fall when it announces the annual open season, during which federal workers can change their insurance enrollments for the coming year.