Now that Senate Bill 600 has passed, health insurance companies in California will be required to cover specific fertility preservation treatments as a basic healthcare service.
Specifically, SB 600 requires insurers to cover fertility preservation when a medical treatment causes iatrogenic infertility, defined as “infertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment.”
The bill is said to clarify the existence of coverage that was already a requirement and is succinct. You can review the law in its entirety by clicking here.
History
Prior to the passing of SB 600, insurers were required to offer infertility benefits, but not necessarily pay for it.
Supporters of the bill argued that infertility is a basic healthcare service, and SB 600 was proposed to force carriers to cover certain fertility preservation services. Those who opposed the bill suggest this was never clearly required by insurers.
Fertility/Infertility coverage has been an emerging trend amongst best in class employers. This also appears to be a hot topic in legislation as well, as seen in another fertility bill proposed under CA AB 767.
This bill proposed to require Covered CA to develop options for the inclusion of IVF as part of or supplement to their current options.
Who must comply?
All group health plan contracts issued in the State of California, except Medi-Cal.
When is it effective?
Immediately. The language in the law implies this was already an existing requirement. Therefore, any past claims of this type could be arguably covered under a group health plan.
Why is there a new law if this was already a requirement?
This is where it gets interesting. The insurers and parties opposed to the bill did not agree that existing law mandated such type of coverage. Supporters of the law disagreed, and to rectify the conflict, the law was passed to ensure the State of CA could take action against insurers who don’t comply.
Action needed?
Insurers are working on updating their contracts for each group health plan as it renews its coverage. As contracts become available, the group health Summary Plan Description should be amended and updated where applicable.
Currently, a little more than 4 percent of enrollees reported to the The Department of Managed Health Care (DMHC) or California Department of Insurance (CDI) have coverage for infertility treatments, including In-Vitro-Fertilization (IVF).
Stay tuned as Bolton keeps you up to date with other laws passed relating to this topic. If you have any questions regarding this topic, please feel free to contact me.
