AN ACT Relating to providing coverage for the diagnosis of infertility, treatment for infertility, and standard fertility preservation services;
SB 5121 requires certain Washington health plans to cover fertility-related services, including diagnosis and treatment of infertility and standard fertility preservation services. The bill applies to group health plans and health plans offered to state employees and their dependents, and it also directs Medicaid coverage for standard fertility preservation services. Coverage for infertility treatment must include two completed oocyte retrievals with unlimited embryo transfers when medically appropriate and consistent with professional guidelines, and the bill specifies that covered spouses and nonspouse dependents must receive benefits to the same extent as other pregnancy-related benefits.
The bill defines key terms such as infertility, regular unprotected sexual intercourse, diagnosis and treatment for infertility, and standard fertility preservation services. It also limits insurers from imposing different restrictions on fertility medications than on other prescription drugs, and from using special deductibles, copays, coinsurance, benefit maximums, waiting periods, or other limits that are more restrictive than those applied to non-infertility services, subject to the bill’s exceptions. The act may be cited as the Washington State Building Families Act, and the insurance commissioner is authorized to adopt rules to implement and enforce it.
The bill would amend Washington insurance and health coverage law by adding new coverage mandates for group health plans, public employee health plans, and Medicaid-related coverage for fertility preservation. It would require insurers and health plans to treat infertility diagnosis and treatment, as well as standard fertility preservation services, as covered benefits under specified conditions, thereby expanding the scope of required health benefits and limiting plan design restrictions that could otherwise reduce access. The bill also creates definitions that would govern how these services are interpreted and administered, and it gives the insurance commissioner rulemaking authority to carry out the new requirements.
The available voting history suggests generally favorable committee sentiment toward the bill. In the Senate Committee on Health & Long-Term Care, the first substitute bill was recommended to do pass by a 10-1 vote, indicating broad support with limited opposition. No committee transcript excerpts were provided, so the record here reflects strong committee-level approval rather than detailed debate.
The main points of contention likely center on the cost and scope of mandated fertility coverage, including whether insurers and public plans should be required to cover two oocyte retrievals, unlimited embryo transfers, and fertility preservation services without more restrictive cost-sharing or utilization limits. Another likely issue is the breadth of the mandate across group plans, state employee plans, and Medicaid, as well as the inclusion of coverage protections for spouses and nonspouse dependents. The lone dissenting vote in committee suggests at least one member had reservations, but no transcript is available to identify the specific objection.