DC fertility coverage as of Jan 1, 2025

[Anonymous]

Has anyone seen their private insurance in DC that started to offer it? I asked my company and they had no idea the law was taking effect. It does make it seem like every private insurance has to cover IVF, correct?

Effective January 1, 2025, District of Columbia law (B25-34) requires that fully insured DC individual and group health plans (including grandfathered plans) provide coverage for the diagnosis and treatment of infertility, including, artificial insemination, in vitro fertilization, and standard fertility preservation services. Self-insured plans may opt in to these benefits. Treatment must be consistent with the physician’s or surgeon’s overall plan of care.

https://code.dccouncil.gov/us/dc/council/code/sections/31-3834.06

Here's CareFirst info on it as well: https://provider.carefirst.com/providers/news/2024/10/new-dc-infertility-legislation-effective-january-1/#:~:text=Coverage%20for%20in%20vitro%20fertilization,under%20the%20prescription%20drug%20benefits.

[Anonymous]

Really surprised not more people are commenting about this! I had no idea that this was the case and planned to do it out of pocket. They ran my issuance last year and gave me the price for out of pocket. I’m about to start a FET and they sent me the OOP price to pay. Then they reran my insurance (I didn’t ask, they just reran it on their own) and told me all I had to pay was my deductible! This is amazing news for those of us with DC insurance!

[Anonymous]

Nice, glad it worked for you! I'm the OP, unfortunately I found out that even though I work in DC, my employee uses an out-of-state insurance, as our HQ is in a different state.

[Anonymous]

65% of workers are covered by a self insured medical plan which those plans do not have to comply. I also can't tell based on the wording of the statute if fully-insured plans with DC members but are written out of a different state cover - for example my husband's company offers a plan through BCBS of Alabama. Generally those plans do not have to comply with mandates for each state where members live, just the mandates for where the plan is written out of (in my example, the plan follows Alabama mandates...which are minimal.) Obtaining a plan through the Exchange would yield better results if you can't go the employer coverage route.

[Anonymous]

My insurance broker said that because there isn't money in the DC budget to cover the cost (not sure if that means just for DC employees or if they would subsidize all insurees in the district) the law is not going to be enforced at least through 2027. Sucks.

[Anonymous]

Anonymous wrote:My insurance broker said that because there isn't money in the DC budget to cover the cost (not sure if that means just for DC employees or if they would subsidize all insurees in the district) the law is not going to be enforced at least through 2027. Sucks.

So the coverage is just for DC govt workers?

[Anonymous]

Anonymous wrote:

Anonymous wrote:My insurance broker said that because there isn't money in the DC budget to cover the cost (not sure if that means just for DC employees or if they would subsidize all insurees in the district) the law is not going to be enforced at least through 2027. Sucks.

So the coverage is just for DC govt workers?

Federal Government doesn't have to follow DC rules.

DC is very business unfriendly so unless your employer has their HQ in DC it won't change.

[Anonymous]

What about federal government insurance?

[Anonymous]

I have BCBS Federal and got a frozen embryo transfer this year. The out of pocket cost would have been $4,000+ but I only paid around $150! The downside to the instance was the copay is $50 a pop and I had to pay that every monitoring appointment.

[Anonymous]

Anonymous wrote:I have BCBS Federal and got a frozen embryo transfer this year. The out of pocket cost would have been $4,000+ but I only paid around $150! The downside to the instance was the copay is $50 a pop and I had to pay that every monitoring appointment.

* Carefirst BCBS to be specific