Insurers Would Be Required to Cover Expanded Infertility Care Under Proposed Illinois Laws

(StockSnap / Pixabay)(StockSnap / Pixabay)

Illinois Sen. Cristina Castro isn’t known as reserved.

Thanks to our sponsors:

View all sponsors

She forcefully runs the Illinois Senate’s executive committee and has been the lead sponsor of legislation that requires complex negotiations, including a 2019 pension consolidation law.

One of her latest bills is different.

It’s “uncomfortable.”

“Difficult to talk about,” she said.

“It took a lot for me to tell you my story right now,” Castro, a Democrat from Elgin, said at a Feb. 7 news conference as she talked about her proposal (Senate Bill 2572) to require businesses to cover expanded infertility diagnoses and treatment.

Illinois law requires Illinois-based and group insurance plans that cover pregnancy services for 25 or more employees to also cover diagnoses and treatment of infertility.

Since 2022, the definition of “infertility” was expanded in state statute (House Bill 3709 / Public Act 102-0170) so that members of same sex couples or single people wouldn’t be excluded. The expansion also included women 35 and older who’d been having unprotected sex for at least six months, and those who a doctor deemed could have fertility issues based on medical history or testing. Previously, the law required insurers to cover infertility after a couple had unsuccessfully tried to conceive for a year.

Castro wants to broaden what insurers must cover when it comes to infertility, explicitly stating that covered services include preimplantation genetic screening, in vitro fertilization (IVF) and other procedures, as well as weight loss medicine and glucose treatments that can help with fertility.

She also seeks to ease restrictions on egg (or oocyte) retrievals.

“Many women in Illinois struggle to afford the care needed to diagnose and treat (infertility),” Castro said. “I was actually one of those people.”

Pregnancy is likely not in the cards for her, Castro said, “but it became a very expensive process for my husband and I, and I am not alone.”

At a time when Illinois Democrats have focused on protecting the right to an abortion, Castro said it’s important that the state also turn attention toward other aspects of reproductive care.

Her proposal looks to another plank of women’s health care that’s rarely talked about in the open: menopause.

Policies would have to cover, without a copayment or deductible, an annual health care visit for menopause for anyone age 45 or older.

Castro’s bill is one of several before the Illinois General Assembly that seeks to expand access to fertility treatments.

Another proposal (Senate Bill 2639), sponsored by state Sen. Mike Hastings, D-Frankfort, would clarify that insurance companies must follow a doctor’s recommendation for treating infertility, rather than requiring tests and procedures before moving onto other options, like IVF, which broadly means fertilization done in a lab.

Hastings said the idea came after a constituent’s doctor recommended IVF, but her insurer required three rounds first of intrauterine insemination (IUI), which has sperm directly injected into a uterus.

That ended up costing the woman time she may not biologically have, and it took an emotional toll.

“It’s a rollercoaster of chaos” to go through, Hastings said, adding that a doctor should make determinations on the best approach rather than an insurance company.

He knows something about it firsthand.

Hastings credited IVF with the “blessing” of his daughter.

Another measure (Senate Bill 2623), brought by state Sen. Natalie Toro, D-Chicago, requires insurers to cover elective egg preservation.

Illinois mandates (Public Act 100-1102) fertility services be covered for “iatrogenic infertility” — for instance, so that cancer patients can have their eggs frozen before receiving chemotherapy or radiation, which could harm the eggs and chances for natural conception.

Toro’s bill extends coverage to anyone who wants to freeze their eggs.

It requires insurers to cover “standard fertility preservation services” like cryopreservation, and mandates that insurers not discriminate based on age, sex or marital status.

Toro, who is 36, said she and many of her friends, have “profound anxiety about running out of time to start a family.”

But she said it’s expensive, quoting a price around $15,000 out of pocket.

“Having the option to have a family later in life, especially when people with uteruses have felt like we have limited time, is life-changing,” Toro said. “People should not have to incur these radically high costs when making choices about their reproductive health care, especially as these costs disproportionately impact women.”

According to Illinois insurers, Illinois would be the first state to require blanket egg freezing coverage should Toro’s plan become law.

Laura Minzer, director of the Illinois Life and Health Insurance Council, said Illinois was on the forefront of fertility coverage and that companies “want to work with” the legislators.

“We just anticipate and hope there will be some changes to make sure that we’re balancing those goals with the cost implications,” she said, noting that expanding coverage will “inevitably increase premiums.”

Any action by Illinois lawmakers will only go so far.

Most people who get insurance through their employer have large, self-insured plans that are subject to the Employee Retirement Income Security Act (ERISA), regulated by the U.S. Department of Labor.

The senators’ package applies to certain state-regulated health insurance plans, like individual, family and small group plans and those sold on the Affordable Care Act marketplace.

Minzer estimates about 30% of the privately insured market would benefit from the proposed fertility changes.

Early discussions between legislators and insurers recently got underway.

Regardless of where those discussions go, Castro said she’s had a lot of people reach out — with questions or in solidarity — since she went public with her fertility struggles.

Even though it was hard to share, Castro said she’s nonetheless now happy to share her story.

“Some people feel it’s a stigma, and I don’t want people to feel like it’s a stigma,” Castro said. “There’s great treatment out there. We’re just trying to help lower the barrier to that treatment.”

“Until you go through it,” she said, “you don’t realize how intensive it is and how intense it is.”

Contact Amanda Vinicky: @AmandaVinicky[email protected]

Thanks to our sponsors:

View all sponsors

Thanks to our sponsors:

View all sponsors