Committee refers infertility coverage proposal to HERC for consideration

Delegate Helmer presented a substitute for HB 1609 that would ask the Health Benefit Review Commission (HERC) to consider insurance coverage for infertility services as part of the essential health benefits review. He recounted his sister’s experience of moving to Maryland to obtain infertility coverage and said he wants that option available to Virginians.

Why it matters: Supporters, including the Leukemia and Lymphoma Society, noted cancer patients can lose fertility to lifesaving treatment and face large out-of-pocket costs to preserve fertility. HERC’s role is to review benefit proposals and report on costs and impacts; the bill is structured to send the coverage proposal to HERC rather than immediately mandate inclusion.

Delegate Helmer described the substitute as creating a presumptive consideration by HERC, leaving the commission authority to decline with justification. Doug Gray of the insurance industry reminded the committee there are actuarial budget limits on adding essential benefits and cautioned members about the tradeoffs inherent in adding benefits to the essential health package.

The committee voted to lay the bill on the table with an instruction that the chair send a letter to HERC; the motion was seconded and approved by recorded roll call. The transcript records the committee disposition as recorded and the bill will await HERC’s review and any further appropriations steps.