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Despite new state law, Denver school district exempt from covering IVF

Exempt from state law are large employers whose health benefit plans are self-funded. 
ivf
Alison Yocum Johanson, a fifth grade teacher at Trevista at Horace Mann elementary school in northwest Denver, said not offering fertility benefits “feels a bit like a betrayal.”Melanie Asmar / Chalkbeat

Editor's note: This story was originally published by Chalkbeat Colorado, a nonprofit news site covering educational change in public schools. Sign up for its newsletters here: ckbe.at/newsletters

After a year of trying to start a family, Denver teacher Alison Yocum Johanson’s doctor told her that her next step in trying to get pregnant is in vitro fertilization. 

But when Yocum Johanson asked Denver Public Schools’ human resources department if her insurance plan covered IVF, she was told it does not. 

“It’s just too darn expensive,” an HR department staff member said in a voicemail to Yocum Johnanson that she shared with Chalkbeat. “Even with the new state mandate, schools are allowed to opt out if they would like to. So we have opted out of participating in covering it.”

The new state mandate is a law passed by Colorado legislators in April. Starting Jan. 1, it requires large employer health benefit plans to cover the cost of fertility treatments, which can cost tens of thousands of dollars.

But there’s a catch. Exempt from state law are large employers like Denver Public Schools whose health benefit plans are self-funded, meaning that the employer takes on the risk, collects the premiums, and pays the insurance claims. 

Yocum Johanson had no idea that her Kaiser insurance plan, which covers both her and her husband, was self-funded. It’s not uncommon for employees not to know. Employers often contract with an insurance company like Kaiser to process claims or run a nurse advice line, and employees’ insurance cards will have the name of that company on them.

The initial shock of discovering she’d need IVF was compounded when she learned its cost would not be covered or shared by the district where she has worked for a decade.

“You have a workforce of mainly women who give their all to make sure the children of this community are taken care of, are loved, are taught,” said Yocum Johanson, who teaches fifth grade at Trevista at Horace Mann elementary school in northwest Denver. “To see that the women who are doing this work are not taken care of by their employers, it feels really unfair. 

“It feels a bit like a betrayal.”

In a statement, Denver Public Schools said its coverage for infertility is “limited to diagnosing and treating underlying medical conditions.” That means the district’s coverage for IVF is far more limited than it would be if it had to follow the new state law, which applies more broadly to people who have tried and failed to get pregnant with their partner, as well as to people who are single or unable to reproduce with their partner.

Several other large public employers in Colorado with self-funded plans have decided to start covering fertility services even though they’re exempt from the state law. The University of Colorado began offering fertility benefits on July 1, said spokesperson Ken McConnellogue.

“Our employees have been requesting the benefit and we strive to listen to our employees, deliver benefits they want where we can, and be an employer of choice,” he said by email.

Similarly, Colorado’s Division of Human Resources will recommend that the self-funded plan that covers state employees begin offering fertility benefits in July 2023 at the start of the new fiscal year, said spokesperson Doug Platt. The cost must ultimately be approved by lawmakers. 

The state also offers a traditional fully-insured plan that must begin offering fertility benefits at the same time to comply with the new law.

Jeffco Public Schools and Douglas County School District, which are the second- and third-largest school districts in Colorado behind Denver, also have a mix of self-funded and fully-insured plans. Both districts will add fertility benefits to their fully-insured plans but haven’t yet decided whether to add them to their self-funded plans, according to district spokespeople.

Michelle Long, a senior analyst for women’s health policy at the Kaiser Family Foundation, said more employers across the country are beginning to offer fertility benefits. But the issue doesn’t have as much traction as other family-related benefits, such as paid leave, she said.

In 2020, Colorado became the first state in the country to approve a state-run paid family and medical leave program at the ballot box rather than through a vote by state lawmakers. The FAMLI program is set to go into effect in 2024. 

But school districts can vote to opt out of FAMLI — and several have done so, including Denver. The district’s rationale is that it already provides paid leave, and it would cost an additional $3.25 million a year to participate. The cost of FAMLI is split between employers and employees, who can opt in individually even if their employer opts out.

However, Long said that opting out of paid family leave programs and not offering fertility benefits “seems like a major missed opportunity” for school districts.

Betsy Campbell, the chief engagement officer for RESOLVE: The National Infertility Association, said employers don’t often add fertility benefits until employees ask for them.

“No one plans on having infertility, so when you then find out, you start paying attention to that benefit and realize, often, that it’s not there,” Campbell said. “By pointing out this gap in coverage, employers, we see time and time again, even one person making the ask, they’ll provide these benefits because there are a lot of reasons to do it.”

While Campbell said many employers are worried about cost, a recent study commissioned by RESOLVE that surveyed 254 employers that offer at least some fertility benefits found that 97% said it didn’t significantly raise their costs.

Yocum Johanson doesn’t yet know how much IVF will cost her and her husband. At an initial consultation this week, the clinic gave her an information sheet with estimates of up to $20,000 per cycle, not counting the costs of testing, medication, and anesthesia.

Because her Denver Public Schools health insurance plan doesn’t cover it, Yocum Johanson said the price tag means she and her husband will start “this next step of our journey in debt.”

“Starting a family is expensive, so we planned for that,” said Yocum Johanson, whose husband is self-employed as a financial advisor. But, she said, unexpectedly “covering 100% of IVF costs is such a daunting thing that hangs over my head and causes so many sleepless nights.”

Correction: This story has been updated to reflect that Douglas County School District hasn’t yet decided whether to add fertility benefits to its self-funded health insurance plan. A previous version of the story said it was adding the benefits.

Melanie Asmar is a senior reporter for Chalkbeat Colorado, covering Denver Public Schools. Contact Melanie at masmar@chalkbeat.org.

 

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Chalkbeat is a nonprofit news site covering educational change in public schools.