The City Council is urging Mayor Eric Adams to change rules under the city’s health plan that it says deny coverage for gay male couples looking to start a family.
Although the city’s health plan covers fertility benefits including in-vitro fertilization, which fertilizes eggs in a lab, Council members say that gay male couples can’t access the benefits because they don’t meet an outdated definition of infertility.
The city’s insurance plan covers up to three cycles of assisted reproductive treatments, which can include IVF. But under state law mandating fertility benefits, employees are required to prove that they have a diagnosis of infertility to get that coverage, meaning that they are unable to get pregnant after a year of unprotected sex.
That definition can include heterosexual couples, same-sex female couples and single women but it prevents gay male couples from qualifying for coverage, the Council said.
A new bill sponsored by Councilwoman Lynn Schulman, who represents parts of eastern Queens, is trying to expand IVF coverage to gay men. The proposal would require the city to cover the costs of IVF or other fertility treatments regardless of an infertility diagnosis, which Schulman said would effectively prevent discrimination based on people’s marital status or sexuality.
“It’s clear that confusion remains over what is covered and how much is covered,” Schulman said at a hearing on Tuesday. The new legislation would clarify the criteria and costs, ensuring people are not denied coverage, she added.
The city refuted claims that its current insurance practices are discriminatory. An infertility diagnosis, for instance, is not the only pathway to obtain coverage for IVF, said Daniel Pollak, first deputy commissioner at the Office of Labor Relations.
All individuals receive the same benefits regardless of their sexual orientation, Pollak said. But he noted that the city does not pay for procedures performed on individuals who aren’t covered by its health plan, making the costs of obtaining a surrogate to carry a pregnancy or a sperm donor ineligible for reimbursement.
The city has stopped short of covering those procedures because of the costs, Pollak added. A donor egg could cost anywhere from $10,000 to $30,000, and frozen sperm could cost up to $3,000.
Of the $11 billion the city spends on health benefits each year, about $50 million goes towards fertility benefits, according to Pollak. Roughly 3,000 municipal workers, dependents and retirees use fertility benefits, approximately 3% of the city’s total covered population.
The Council is not the only party pushing back on the city’s coverage practices. The Adams administration is also facing a class action lawsuit filed by Corey Briskin, a former Manhattan assistant district attorney, and his husband Nicholas Maggipinto, who said they were not eligible for IVF coverage because neither was diagnosed with infertility.
“For most city employees who earn modest salaries, it’s impossible to grow their families through IVF without coverage,” Briskin testified at Tuesday’s hearing. Briskin and his husband were forced to delay having children for years due to the cost, he said.
The average individual in the U.S. pays roughly $15,000 for a single cycle of IVF, according to the Association of Reproductive Medicine. People must often go through more than one cycle before they successfully have a baby.
Briskin added that the city’s claim that an infertility diagnosis is not needed to receive IVF coverage is inconsistent with what he and his husband were told when they were first denied coverage back in 2021, and called for clarity and equity in coverage policies.
The attention on fertility coverage comes as IVF has become a target of the anti-abortion movement. U.S. Senate Republicans voted last week to shut down a bill that would have protected access to IVF, on the same day that the Southern Baptist Convention – the country’s largest Protestant denominations – voted to oppose the procedure.
Amanda D'Ambrosio , 2024-06-18 19:55:54
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