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Denver teachers won’t benefit from new state law mandating fertility treatments

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

But when Yocum Johanson asked the Denver Public Schools Human Resources Department if his insurance plan covered IVF, he was told no.

“It’s just too expensive,” a staff member from the human resources department said in a voicemail message to Yocum Johnanson that she shared with Chalkbeat. “Even with the new state mandate, schools are allowed to opt out if they wish. We have therefore chosen not to participate in its coverage.

The new state mandate is a law passed by Colorado lawmakers in April. Starting Jan. 1, health insurance plans at major employers must cover the cost of fertility treatments, which can cost tens of thousands of dollars.

But there is a catch. Large employers like Denver Public Schools are exempt from state law, whose health benefit plans are self-funding, meaning the employer bears the risk, collects premiums, and pays insurance claims. .

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

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

“You have a predominantly female workforce who are giving their all to make sure the kids in this community are cared for, loved, educated,” said Yocum Johanson, who teaches fifth grade at Trevista at Horace Mann Elementary School northwest of Denver. . “To see that the women who do this work are not supported by their employers, it’s really unfair.

“It feels a bit like a betrayal.”

In a statement, Denver Public Schools said its infertility coverage is “limited to the diagnosis and treatment of underlying medical conditions.” This means that district coverage for IVF is much 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 people who are single or unable to reproduce with their partner.

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

“Our employees have asked for the benefit and we are working to listen to our employees, provide them with the benefits they want where we can, and be an employer of choice,” he said via email. -mail.

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, spokesman Doug Platt said. The cost must ultimately be approved by lawmakers.

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

Jeffco Public Schools and the Douglas County School District, which are the second and third largest school districts in Colorado behind Denver, also offer a mix of self-funded and fully insured plans. Both districts will add fertility benefits to their fully insured plans, but Douglas County also plans to add them to its self-funded plan, while Jeffco has yet to decide, according to district spokespersons.

Michelle Long, senior analyst for women’s health policy at the Kaiser Family Foundation, said more and more employers across the country are starting to offer fertility benefits. But the issue doesn’t carry as much weight as other family-related benefits, such as paid time off, she said.

In 2020, Colorado became the first state in the nation to approve a state-run paid family and medical leave program. at the polls rather than by a vote of state legislators. The FAMLI program is expected to come into effect in 2024.

But school districts can vote to opt out of FAMLI — and several have, including Denver. The reason for the neighborhood is that it already offers paid time off and it would cost an additional $3.25 million per year to participate. The cost of FAMLI is split between employers and employees, who can register individually even if their employer withdraws.

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

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

“Nobody plans to be infertile, so when you find out, you start paying attention to that benefit and you realize, often, it’s not there,” Campbell said. “Highlighting this gap in coverage, employers, we see time and time again, even a person who applies, they will provide these benefits because there are a lot of reasons to do so.”

Although Campbell said many employers are concerned about costs, a recent study commissioned by RESOLVE which surveyed 254 employers offering at least some fertility benefits found that 97% said it did not significantly increase their costs.

Yocum Johanson does not yet know how much IVF will cost her and her husband. During an initial consultation this week, the clinic handed her a fact sheet with estimates of up to $20,000 per cycle, not including the costs of tests, medications and anesthesia.

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

“Starting a family is expensive, so we’ve planned for that,” said Yocum Johanson, whose husband is self-employed as a financial adviser. 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.”

Melanie Asmar is a senior reporter for Chalkbeat Colorado, covering Denver Public Schools. Contact Melanie at [email protected].

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