N.H. to require insurance to cover fertility care

  • Sen. Martha Hennessey, D-Hanover, and other local Democrats hold a news conference about the state budget on the steps of City Hall in Lebanon, N.H., on March 18, 2019. (Valley News - Geoff Hansen) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Valley News File photo — Geoff Hansen

Valley News Staff Writer
Published: 7/4/2019 9:55:49 PM
Modified: 7/9/2019 11:52:41 AM

HANOVER — New Hampshire is about to expand health insurance coverage for fertility care by requiring group plans to cover it.

Lawmakers passed a bill to require the coverage last week, and Republican Gov. Chris Sununu intends to sign it, according to his spokesman.

State Sen. Martha Hennessey, D-Hanover, said she was motivated to sponsor the legislation, SB 279, after hearing stories of women in New Hampshire who have struggled to have children because of the cost of fertility care.

That struggle has led some of them to move south to Massachusetts, where insurance plans are required to cover the diagnosis of infertility and fertility treatments such as in vitro fertilization, which can cost approximately $15,000 per attempt.

“It’s that expensive,” Hennessey said. “It really touched me. I know for sure my life would be completely different if I hadn’t been able to have my three children.”

The legislation would require group insurance plans to cover the diagnosis and treatment of fertility-related conditions for all patients regardless of their gender, as well as fertility preservation for patients who are undergoing treatment such as chemotherapy that may affect their ability to have children.

The bill also would require insurers to cover storage of sperm, eggs and embryos for the length of the policy. Patients would be required to pick up the tab for storage after that.

The bill would apply only to the approximately 175,000 members covered by employer-sponsored health plans, not to people covered by individual plans purchased on the state health insurance exchange or to Medicaid, Jenny Patterson, life and health director at the New Hampshire Insurance Department, said in an email.

Among the members who would be affected by the new legislation are Bath, N.H., residents Sara Lang and Shawn Applebee. The couple has been struggling with infertility for three years without success. They went through one cycle of IVF to the tune of $12,000 for the procedure plus $4,600 for necessary medications. Though they were able to conceive a child, they lost it through miscarriage.

“It was really hard,” said Lang, a 38-year-old pediatric occupational therapist. “We didn’t have any viable embryos at the end of that cycle. (We) put everything that we could into that cycle.”

Though they’ve been saving up for another round, the need for a new roof on their house delayed them.

Finances are just one element of the challenges facing a couple struggling with infertility, said Lang, a Woodsville High School and University of New Hampshire graduate. They also struggle with emotional and logistical issues.

Since Dartmouth-Hitchcock Medical Center closed its fertility clinic in 2017, Lang has had to travel an hour and 40 minutes to a clinic in Colchester, Vt., for treatments. She has to schedule appointments around work and time she spends caretaking for her father, who had a stroke in recent years.

It’s worth it though, Lang said.

“I have wanted nothing more than to be a mom,” she said.

Though the couple has considered other paths to parenthood, surrogacy and adoption also carry hefty price tags, she said.

“As much as I do want to carry a baby, it’s also (one of) the more practical options,” she said.

Lang is self-employed but is covered by her husband’s employer-sponsored health insurance. She is looking forward to the governor signing the bill and the law going into effect on Jan. 1, 2020.

“At this point, any assistance at all would be helpful,” she said.

For Hennessey, the bill also helps to address one of the state’s top challenges — its labor force.

“We do need to be making this state a place that young people want to move,” she said. “Some are leaving because they get to the time in their lives when they want to have children; New Hampshire was not hospitable.”

Neither Vermont nor Maine currently require that health insurers provide coverage for fertility care. In Vermont, plans purchased through Vermont Health Connect include coverage for fertility screening and diagnosis but not treatment, Nissa James, director of communications and legislative affairs for the Department of Vermont Health Access, said in an email.

This summer, the Vermont Department of Financial Regulation is studying the benefits and costs of mandating that insurers cover fertility treatment, Stephanie Brackin, a department spokeswoman, said in an email.

Once SB 279 becomes law in New Hampshire, Davina Fankhauser, president of the Massachusetts-based nonprofit advocacy group Fertility Within Reach, said she thinks it will attract some young people from Vermont and Maine.

“For the economy, it’s going to be beneficial,” said Fankhauser, who lobbied in favor of the bill.

Kate Weldon LeBlanc, executive director of the Massachusetts-based nonprofit Resolve New England who also lobbied in favor of the bill, said she thinks the measure also will pave the way for an expansion of fertility services within the state.

Dartmouth-Hitchcock had no comment about whether the new legislation would allow it to resume providing fertility services at DHMC, spokesman Rick Adams said in an email.

But in a letter provided to the Senate Commerce Committee in February, Dr. Elisabeth Erekson, D-H’s interim chairwoman of the Department of Obstetrics and Gynecology, expressed her “strong support” for the bill.

She noted that “infertility is NOT an inconvenience; it is a disease of the reproductive system that impairs the body’s ability to perform the basic function of reproduction.”

Additionally, citing the federal Centers for Disease Control and Prevention, she said infertility affects about 11% of the reproductive-age population of women in the U.S. It affects men as well as women, she said.

“We strongly urge you to support this legislation that will improve … access to infertility services allowing them to achieve their dreams and grow their families,” Erekson wrote. “There are now treatments to help almost everyone have a baby.”

Some pieces of the bill as it was originally proposed did not survive, such as the length of time sperm and eggs gathered from people undergoing medical treatments that might affect their fertility could be stored. Surrogacy-related legal fees, compensation of a surrogate and the transfer of embryos to a surrogate also are not covered by the bill.

“We would love to have that covered in the future,” LeBlanc said.

After these changes, insurers seemed to come around to support the bill.

“I think it’s going to be something that we can do … make it operational without it being an undue burden,” said Dr. Bill Brewster, the vice president responsible for Harvard Pilgrim in New Hampshire.

Brewster, who said Harvard Pilgrim covers about 80,000 people through these employer-sponsored plans in New Hampshire, was not sure what the effect of the fertility coverage would be on premiums in New Hampshire. He cited a 2016 study in Massachusetts that found that fertility coverage costs about $4.50 per member per month.

Stephanie DuBois, a spokeswoman for Anthem, said she did not think the bill’s passage would have an effect on Anthem premiums in New Hampshire.

“Since Anthem already provides fertility benefits for the majority of our health plans, any impact will be muted for Anthem consumers,” DuBois wrote in an email.

Though the bill had bipartisan support and was co-sponsored by Republican state Sens. Jeb Bradley and Chuck Morse, it did have some opposition, particularly in the House, where the vote to approve it was 209-141. It was passed by a voice vote in the Senate.

Rep. John Hunt, R-Rindge, said he opposed the measure because he was concerned about the impact on premiums, especially for small businesses of what he called “the mother of all mandates.”

Because the bill does not apply to the individual market, Hunt said, this would be a direct hit on small businesses “who are the ones who are already overburdened by health care costs.”

But Hunt acknowledged in a phone interview Monday that he is in the minority, even within his own party. “Yes,” he said. “I’m tilting at windmills.”

Lang, the Bath woman hoping to become a mother, acknowledged that her premiums could go up as a result of the new legislation, but she said climbing premiums are nothing new and infertility is the only chronic illness she has.

“This will give families a chance in New Hampshire to grow,” she said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.


A New Hampshire bill requiring that group health insurance plans cover fertility care excludes surrogacy-related legal fees, compensation of a surrogate and the transfer of an embryo to a carrier. An earlier version of this story was unclear on this point.

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