SSB 5121
In CommitteeSenate
Fertility-related services
Concerning health plan coverage of fertility-related services.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill requires most group health plans and state employee health plans to cover infertility diagnosis and treatment, as well as fertility preservation services, beginning in 2026 and 2027. It also requires Medicaid to cover fertility preservation. The goal is to reduce disparities in access to care, especially for marginalized groups, and improve health outcomes for families.
- Starting January 1, 2026, group health plans and state employee health plans must cover standard fertility preservation services (e.g., egg or sperm freezing) for people at risk of infertility due to medical treatment.
- Starting January 1, 2027, group health plans and state employee health plans must cover diagnosis and treatment of infertility, including up to two oocyte (egg) retrievals with unlimited embryo transfers, following medical guidelines.
- Coverage must be provided to enrollees and their dependents (including spouses and non-spouse partners) at the same level as other pregnancy-related care, with no extra copays, deductibles, or exclusions for fertility-related services.
- Plans cannot impose stricter rules on fertility medications or services based on who provides or receives them (e.g., third-party reproduction like donors or surrogates).
- Medicaid (Apple Health) must cover fertility preservation services starting in 2026, and may cover infertility treatment in 2027—subject to state implementation.
Who is affected
- State and private-sector employees with group health insurance — Employees and their dependents enrolled in state-sponsored group health plans (e.g., Washington State Health Benefit Exchange plans, employer-sponsored plans) will gain coverage for infertility diagnosis, treatment, and fertility preservation starting in 2026–2027.
- Low-income individuals enrolled in Medicaid (Apple Health) — Medicaid (Apple Health) enrollees will gain access to fertility preservation services starting in 2026, and may gain infertility treatment coverage in 2027, depending on implementation by the Department of Social and Health Services (DSHS) or managed care organizations.
- Patients facing medical treatments that threaten fertility — People undergoing cancer treatment or other medical therapies that risk fertility (e.g., chemotherapy, radiation) will be able to access covered fertility preservation services like egg or sperm freezing.
- People experiencing infertility — Couples or individuals experiencing infertility—including single people, LGBTQ+ individuals, and people of color who face disparities in access—will gain broader insurance coverage for evaluation and treatment.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
Mandating coverage for standard fertility preservation services for patients at risk of infertility due to medical treatment (e.g., cancer patients) directly improves access to time-sensitive, preventive care — particularly beneficial for low-income and marginalized patients who otherwise might forgo treatment due to cost.
HealthcarePeopleRef: Sec. 2(1), Sec. 3(1), Sec. 4(1)Mandating coverage for infertility diagnosis and treatment (including two oocyte retrievals) reduces financial barriers to care, especially for LGBTQ+ individuals, single people, and people of color who face systemic disparities in access to reproductive care — aligning with the bill’s stated goal of reducing inequities.
HealthcarePeopleRef: Sec. 2(2), Sec. 3(2)Requiring parity with pregnancy-related benefits (no extra copays, deductibles, or exclusions) ensures that fertility services are treated as essential health care, not elective — reducing stigma and improving equity in coverage design.
HealthcarePeopleRef: Sec. 2(3), Sec. 3(3), Sec. 4(2)Prohibiting exclusions for third-party reproduction (e.g., donor gametes, surrogacy) expands access to family-building for same-sex couples, single individuals, and others who rely on assisted reproduction — directly benefiting historically underserved groups.
HealthcarePeopleRef: Sec. 2(4)(b), Sec. 3(4)(b)Expanding the definition of infertility to include inability to reproduce as a single person or with a partner without medical intervention, and recognizing disability-based infertility, ensures broader eligibility and reduces discriminatory exclusions — directly supporting LGBTQ+, disabled, and single individuals seeking care.
HealthcarePeopleRef: Sec. 2(5)(b), Sec. 3(5)(b)
Potential Concerns (5)
The bill requires that infertility coverage be provided at the same level as pregnancy-related benefits, but does not specify how this will be funded — potentially increasing premiums or premiums for employers and enrollees without offsetting revenue. While the bill notes potential long-term savings, no fiscal impact estimate is provided, leaving cost burden uncertain.
HealthcareRef: Sec. 2(3), Sec. 3(3), Sec. 4(2)Prohibiting different deductibles, copays, or coinsurance for infertility services may reduce out-of-pocket cost predictability for some patients, but could also compress margins for insurers and employers, potentially leading to broader premium increases across all services.
HealthcareRef: Sec. 2(4)(c), Sec. 3(4)(c)Limiting infertility treatment coverage to two oocyte retrievals with unlimited embryo transfers may not align with clinical need for all patients — some individuals may require more retrievals for successful outcomes, especially those over 35 or with diminished ovarian reserve.
HealthcareRef: Sec. 2(2), Sec. 3(2)Medicaid coverage for fertility preservation is mandated, but coverage for infertility treatment is permissive and subject to state implementation — creating uncertainty for low-income enrollees and potentially leaving them with incomplete coverage compared to private plans.
HealthcareRef: Sec. 4(1)Prohibiting exclusions for third-party reproduction (e.g., donor eggs, surrogacy) expands access, but may increase utilization and costs for plans that serve populations less likely to use these services — potentially leading to risk-pooling distortions and premium increases.
HealthcareRef: Sec. 2(4)(b), Sec. 3(4)(b)
Who Is Most Affected
Employees and dependents in group health plans gain access to infertility and fertility preservation coverage, reducing out-of-pocket costs and expanding family-building options — especially beneficial for LGBTQ+ individuals, single people, and those facing medical threats to fertility.
Low-income Medicaid enrollees gain access to fertility preservation (mandated) and possibly infertility treatment (permissive), reducing disparities in access — though implementation uncertainty may limit full benefit realization.
Patients undergoing cancer treatment or other fertility-threatening therapies gain access to covered fertility preservation, preserving future reproductive options — a critical health and equity advance for vulnerable populations.
People experiencing infertility, especially marginalized groups (LGBTQ+, people of color, single individuals), benefit from expanded coverage and inclusive definitions — directly addressing documented disparities in access and outcomes.