This bill adds new sections to chapters 48.43 RCW, 41.05 RCW, and 74.09 RCW to require insurance coverage related to infertility and fertility preservation. For group health plans other than small group plans and for health plans offered to employees under chapter 41.05 RCW, the bill requires coverage of standard fertility preservation services beginning January 1, 2026, and requires coverage of diagnosis and treatment for infertility beginning January 1, 2027. The infertility treatment coverage expressly includes coverage for two completed oocyte retrievals with unlimited embryo transfers according to American Society for Reproductive Medicine (ASRM) guidelines, and use of single embryo transfer when recommended and medically appropriate. The Health Care Authority must provide coverage for standard fertility preservation services and Medicaid managed care organizations are subject to the same limitation and parity rules described below. The act creates parity and procedural rules: group and employee health plans may not impose exclusions, limitations, or restrictions on fertility medication coverage or on fertility services based on participation by or to a third party that differ from those applied to other prescription drugs or services not related to infertility. Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or other limitations for infertility diagnosis, treatment, and standard fertility preservation services must not differ from limitations on non‑infertility services, and benefits must be provided to enrollees (including covered spouses and nonspouse dependents) to the same extent as other pregnancy‑related benefits. The bill defines key terms such as “diagnosis of and treatment for infertility,” “infertility,” “regular, unprotected sexual intercourse,” and “standard fertility preservation services,” and references professional guidelines from ASRM, ACOG, and ASCO. The bill may be cited as the “Washington state building families act,” and grants the Office of the Insurance Commissioner rulemaking authority to implement, administer, and enforce section 2 of the act. The text provided leaves some details unclear: the specific new RCW section numbers are not given; “small group health plans” is referenced but not defined here; several provisions except unspecified exceptions by saying “except as provided in this section”; and it is not stated whether the insurance commissioner’s rulemaking authority extends beyond section 2.

If enacted, larger employer group health plans and state employee plans must begin covering fertility preservation services starting January 1, 2026, and must add diagnosis and treatment for infertility, including coverage for two completed oocyte retrievals with unlimited embryo transfers (following ASRM guidance) starting January 1, 2027. The Health Care Authority and Medicaid managed care organizations will also be required to cover fertility preservation services, and plans may not treat fertility medications or services with different deductibles, copays, coinsurance, waiting periods, or benefit maximums than other medical services. The practical effect will fall most heavily on insurers, the Health Care Authority, Medicaid managed care organizations, and employers who sponsor non‑small group plans, who will need to absorb or pass along higher claim costs and adjust plan designs to ensure parity for fertility care; state budgets or premiums for employer plans may increase as a result. Important details are missing here that could change the scope and cost impact: the bill excludes "small group" plans without defining them in these excerpts, it references unspecified exceptions and new RCW section numbers, and only authorizes the insurance commissioner to adopt rules for one section, so implementation specifics and budget authority remain unclear.