October 24, 2024

OLYMPIA, Wash. — Washington state Insurance Commissioner Mike Kreidler has announced that expanded coverage for human donor milk, hearing aids and artificial insemination will be included in the state’s essential health benefits plan. 

Some benefits were also revised to ensure plans do not discriminate based on disabilities or health conditions. The changes take effect in plan years starting on or after January 1, 2026.

The benefits include:

• Coverage for human milk for inpatient use, when an infant is unable to receive maternal milk or when the parent is unable to produce maternal milk in sufficient quantities or caloric density.
• Coverage for hearing exams, or hearing aids in each ear, every three years.
• Coverage for artificial insemination in vivo, a fertilization treatment in which fertilization occurs internally as opposed to externally and in a lab. 

“These benefits could be necessary for parents, or prospective parents, and are important coverages to add to our health plans,” Kreidler said. “My office has worked hard to strengthen health insurance coverage and to the people who will need them, these will be crucial changes.”

The Affordable Care Act requires individual and small group health plans to cover a set of essential health benefits, but states can make additions to their specific benchmark plan by submitting an application to the Federal Centers for Medicare & Medicaid Services (CMS). 

The Office of the Insurance Commissioner received approval for the changes from the CMS on October 7.