# 2017-004 Medical and Dental Care, In Vitro Fertilization

Case Summary

F&R Date: 2017–03–30

The grievor, and his civilian spouse who was insured by the Public Service Health Care Plan (PSHCP), were prescribed in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) as the only option to treat the grievor's male factor infertility. Although the ICSI treatment for the grievor was covered under the CAF Spectrum of Care (SoC), the IVF portion was not covered for the grievor's spouse under the PSHCP since she did not suffer from an infertility issue.

The grievor argued that the provinces of Ontario and Quebec, which make up 61% of the Canadian population, both cover the cost of at least one cycle of IVF at public expense. He contended that the SoC should provide the same coverage to CAF members. He also stated that to exclude IVF from the ICSI treatment results in a meaningless treatment, given that one cannot be performed without the other. He requested that the IVF portion of his ICSI treatment be funded by the CAF.

The Commander Canadian Forces Health Services Group, acting as the initial authority (IA), denied the grievance. He stated that the SoC does not reimburse all health services. He noted that, for infertility treatments, only some services are funded and only those attributable to a CAF member. The IA noted that the SoC funds IVF for female members and ICSI for male members. As such, he found that IVF is not funded by the SoC in the grievor's circumstances. The IA acknowledged that there was a difference between infertility benefits in the CAF and those provided by the province of Ontario. However, he noted that the province of Ontario provides these benefits under a social program since infertility treatment was removed as an insured service, whereas the SoC is based on medical need. He also pointed out that the province of Quebec's prior program was scaled back and now provides some relief through tax credits.

The Committee reviewed the SoC, which only funds IVF for a CAF member who suffers from bilateral blocked fallopian tubes. Given that the grievor's spouse was not a CAF member, the Committee found that the CAF has no obligation to cover the cost of IVF despite both procedures being required to complete the treatment.

The Committee recommended that the grievance be denied.

FA Decision Summary

There is no Final Authority decision as the grievor withdrew the grievance.