In Executive Order 14216, “Expanding Access to In Vitro Fertilization,” President Trump highlighted the importance of family formation and made it the policy of the Administration to ensure reliable access to IVF treatment, including by easing unnecessary statutory or regulatory burdens to make IVF treatment drastically more affordable.
In response to Executive Order 14216, the Departments of the Treasury, Labor, and Health and Human Services (the Departments) are now proposing to offer a new regulatory pathway for employers to provide fertility benefits as a new limited excepted benefit.
Top 5 benefits to employers
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More flexibility to offer fertility benefits
Employers could offer fertility benefits as a limited excepted benefit, rather than only through major medical coverage.
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Reduced regulatory burden
Excepted benefits are generally exempt from many market requirements under HIPAA, the ACA, the No Surprises Act, and related laws.
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Ability to offer fertility benefits even if employees do not enroll in major medical coverage
The proposal allows employees to access the fertility benefit without having to enroll in the employer’s other non-excepted group health plan, similar to standalone vision and dental.
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Benefit design flexibility
Employers can tailor coverage to include diagnosis, mitigation, and treatment of infertility, including potentially IVF and non-IVF services, subject to the proposed scope and $120,000 lifetime dollar limit.
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Potential workforce advantages
The rule would allow employers to offer a benefit option to attract young employees planning to start families of their own.
Top 5 benefits to workers
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Improved access to fertility services
Workers may gain access to coverage for diagnosis, mitigation, and treatment of infertility and infertility-related reproductive health conditions.
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Potentially lower out-of-pocket costs
Coverage could reduce the financial burden of high-cost fertility services, especially IVF and related testing, medications, and procedures.
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Access to a broad range of fertility care
The proposed benefit can include not just IVF, but also diagnostics, counseling, medications, surgical treatments, and services addressing underlying causes of infertility.
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Ability to enroll in fertility coverage without enrolling in employer major medical coverage
This may help workers who get medical coverage elsewhere, such as through a spouse, but still want fertility benefits.
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Clear information through required notice
Plans and issuers would have to provide a clear notice describing coverage, limits, provider access, and claims procedures.