Background on fertility benefits

Demand for fertility benefits from employer-sponsored health plans is on the rise. Plan sponsors also are offering fertility benefits as a competitive advantage to attract workers.

According to the International Foundation of Employee Benefit Plans’ Employee Benefits Survey: 2024 Report, 42 percent of U.S. organizations currently offer fertility benefits.

Percentages of Organizations Covering Types of Fertility Benefits

Source: International Foundation of Employee Benefit Plans, Employee Benefits Survey: 2024 Report

Plan sponsors that currently offer fertility benefits generally do so through their existing group health plans and pharmacy benefit managers (PBMs). Plans also can use several “carve out” fertility providers that offer managed fertility coverage benefits designed to improve coordination between medical and pharmacy benefits as well as fertility success rates and reduce maternal morbidity. Plans that use a “carve out” fertility provider generally carefully review prices with the provider and their PBM to ensure that they have most cost-effective coverage that also takes into consideration treatment needs, such as drug interaction programs. Some third-party administrators also offer a managed fertility benefit through their administrative services platforms. The new guidance does not affect any of these existing family-building benefit options.

Nineteen states mandate some form of fertility coverage for insured plans although what is required may vary by state. Employers in those states often mirror that coverage in self-insured benefit programs.

Additionally, employers offer family-building benefits through other programs, such as adoption benefits. For more information about family-building benefits see our article, “You Need an Inclusive Family‑Building Benefits Package.”

The new guidance identifies excepted benefit options

The new guidance, Affordable Care Act FAQ 72, which was issued on October 16, 2025, discusses how plan sponsors can use existing guidance to offer fertility benefits and states that the Departments are also considering whether to modify standards under which supplemental health insurance coverage can be expanded to include fertility coverage.

FAQ 72 discusses options for plan sponsors to offer fertility benefits through either an independent, non-coordinated excepted benefit or an excepted benefit Health Reimbursement Arrangement (HRA). However, these options are likely to be less flexible than the existing structures to deliver fertility coverage.

Independent, non-coordinated, excepted benefits

Independent, non-coordinated, excepted benefits are generally offered as specific disease insurance, such as a standalone cancer policy. An independent, non-coordinated, excepted benefit fertility benefit would have to be provided under a separate policy, certificate or contract of insurance, and could not be self-insured. It would also not be able to coordinate with any other parts of the group health plan and must pay benefits regardless of coverage under any other plans.

Fully insured fertility coverage is not commonly used in group health arrangements because the benefits can be offered under the existing group health plan. However, the guidance could result in new insured options with fertility-only benefits. The lack of ability to coordinate coverage with the existing group health plan or PBM could be an area of concern and should be carefully addressed during implementation.

Excepted benefit HRAs

An excepted benefit HRA could be offered to reimburse employees for fertility coverage costs. However, this type of HRA would have a dollar limit on reimbursement of only $1,800 adjusted for inflation ($2,150 for plan years beginning in 2025). For more information, see our June 14, 2019 insight.

Limited excepted benefits

Finally, FAQ 72 notes that benefits for coaching and navigator services to help participants and their dependents understand their fertility options could be offered under an employee assistance program (EAP) that qualifies as a limited excepted benefit.

To qualify as a limited excepted benefit, the EAP cannot:

• Be coordinated with benefits under another group health plan
• Require employee premiums or contributions as a condition of participation
• Have cost sharing
• Offer any fertility benefits that are significant benefits for medical care

Executive Order on IVF

The guidance is consistent with Executive Order 14216, “Expanding Access to In Vitro Fertilization,” issued in February 2025, which directed the Domestic Policy Council (DPC) to submit a list of policy recommendations to protect IVF access and reduce out-of-pocket and health plan costs for IVF treatment. See our February 25, 2025 insight on the Executive Order on IVF.

Modifying the cost of fertility medications

On October 16, 2025, the administration announced that a pharmaceutical manufacturer of medication used in IVF treatment, EMD Serono, will offer direct-to-consumer sales of its complete portfolio of IVF therapies — including Gonal-f^® (follitropin alfa injection), Ovidrel^® (choriogonadotropin alfa injection) and Cetrotide^® (cetrorelix acetate for injection) — to eligible patients with prescriptions at a significant discount off list prices. This could make IVF medications, which are often very expensive, more affordable.

EMD Serono will participate in the TrumpRx.gov direct purchasing platform, which will go live in January 2026. The administration has not provided information about how TrumpRx.gov will be structured and whether those negotiated prices would be available to group health plans or other insurance coverage.

Additionally, EMD Serono entered into an agreement with the U.S. Secretary of Commerce to exclude its pharmaceutical products and ingredients from tariffs, provided EMD Serono invests in manufacturing and research in the U.S.

Implications of the fertility guidance for group health plan sponsors

The number of organizations offering family-building benefits, including fertility coverage, continue to grow. The new guidance illustrates how employee benefit rules can be used to offer fertility coverage but, as a practical matter, these options may be challenging either because of limitations in funding or requirements to have a fully insured benefit.

Group health plans have a wide range of options for offering fertility coverage under their existing group coverage, particularly if they take advantage of fertility management services either offered through their TPA or a fertility carve-out. Plan sponsors that wish to offer an improved, cost-effective fertility benefit should discuss these options with existing service providers to determine if they are appropriate for their participants.