The departments of Labor, Health and Human Services, and Treasury proposed a rule that would allow employers to offer standalone IVF and infertility treatment plans as a separate, limited excepted benefit (like dental or vision).
Why it matters: The rule, following guidance, would enable employers to offer meaningful fertility coverage, including self-funded, outside of Affordable Care Act (ACA) major medical requirements and limitations.
The Proposed Rule: Under the proposal, fertility benefits would be exempt from ACA market reforms, HIPAA mandates, and No Surprises Act requirements if they meet a few conditions:
- All benefits go to diagnosis, mitigation, or treatment of infertility and related reproductive conditions.
- A combined lifetime cap of $120,000 per participant and beneficiaries, indexed for inflation after 2028.
- Participants get a plain-language notice describing coverage, limits and claims procedures.
- Abortion and abortion-related services are explicitly excluded.
Increasing access to fertility benefits:
If finalized, DOL estimates the Rule would roughly double the number of employers offering fertility benefits from ~268,000 to ~523,000 and bring coverage to about 750,000 enrollees a year.
- Surveys have found that as many as 40% of U.S. employers are already offering fertility benefits, a number that has steadily increased over the last 5 years.
CHRO Considerations:
- For companies that already offer fertility benefits under major-medical coverage, CHROs will need to layer new standalone benefits on top of existing coverage or replace it.
- CHROs should evaluate how the Proposed Rule’s $120,000 cap compares to current vendor spend.
- When designing new benefits under the proposal, avoid eligibility language that could be potentially discriminatory against LGBTQ+ employees.
