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Requires individual and small-group health plans to include fertility treatment and care as an essential health benefit, covering services such as IVF, gamete preservation, artificial insemination, fertility medications, genetic embryo testing, and related services. Plans must treat fertility benefits the same as predominant medical/surgical benefits for cost-sharing and treatment limits, may not deny coverage because a person lacks a formal infertility diagnosis, and must report how they use utilization management tools. Applies to individual and small-group market plans for plan years beginning one year after enactment. Issuers must analyze and report their use of utilization management for the first five plan years after that date, and the Comptroller General must report to Congress annually about those plan-year reports.
The bill expands and standardizes coverage for fertility care and preservation—improving access and transparency—but will likely raise plan costs and premiums and could prompt insurer workarounds that complicate access.
People seeking fertility care — especially women, infertile couples, and patients with chronic conditions — would have fertility treatments (IVF, IUI, medications) covered as an essential health benefit with parity so cost-sharing and limits cannot be more restrictive than predominant medical/surgical benefits, reducing out-of-pocket costs and financial barriers to care.
Patients at risk of losing fertility (e.g., many cancer patients) would be able to access fertility preservation (oocyte, sperm, embryo cryopreservation) even before a medical event, preserving future reproductive options.
Issuers must analyze and report on utilization management for fertility benefits for the first five plan years, increasing transparency and giving regulators and consumers data to identify and address overly restrictive coverage practices.
Mandating expanded fertility coverage could raise premiums for individual and small-group plans, increasing costs for enrollees and small employers.
Insurers may respond by narrowing provider networks or imposing nonfinancial restrictions (e.g., prior authorization, visit limits) to control utilization, which can delay or complicate access despite parity rules.
Covering higher-cost services such as embryo genetic testing, gamete donation, and storage could drive greater utilization of expensive options and put additional upward pressure on plan costs and premiums.
Introduced May 19, 2025 by Lauren Underwood · Last progress May 19, 2025