Sponsors (2)
The bill substantially expands and clarifies access to fertility and family-building services and reduces certain out-of-pocket barriers for many people seeking care, but it likely raises insurance costs and administrative burdens that could translate into higher premiums and continued affordability challenges for the lowest-income enrollees.
People seeking fertility care (e.g., women, cancer patients, single people, and others) will have explicit, broader coverage for services such as IVF, gamete preservation, medications, and genetic testing under individual and small-group plans.
Insured people cannot be denied fertility benefits solely for lacking an infertility diagnosis, expanding eligibility (for example, for fertility preservation before medical treatment or for single people) and increasing access.
Financial cost-sharing for fertility services must be no more restrictive than for other medical/surgical benefits, which will reduce out-of-pocket costs for enrollees.
Expanding mandated fertility coverage will raise insurer costs that are likely to increase premiums or insurance expenses, which may be passed on to consumers and taxpayers.
Even with mandated coverage, any resulting premium increases or other affordability pressures could leave low-income enrollees unable to afford insurance or care, limiting practical access.
Smaller insurers and self-funded plans face additional administrative burdens and compliance costs from required utilization-management analyses and GAO reporting, which could strain small businesses and insurers.
Based on analysis of 2 sections of legislative text.
Makes fertility treatment an essential health benefit and requires parity for cost-sharing and limits in individual and small-group plans, prohibits denial for lack of infertility diagnosis.
Official title: To amend the Patient Protection and Affordable Care Act to include fertility treatment and care as an essential health benefit.
Introduced May 19, 2025 by Lauren Underwood · Last progress May 19, 2025
Adds fertility treatment and related services to the list of essential health benefits and requires parity protections for financial requirements and treatment limits in individual and small-group health plans that offer fertility coverage. Plans may not deny fertility benefits for lack of a formal infertility diagnosis, and issuers using utilization management for fertility care must analyze and report those practices to HHS and the GAO for the first five plan years after implementation. The rule takes effect for plan years beginning one year after enactment and authorizes HHS to add related items; GAO must report annually on issuer submissions and compliance findings.