Government Greenlights Fertility Free-for-All: Insurance Rules Get Baby Bumped
Published Date: 5/13/2026
Proposed Rule
Summary
The government is proposing new rules to create a special category for fertility benefits that don’t have to follow all the usual health insurance rules. This change affects employers and health plans offering fertility help, making it easier and more flexible to provide these benefits. If you want to share your thoughts, you have until July 13, 2026, to comment—this could impact how much fertility care costs and how it’s covered.
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Analyzed Economic Effects
3 provisions identified: 1 benefits, 2 costs, 0 mixed.
Fertility Benefits Exempt From ACA Market Rules
If fertility benefits qualify as excepted benefits, they generally would be exempt from market rules added by HIPAA, the Affordable Care Act, the No Surprises Act, and related Federal laws. That means such fertility benefits would not have to follow protections like the PHS Act's maximum out-of-pocket limit (section 2707(b)) or the prohibition on annual and lifetime dollar limits (section 2711).
New Excepted Fertility Benefits Category
The departments propose to create a new category called "excepted fertility benefits" so employers and health plans can offer fertility care (like IVF) as a separate, limited benefit. This proposed rule was published May 13, 2026, and the public comment deadline is July 13, 2026.
Proposed Limits and Lifetime Cap
The departments propose that excepted fertility benefits be limited in scope similar to limited dental/vision benefits and that they include a lifetime dollar limit. That means fertility benefits offered under the new category could be capped in what services they cover and limited by a lifetime dollar maximum.
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Key Dates
Department and Agencies
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