Public Employees' Benefit and Insurance Program Modifications

More fertility coverage for Utah public employees

Beginning July 1, 2025, Utah's Public Employees' Benefit and Insurance Program covers qualifying assisted reproductive technology cycles. Coverage is for patients in the state risk pool who qualify for maternity benefits. The law replaces the $4,000-per-cycle benefit with coverage subject to normal plan cost-sharing, without specifying a new per-cycle dollar cap. Each covered cycle must transfer a single embryo for implantation. A physician must verify an infertility condition affecting the patient or their spouse. Alternatively, the patient must attest to at least one year of regular intercourse without contraception without conceiving or carrying a pregnancy to live birth. Patients must also attest that less-costly, potentially effective treatments covered by their plan have not produced a successful pregnancy. Treatment must follow program clinical policies and use a provider contracted with or approved by the program. This coverage satisfies the state's adoption indemnity benefit requirement; members who already received that adoption benefit cannot receive this fertility benefit.