Administration Proposes Standalone Fertility Benefits Including IVF Coverage

The administration announced a proposed federal rule Monday that would allow employers to offer stand-alone fertility benefits, including coverage for in vitro fertilization, as a new category of limited excepted benefits separate from traditional health plans.

The regulation is designed to give employers an optional pathway to cover fertility treatments often excluded from standard insurance, similar to dental or vision plans. Workers could enroll in the coverage even if their primary health insurance does not include fertility benefits.

A lifetime cap of $120,000 would apply per participant and would be indexed for inflation after 2028.

Health officials said the United States is facing a fertility crisis, noting that male fertility rates are now lower than they were in the 1970s. They cited declining sperm counts as evidence of a generational public-health problem. The general fertility rate fell 3 percent in 2023 to 54.5 births per 1,000 women ages 15-44, according to the CDC’s National Center for Health Statistics.

Provisional 2024 data show only a slight uptick, with the total fertility rate remaining near historic lows at about 1.63 births per woman, well below the replacement level of 2.1. Associated Press reporting placed the 2024 rate at roughly 1.6, the lowest on record.

The administration first previewed the fertility-benefit plan last fall. In October it reached an agreement with a drugmaker to lower the cost of fertility medications. Officials said the new rule, combined with the pricing deal, is intended to reduce out-of-pocket expenses for families seeking IVF and other treatments.

Supporters at a Monday press briefing said reducing regulatory barriers could prompt more employers to add fertility benefits. The change could reshape workplace family-policy offerings and influence hiring and retention. The proposal arrives as states pursue their own family-policy changes, including Indiana’s recent expansion of paid parental leave to foster parents.

The proposed fertility-benefits rule would give workers access to the new coverage only if their employer chooses to offer it under the newly created category of limited excepted benefits. Employers could provide stand-alone fertility plans that cover diagnosis and treatment of infertility, subject to the lifetime cap.

The current proposal is open for public comment for 60 days before it can be finalized. If passed, workers would have to select the coverage from the benefits provided by their employers. The fragmented U.S. family benefits landscape means access still varies widely depending on geography, employer and sector.

" — Dr. " — Health and Human Services Secretary Robert F. Kennedy Jr.