Twenty-five states and Washington, D.C. now require some form of fertility coverage, and more than half of U.S. states introduced or carried over fertility legislation in 2026.

IVF has shifted from a talent perk to a compliance question and a growing line item on the CFO’s radar, with rules that vary by state, plan type, and pending federal action.

This FAQ answers the questions benefits leaders are asking most, from self-insured exemptions to the plan design decisions that control cost.

With this FAQ:

• Determine whether state mandates apply to your fully insured or self-insured plan
• Track where federal IVF proposals stand, including the proposed fertility excepted benefits rule
• Benchmark your coverage against what a well-designed fertility benefit actually includes
• Make smarter calls on cycle caps, step therapy, Centers of Excellence, and eligibility
• Control fertility costs through clinical management instead of benefit restrictions

Waiting for a federal mandate means designing your benefit on someone else’s timeline. Act now and offer the fertility coverage that keeps you competitive for top talent.

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