Background

IVF is a type of medical procedure known as assisted reproductive technology (ART). These procedures help couples achieve pregnancy when they are unable to conceive on their own. In IVF, eggs are surgically removed from the ovary, fertilized with sperm outside the body, and then placed in the uterus. Other types of ART include intrauterine insemination, sperm or egg donation and surrogates/gestational carriers.

According to Fertility IQ, the majority of IVF patients will fail on their first cycle and will continue treatment for a second, third or fourth cycle. With IVF costing from $12,000 to $25,000 per cycle, the average patient could spend close to $50,000 in treatment.

According to the 2024 Employee Benefits Survey by the International Foundation of Employee Benefit Plans (IFEBP), 42 percent of overall respondents offered fertility benefits. Among those that offered fertility benefits, 76 percent of group health plans cover IVF treatments, including 50 percent of multiemployer plans. Other types of fertility benefits provided by plans include medications, lab tests and diagnosis, genetic testing and egg harvesting/freezing.

The executive order

The executive order and accompanying fact sheet state, in contrast to the IFEBP survey, that only a quarter of employers report coverage of IVF for their employees. The executive order directs the Assistant to the President for Domestic Policy to submit a list of policy recommendations on protecting IVF access and reducing out-of-pocket costs. These recommendations should address:

• Ensuring reliable access to IVF
• Changing any current policies that exacerbate the cost of IVF treatments
• Easing unnecessary statutory or regulatory burdens

While there are no specifics in the executive order, the president said during his campaign that under his administration the government or insurance companies would be mandated to pay for all costs associated with IVF treatment. However, he did not provide specifics.

According to the American Society for Reproductive Medicine, IVF is regulated by a complex and comprehensive network of federal and state regulations and professional oversight. These include the Food and Drug Administration, Clinical Laboratory Improvement Acts, Centers for Disease Control and various state licensure requirements. The executive order does not address any particular regulation but is broad enough that recommendations could be made in any of these regulatory areas.

Implications for plan sponsors

In recent years, benefits to support family-building began shifting beyond traditional coverage of infertility diagnosis. IVF, fertility preservation and egg freezing, gestational surrogacy and adoption are now part of a broader, more inclusive conversation around fertility. Plan sponsors have increasingly recognized that a comprehensive, family-building benefits package can also include a managed fertility benefit that can reduce organizations’ healthcare costs and improve outcomes. For some workers, fertility benefits are highly sought after and can be a valuable tool for employers seeking to attract talent.

 (For more information, see our June 30, 2021 insight, “You Need an Inclusive Family‑Building Benefits Package.”)

Nineteen states have insurance laws regarding infertility treatment coverage, but only 14 either require coverage or an offer of coverage for IVF. The state law requirements vary greatly. Self-insured plans governed by ERISA are not subject to these state insurance laws.

There are currently no federal laws that mandate coverage for infertility treatment or IVF. Moreover, it is unlikely that existing employee benefit laws could be interpreted to require a self-insured group health plan to pay a certain amount for IVF. Consequently, legislation may be necessary to require group health plans to have mandated IVF coverage.

Plan sponsors should look for the policy recommendations from the White House and determine how they can be reflected in their employee benefits strategy.

In addition, plans should continue to evaluate the cost implications related to adding IVF coverage along with cost and value considerations related to comprehensive family-building benefit packages best suited to their population.