Access to Fertility Treatment and Care Act
The Access to Fertility Treatment and Care Act would require many health plans and government programs to include coverage for fertility treatment whenever they cover obstetrical (pregnancy-related) services. It creates a broad definition of fertility treatment (including preservation of eggs/sperm/embryos, artificial insemination, assisted reproductive technology like IVF, genetic testing of embryos, fertility medications, gamete donation, and related services) and applies these coverage requirements across multiple federal program frameworks (Public Health Service Act, ERISA, Internal Revenue Code, FEHB/TRICARE, Veterans' programs, Medicaid, and Medicare). The bill also sets rules to limit cost-sharing, prohibit certain practices that would discourage or penalize fertility care, require clear notice to participants, and empower federal agencies to issue interim final regulations to implement the provisions. Importantly, it states that coverage should be determined appropriate by a health care provider and applied at facilities in compliance with federal standards, and it explicitly does not force any individual to undergo fertility treatment. In short, the bill would substantially expand and standardize access to fertility treatment across many health coverage systems, with a focus on parity with other medical services, protections against discrimination and coercion, and a clear mechanism for implementation through regulations and notices. It includes phased effective dates, with some provisions applying to plan years 6 months after enactment and others (notably Medicaid and certain federal programs) on defined future dates.
Key Points
- 1Coverage expansion and scope
- 2- Requires group health plans and health insurance issuers that cover obstetrical services to also cover fertility treatment, as determined appropriate by a health care provider, when treatment is prescribed at or performed by compliant facilities.
- 3- Defines a broad set of fertility treatments (preservation of oocytes/sperm/embryos, artificial insemination, ART including IVF, genetic testing of embryos, fertility medications, gamete donation, and related services).
- 4Applicability across programs and plans
- 5- Applies to: Public Health Service Act-regulated plans, ERISA-regulated plans, the Internal Revenue Code (employer-sponsored plans), FEHB/TRICARE, Veterans’ benefits, state Medicaid plans, and Medicare.
- 6- Each program has its own implementing provisions but follows the same core standard: fertility treatment coverage when obstetrical coverage exists.
- 7Cost-sharing and protections
- 8- Prohibits higher cost-sharing (deductibles, coinsurance) or more stringent limits for fertility treatment than for other medical services, and allows more favorable limits.
- 9- Prohibits incentives to discourage treatment, retaliation against providers, or discrimination in coverage on grounds tied to civil rights laws.
- 10- Includes a rule stating it does not require a participant to undergo fertility treatment.
- 11Notice and regulatory framework
- 12- Requires plan/issuer notices to participants about the coverage, with specific timing rules and annual updates.
- 13- Authorizes the Secretary to issue interim final regulations to implement cost-sharing parity and other provisions, bypassing ordinary notice-and-comment requirements to move quickly.
- 14Effective dates and carve-outs
- 15- General amendments to PHSA, ERISA, and IRC provisions: plan years beginning 6 months after enactment.
- 16- Collective bargaining exception: for union plans, the new requirements apply no earlier than the later of the plan’s collective bargaining end-date or 6 months after enactment.
- 17- Medicaid: effective October 1, 2026, with a delayed start if state legislation is required; Medicare and other programs have their own specified dates tied to existing law updates.
- 18Special program sections
- 19- FEHB/TRICARE, Veterans: require fertility treatment coverage consistent with the new standards, including cost-sharing rules and enforcement provisions.
- 20- Veterans: adds a new section to provide fertility treatment for veterans and their spouses/partners, with regulations to be issued.
- 21- State Medicaid: requires Medicaid to follow the 2799A-11 fertility treatment standards for coverage, aligning Medicaid with private plans.
- 22- Medicare: expands coverage to include fertility treatment and aligns payment to ensure reasonable reimbursement.