Health Coverage for IVF Act of 2025
This bill would expand the Affordable Care Act’s "essential health benefits" to explicitly cover fertility treatment and care in the individual and small-group health insurance markets. It defines a broad set of services under fertility treatment (including IVF) and sets specific guidelines intended to promote medically appropriate, family-building care while limiting costs and gatekeeping. Key features include requiring parity between fertility benefits and other medical benefits (no extra cost sharing or restrictive limits), prohibiting denial of coverage based solely on lack of infertility diagnosis, and mandating oversight of any utilization management tools used for fertility benefits. The bill also establishes an IVF-specific framework that emphasizes guidelines from the American Society for Reproductive Medicine, including at least three complete oocyte retrievals and the option of unlimited embryo transfers from those retrievals, with a preference for single embryo transfers when recommended. It would take effect for plan years beginning one year after enactment. Introduced by Rep. Underwood and referred to the Committee on Energy and Commerce, the measure would apply to both the medical and fertility components of coverage and impose reporting requirements for insurers on how they use utilization management tools for fertility care. If enacted, states that use the ACA’s essential health benefits framework would need to align with these new requirements in the individual and small-group markets.
Key Points
- 1Adds fertility treatment and care as an essential health benefit under the ACA, with a detailed definition of covered services (including preservation, artificial insemination, ART/IVF, genetic testing of embryos, medications, gamete donation, and other related services) and aligning with ASRM guidelines.
- 2IVF-specific terms require clinically appropriate practices, including at least 3 complete oocyte retrievals and an unlimited number of embryo transfers from those retrievals, when medically appropriate, with single embryo transfer recommended when appropriate.
- 3Coverage parity requirement: for individual and small-group plans, financial requirements and treatment limitations for fertility benefits cannot be more restrictive than those for other medical/surgical benefits; no separate cost sharing or restrictive treatment limits for fertility benefits.
- 4Prohibition on denial of care: issuers may not deny fertility benefits solely because a person lacks an infertility diagnosis.
- 5Utilization management oversight: insurers using utilization tools for fertility care must analyze their impact for the first five plan years after enactment and report to the Secretary and GAO; GAO must publish a public report summarizing analyses and compliance findings.
- 6Effective date: provisions apply to plan years beginning one year after enactment.