Excepted Fertility Benefits

Aflac, Inc., a Fortune 500 supplemental health insurance provider, supports the proposed rule and requests specific clarifications to ensure fertility benefits can be offered in both group and individual markets. They argue for the ability to combine fertility benefits with other excepted benefits and for payment triggers to include "per service" basis to harmonize regulations across markets.

Business Group on Health, a non-profit representing the perspectives of large employers (including the majority of Fortune 100 companies), supports the proposed rule to allow excepted fertility benefits. They argue that this will provide employers with the flexibility to offer fertility coverage without burdensome administrative costs, while requesting specific adjustments to align with tax definitions and maintain employer discretion over cost-sharing and notice requirements.

Progyny, Inc. supports the proposed rule establishing fertility benefits as a new category of limited excepted benefits to expand access to care. They urge the Departments to align the federal framework with existing state cycle-based coverage models and to recognize cycle-based structures as functionally equivalent to lifetime dollar limits.

Blood Cancer United opposes the proposed rule to create an excepted benefit framework for fertility-related care, arguing that it creates cost barriers and fragments insurance coverage. They urge the Department to instead include all medically necessary fertility preservation and infertility services within major medical coverage based on evidence-based standards.

AHIP, a national health insurance association, supports the proposal to create limited excepted fertility benefits but expresses concerns regarding increased medical costs, selection risk, and administrative complexities. They recommend delaying implementation to 2028, providing a good-faith compliance safe harbor for lifetime caps, and including explicit language to ensure the benefits remain voluntary and do not constitute a mandate.

The American College of Obstetricians & Gynecologists (ACOG) opposes the proposed rule to create an excepted fertility benefit, arguing it lacks sufficient oversight, creates regulatory inconsistencies, and imposes harmful lifetime dollar limits. They recommend withdrawing the rule in favor of a comprehensive fertility insurance coverage mandate that includes IVF as an essential health benefit.

The American Medical Association (AMA) supports the goal of expanding access to fertility treatments but argues that the proposed rule may have limited impact without employer incentives or subsidies. They specifically urge the Departments to eliminate the proposed lifetime dollar limit, provide a transitional implementation period, and ensure clear, accessible notice for participants.

The American Society for Reproductive Medicine (ASRM) opposes the proposed rule on Excepted Fertility Benefits, arguing that it fails to mandate coverage as promised and creates risks regarding cost containment, lack of federal oversight, and patient safety. They urge the administration to withdraw the rule and instead pursue insurance fertility coverage mandates.

The Blue Cross Blue Shield Association (BCBSA) supports the proposed rule creating a voluntary, employer-driven pathway for excepted fertility benefits. They recommend adding specific regulatory text to clarify the voluntary nature of the benefit, establishing a quantitative threshold for "substantially all," and extending the applicability date to January 1, 2028.

Americans for IVF (AIVF), a national advocacy organization, strongly supports the proposed rule to establish fertility benefits as a new category of limited excepted benefits. They commend the move as a landmark step for expanding access to IVF and urge the Departments to ensure the rule clearly encompasses IVF coverage and includes medically appropriate treatments for underlying infertility conditions.