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.

Hanna Tomory, President of Isidore Ventures, supports the proposed rule for excepted fertility benefits but urges the Departments to provide more clarity on including root-cause diagnostic and treatment care. The commenter requests specific regulatory language, standardized outcome reporting, and support for value-based payment structures to ensure employers can offer effective, cost-predictable benefits.

SHRM, a trade association representing HR professionals and business executives, supports the proposed rule to create an optional pathway for fertility-related benefits. They argue that the proposal provides employers with necessary flexibility to offer these benefits outside of traditional major medical frameworks, helping to expand access for employees while managing costs and administrative burdens.

The Pharmaceutical Care Management Association (PCMA) supports the creation of a new category of limited excepted fertility benefits but requests specific refinements to ensure administrative feasibility. They advocate for clarifying the voluntary nature of the benefits, allowing for cycle-based treatment limits, providing guidance on coordination with major medical coverage and state mandates, and delaying the applicability date to January 1, 2029.

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.

The ERISA Industry Committee (ERIC), a trade association representing large employers, supports the proposed rule to establish fertility benefits as a new category of limited excepted benefits. They argue that the rule preserves employer flexibility in plan design while expanding access to fertility services for employees.

Maven Clinic, a large virtual clinic for women's and family health, strongly supports the proposed rules establishing a new category of excepted benefits for fertility care. They argue that these rules will provide a cost-effective and administratively manageable pathway for employers to offer fertility benefits while advocating for specific flexibilities regarding benefit caps and HSA eligibility.

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 MyCatholicDoctor Foundation, a nonprofit medical organization, supports the proposed Excepted Fertility Benefits but advocates for specific modifications. They request the inclusion of "Restorative Reproductive Medicine" (RRM) and root-cause diagnosis in the benefit definitions, the creation of a bundled payment model, updated medical coding, and protections for faith-based employers and providers to offer RRM without being required to cover IVF.