Departments Issue Proposed Rules on Excepted Fertility Benefits; Comments Due July 13

The U.S. Departments of Labor, Health and Human Services, and Treasury issued proposed rules amending the regulations regarding excepted benefits under the Employee Retirement Income Security Act of 1974, the Internal Revenue Code, and the Public Health Service Act to establish certain fertility benefits as a new category of limited excepted benefits.

Excepted benefits are generally exempt from the market requirements that were added to those laws by the Health Insurance Portability and Accountability Act (HIPAA), the Patient Protection and Affordable Care Act (ACA), the No Surprises Act, and certain other Federal laws specifically related to group health plans and group and individual health insurance coverage. 

The proposed rules address employers’ sparse coverage of fertility-related treatments for the American worker and increases benefit options by easing statutory and regulatory burdens to make IVF and other fertility treatments more affordable.

• Substantially all of the benefits must be for diagnosis, mitigation, or treatment of infertility or related reproductive health conditions.
• Benefits are capped at a combined lifetime maximum of up to $120,000 for the participant and their beneficiaries, indexed for inflation for plan years starting after 2028.
• Employers must provide a notice that clearly describes the coverage and meets other specified requirements.