The Labor Department's proposed rule to make it easier for employers to offer a fertility benefit isn't likely to result in many more employers doing so, although it may tip the scales for employers who were already considering it, experts said.
"The proposal mostly changes the ease of offering, not the economics of fertility treatment itself," Paul Fronstin, PhD, director of health benefits research for the Employee Benefit Research Institute, said in an email to MedPage Today. "So, my sense is it probably increases availability at the margin, but mainly among employers already inclined to offer fertility benefits. I would not expect transformational uptake across the entire employment-based system."
The proposed rule, issued on Sunday -- Mother's Day -- by HHS and the Treasury Department in addition to the Labor Department, allows employers to offer fertility coverage as an excepted benefit, meaning that it is "exempt from the market requirements that were added to those laws by the Health Insurance Portability and Accountability Act, the Patient Protection and Affordable Care Act, the No Surprises Act, and certain other federal laws specifically related to group health plans and group and individual health insurance coverage," according to the rule. The rule is an outgrowth of President Trump's Executive Order "Expanding Access to In Vitro Fertilization," issued in February 2025, which called for government agencies to facilitate reliable and affordable access to in vitro fertilization and other fertility-related services.
"The decline in birth rates is a serious challenge for our nation," HHS Secretary Robert F. Kennedy Jr. said in a press release about the proposed rule. "This rule expands access to fertility care and gives more Americans a real path to starting and growing their families."
The rule would require employers offering the benefit to meet several conditions, including:
- Ensuring that substantially all of the benefit must be for diagnosis, mitigation, or treatment of infertility or related reproductive health conditions.
- Capping the benefit 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.
- Providing a notice that clearly describes the coverage and meets other specified requirements.
During a press conference at the White House Monday, President Trump praised the rule. "This will be a supplemental option available to those who need it, much like vision or dental insurance," he said. "So we're bringing it right down into the mainstream by offering coverage for care at every step ... This is an option that will be a major help for millions of American moms, that will result in more beautiful American babies. We like that."
There are big reasons why uptake could be limited, Fronstin said. "Fertility benefits are expensive and highly visible. The rule will probably get the most traction in tech/professional services, where employers compete for highly educated younger workers who might see fertility benefits as valuable for recruitment/retention; and employers concerned about women's workforce retention."
Usha Ranji, associate director for Women's Health Policy at KFF, noted in a phone call that 2 years ago, during his reelection campaign, "Trump promised full coverage or access to IVF [in vitro fertilization] services to everybody. This [rule] is receiving attention for sure, but this does not mean everyone has full coverage -- or any coverage -- for IVF services."
Instead, this proposed rule clarifies existing federal rules for "limited, exempted" insurance policies for "optional" benefits like dental care and vision care, she said. For example, while major medical insurance counts employer contributions toward employee out-of-pocket spending limits, the exempted plans do not count those contributions, Ranji explained.
Overall, "it really remains to be seen how much this moves the needle," she added. "If employers are not interested in offering this benefit, I'm not sure how much this adds."
The National Alliance of Healthcare Purchaser Coalitions (NAHPC), which represents employers interested in health benefits issues, generally welcomed the proposed rule, with Jenny Goins, the alliance's chief of staff, noting that NAHPC's 2025 Pulse of the Purchaser survey revealed 64% of employers offer reproductive healthcare and fertility services. "In addition, 33% of employers provide managed maternity and fertility benefits as a top strategy for managing high-cost claims, with 40% considering these benefits to manage high-cost claims in the next 1 to 3 years."
"The proposed rule to ensure reliable and affordable access to expanded fertility benefits aligns with employers' recognition that managed reproductive healthcare and fertility services assists in the reduction of high-cost claims for reproductive health," Goins said in an email. "These efforts would be even more impactful if the rules included ways for employers to receive premium assistance or discounts that help them provide this coverage."