The U.S. Departments of Labor, Health and Human Services, and the Treasury (the Departments) released new guidance clarifying which excepted benefits employers can use to provide fertility coverage. This follows Executive Order 14216, which called for expanded access to in vitro fertilization (IVF) and recommended allowing employers to offer fertility benefits as an excepted benefit to help reduce IVF costs for employees.
Key Highlights
The new guidance allows employers to:
- Fertility benefits may qualify as an independent, non-coordinated excepted benefit if certain conditions are met. Employees with this coverage can contribute to a health savings account. To qualify, the policy must be a separate insurance contract (not self-funded), operate independently from any group health plan exclusions, and pay benefits regardless of other coverage.
- An excepted benefit health reimbursement arrangement (HRA) can reimburse employees for eligible out-of-pocket fertility expenses, provided it complies with all regulatory requirements.
- Benefits for coaching and navigator services are available to help employees, and their dependents understand their fertility options through an employee assistance program (EAP) that qualifies as a limited excepted benefit. To meet this standard, the EAP must not coordinate with another group health plan, require no employee premiums or contributions, and have no cost sharing. Offering significant fertility benefits for medical care would cause the EAP to lose its limited excepted benefit status.
Future Rulemaking
The Departments announced plans to propose new rules that would expand options for offering certain fertility benefits as limited excepted benefits. They are also considering updates to the criteria that allow supplemental health insurance, including fertility coverage, to qualify as an excepted benefit. Download the bulletin for more details.
