Health Coverage for IVF Act of 2025
- Sponsor
- Rep. Underwood, Lauren [D-IL-14]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- May 19, 2025
Bottom line
This bill expands mandatory health insurance coverage under the ACA to include a comprehensive range of fertility treatments and care, aiming to make these services more accessible and affordable for a broader population.
What it actually does
This bill amends the Patient Protection and Affordable Care Act (ACA) to mandate that fertility treatment and care be included as an essential health benefit (EHB) for health insurance plans offered in the individual and small group markets. It defines a comprehensive set of covered fertility services, establishes parity requirements for financial and treatment limitations, prohibits denial of benefits based on a lack of infertility diagnosis, and mandates reporting on utilization management tools.
Proponents argue
Supporters argue this bill addresses a significant gap in health coverage, recognizing infertility as a medical condition and ensuring equitable access to family-building options for all individuals, including single people and same-sex couples. They contend it reduces financial barriers, promotes reproductive autonomy, and aligns with modern medical standards.
Opponents contend
Opponents might argue that mandating additional benefits will increase health insurance premiums for all enrollees, potentially making coverage less affordable for some. They may also raise concerns about the broad scope of mandated services, the potential for increased utilization, and the impact on the overall cost structure of the individual and small group insurance markets.
The bill is concise and clearly structured, allowing for a quick and comprehensive understanding of its provisions.
Section 2(a)(1)
Mandating Fertility Treatment and Care as an Essential Health Benefit
This provision amends Section 1302(b)(1) of the Patient Protection and Affordable Care Act to add 'Fertility treatment and care' as a new essential health benefit. This means that health insurance plans offered in the individual and small group markets must cover these services, making them a standard part of ACA-compliant plans.
Supporters argue
Supporters argue this is a crucial step towards health equity, recognizing infertility as a disease and ensuring that family-building options are not limited by financial status.
Critics contend
Critics may argue that mandating this benefit will lead to higher premiums for all enrollees, including those who do not need or use fertility services, potentially making health insurance less affordable overall.
Tradeoffs
Balances the goal of expanding access to fertility care against concerns about potential increases in health insurance premiums and the scope of mandated benefits.
Section 2(a)(2)
Comprehensive Definition of Covered Fertility Services
This section defines 'fertility treatment and care' to include a broad range of services: preservation of human oocytes, sperm, or embryos; artificial insemination; assisted reproductive technology (including in vitro fertilization with at least 3 oocyte retrievals and unlimited embryo transfers); genetic testing of embryos; fertility medications; and gamete donation. It also allows the Secretary to determine other appropriate services.
Section 2(b) (adding new Section 2730(a) to PHSA)
Financial and Treatment Limitation Parity for Fertility Benefits
This provision requires that financial requirements (such as deductibles, copayments, and out-of-pocket maximums) and treatment limitations (such as visit limits or duration of treatment) for fertility treatment and care benefits must be no more restrictive than those applied to substantially all medical and surgical benefits. It also prohibits separate cost-sharing or treatment limitations that apply only to fertility benefits.
Section 2(b) (adding new Section 2730(b) to PHSA)
Prohibition on Denial of Care Based on Lack of Infertility Diagnosis
This provision explicitly prohibits health insurance issuers from denying benefits for fertility treatment and care solely because an individual lacks a diagnosis of infertility. This is significant for individuals who may not meet traditional definitions of infertility but still require fertility services, such as single individuals, same-sex couples, or those undergoing cancer treatment.
Section 2(b) (adding new Section 2730(c) to PHSA)
Transparency and Oversight of Utilization Management Tools
This provision requires health insurance issuers to conduct and submit detailed analyses to the Secretary and the Comptroller General for the first five plan years after enactment regarding their application of utilization management tools (e.g., prior authorization, step therapy) to fertility treatment and care. The analysis must detail coverage terms, factors, evidentiary standards, consistency with clinical guidelines, and any non-compliance findings. The Comptroller General will then compile and publicly report on these analyses to Congress.