“A bill to require health insurance plans to provide coverage for fertility treatment, and for other purposes.”
No CRS summary available for this bill.
This section requires group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for specified fertility treatments—including preservation of oocytes, sperm, or embryos; artificial insemination; assisted reproductive technology such as in vitro fertilization; genetic testing of embryos; fertility medications; and gamete donation—if the plan or coverage provides obstetrical services. Coverage must be provided for provider-determined appropriate fertility treatment at compliant facilities, regardless of infertility diagnosis; cost-sharing may not exceed that applied to other medical services (with Secretary to issue interim final regulations); and plans or issuers are prohibited from offering incentives to forgo treatment, restricting provider discussions, penalizing providers, or discriminating against covered individuals on specified civil rights grounds. (Thus, plans covering maternity care—which most do—must offer parity in fertility benefits such as IVF.) The section further requires written notice of the coverage to participants by January 1, 2027 (or earlier upon mailing/enrollment), annually thereafter; permits negotiation of provider reimbursements; and clarifies that no one is required to undergo treatment. These requirements are codified as new §2799A-11 in the Public Health Service Act and new §726 in ERISA.
This section requires contracts under the Federal Employees Health Benefits Program (FEHBP)—which provides health insurance to federal civilian employees, retirees, and dependents—to cover fertility treatment (as defined in section 2799A–11(b) of the Public Health Service Act (PHSA)) if the plan covers obstetrical benefits, consistent with PHSA section 2799A–11. Such coverage may not be subject to copayments or deductibles greater than those applicable to obstetrical benefits under the plan, and existing FEHBP restrictions under subsection (m)(1) do not prevent inclusion of these required terms. The requirements apply to contracts entered into or renewed for contract years beginning on or after 180 days after enactment.
This section requires TRICARE health care plans—serving active duty service members, retirees, and their families—to provide coverage for fertility treatment (as defined in section 2799A–11(b) of the Public Health Service Act), if such plans cover obstetrical benefits. Coverage must be provided in a manner consistent with section 2799A–11 of the Public Health Service Act, with cost-sharing requirements established by the Secretary of Defense to align with section 2799A–11(d) of that Act; the Secretary must also prescribe implementing regulations.
This section establishes a new VA benefit under 38 U.S.C. §1720M requiring the Secretary of Veterans Affairs to furnish fertility treatment services (as defined in section 2799A–11(b) of the Public Health Service Act, i.e., including counseling, diagnostics, medications, and procedures such as in vitro fertilization) to a veteran or the veteran's spouse or partner if they apply jointly. It directs the Secretary to prescribe implementing regulations within 18 months of enactment.
This section requires state Medicaid plans to cover fertility treatment—provided in accordance with requirements of section 2799A–11(b) of the Public Health Service Act (i.e., as applied to group health plans and health insurance issuers)—as part of family planning services under section 1905(a)(4)(C) of the Social Security Act. It makes a conforming amendment to the federal matching payment provision for such services under section 1903(a)(5). The amendments take effect October 1, 2026, with a delay permitted until the first calendar quarter after the first regular legislative session ending within one year of enactment for states requiring legislation (treating each year of a two-year session as separate).
This section establishes Medicare Part B coverage for fertility treatment (as defined in section 2799A–11(b) of the Public Health Service Act) for services furnished on or after January 1, 2026. It (1) adds fertility treatment to the list of covered outpatient services; (2) provides payment equal to 100 percent of the lesser of the actual charge or the physician fee schedule amount (thus, waiving the standard 20 percent coinsurance); (3) waives the Part B annual deductible; (4) applies the physician fee schedule to such payments; and (5) makes a conforming amendment to exclude fertility treatment from the prohibition on coverage for services not reasonable and necessary. (As background, Medicare Part B covers 80 percent of approved amounts for outpatient services—such as physician services—after the annual deductible, with beneficiaries responsible for 20 percent coinsurance; certain services, including many preventive services, are covered at 100 percent with no deductible or coinsurance.)