Employers continue to view fertility coverage as a strategic benefit for attraction and retention, supporting diverse paths to parenthood. This includes employees facing medical or age-related barriers, those pursuing assisted reproduction, and single individuals or couples building families through various means. Meanwhile, decisions to expand this benefit are increasingly shaped by cost pressures and evolving market conditions, including broader state fertility coverage mandates in 2026 and continued growth in the assisted reproductive technology market. As fertility treatment utilization grows, well-designed programs can guide employees to evidence-based care, potentially improving outcomes and making costs more predictable.
The coverage landscape is shifting as fertility benefit managers and solutions enter the market, while more states adopt or expand fertility coverage requirements for commercial fully insured plans. At the federal level, recent guidance from the Departments of Labor, Health and Human Services, and Treasury has clarified that employers can structure certain fertility offerings as “excepted benefits,” creating additional flexibility in plan design and funding. At the same time, drug-pricing initiatives such as TrumpRx are lowering the cost of key fertility medications, potentially improving affordability for individuals and plan sponsors.
This paper presents the key dynamics of the fertility coverage landscape, including new pathways being offered to services. We cover the following points.
- Background: Fertility background information, utilization trends over time, and current costs of treatments
- Employer coverage of fertility benefits: Prevalence of current fertility benefits, fertility benefit design, and vendor RFP considerations
- Fertility benefits in the headlines: How retail and digital health partnerships are creating new access pathways to fertility services