Fertility Benefits Employer Evaluation Checklist

How to Use This Checklist

This checklist is designed for HR Directors, CFOs, and benefits decision-makers at organizations with 25 to 500 employees who are evaluating whether to add fertility benefits, and if so, how. It covers regulatory context, cost considerations, workforce factors, and coverage options.

Work through each section in order. For each item, mark: Yes, No, Not Sure, or N/A., -

Section 1: Understand Your Regulatory Environment

State Mandate Review

☐ Determine whether your state has an infertility insurance mandate. Over 20 states now have some form of fertility coverage mandate. State mandates vary significantly in scope, some require IVF coverage, others only require diagnosis and basic treatment. Check your state's insurance department or consult legal counsel.

☐ Confirm whether the mandate applies to your plan type. Fully insured plans (purchased through an insurance carrier) are subject to state mandates if your state has one. Self-funded plans (including level-funded plans) are governed by federal ERISA law and generally exempt from state insurance mandates.

☐ California employers: Confirm SB 729 compliance. California's Senate Bill 729 took effect January 1, 2026. Large-group fully insured plans (100+ employees) must cover infertility diagnosis and treatment, including IVF. Small-group plans (1-100 employees) must be offered the option to purchase this coverage. Confirm whether you have taken the necessary steps.

☐ Review any pending state legislation in your operating states. Several additional states are advancing fertility coverage bills in 2026. If you operate in multiple states, flag those with active legislation for monitoring.

Federal Guidance Review

☐ Review the May 2026 federal "excepted fertility benefits" rule. The Departments of Labor, Treasury, and HHS published final guidance in May 2026 creating a new category of "excepted benefits" for fertility coverage, including IVF. This allows employers to offer fertility benefits separately from major medical insurance, similar to dental or vision, without triggering ACA coverage requirements for the standalone benefit. This is optional, not required.

☐ Understand what the excepted fertility benefits rule does and does not cover. Excepted fertility benefits can include IVF, egg retrieval cycles, embryo transfers, and related services. They cannot be combined with major medical in a way that circumvents other ACA requirements. Review the guidance with your broker or benefits attorney before implementing.

☐ Note any IVF-related executive orders or federal policy developments. The administration issued guidance in early 2026 directing federal agencies to take steps to promote access to IVF. While this does not create a direct employer mandate, it signals a policy environment where fertility benefits are gaining federal visibility., -

Section 2: Understand Your Workforce

Demographic Assessment

☐ Identify the approximate age distribution of your workforce. Fertility benefits are most valued by employees in their late 20s through early 40s. If a significant share of your workforce falls in this range, fertility benefits may be a meaningful differentiator for recruiting and retention.

☐ Assess whether your workforce includes employees who have expressed interest in fertility coverage. This does not require a formal survey. Review open enrollment questions, exit interview feedback, and informal conversations HR has had with employees about their benefits needs.

☐ Review whether any employees have raised fertility-related coverage gaps with HR or on benefits satisfaction surveys. A single question on your next benefits survey ("Are there any benefits you wish we offered that we currently do not?") can surface relevant data for this and future decisions.

Recruiting and Retention Context

☐ Determine whether competitors in your industry or geography offer fertility benefits. Approximately 40% of employers now offer some form of fertility benefit, up sharply from prior years. If your primary competitors for talent offer coverage and you do not, you may be at a disadvantage with specific candidate segments.

☐ Assess whether fertility benefits have come up in recruiting conversations or offer declines. Anecdotal information from your recruiting team can be valuable context here. If candidates are asking about fertility coverage, or if it has appeared in offer negotiations, that signals relevance., -

Section 3: Evaluate Coverage Options

Option A: Add Fertility Coverage to Your Medical Plan

☐ Request a quote from your current carrier for adding fertility coverage to your existing medical plan. Coverage options vary widely by carrier. Some cover diagnosis only; others cover full treatment including IVF. Ask specifically about: lifetime benefit maximums, covered services, prior authorization requirements, and network restrictions.

☐ Understand the premium impact. Early data from states with similar mandates suggests that adding fertility coverage increases premiums by 0.5% to 1.1% on average. For an employer spending $500,000 per year on health premiums. That is roughly $2,500 to $5,500 annually. Get a carrier-specific estimate for your group.

☐ Confirm whether adding fertility coverage would trigger any self-funded plan compliance requirements. If you are self-funded or level-funded, adding fertility coverage does not create a state mandate obligation, but it does create new claims exposure. Review your stop-loss coverage to understand how fertility claims would be treated.

Option B: Standalone Excepted Fertility Benefit

☐ Evaluate whether a standalone excepted fertility benefit makes sense for your organization. Under the May 2026 federal guidance, you can offer fertility coverage as a standalone benefit, separate from your major medical plan, similar to how dental or vision works. Employees elect (and often pay a portion of) the standalone benefit.

☐ Identify vendors offering standalone fertility benefit products. Several specialty vendors have launched fertility benefit products designed to comply with the new excepted benefits framework. These typically include IVF, egg freezing, and related services, with defined lifetime maximums (commonly $10,000 to $30,000).

☐ Evaluate cost sharing structure. Standalone fertility benefits are often voluntary or partially employer-funded. Determine what cost-sharing approach fits your budget and workforce expectations.

Option C: Voluntary Fertility Benefit (Employee-Paid)

☐ Consider whether a voluntary, employee-paid fertility benefit is appropriate as a first step. If budget is a constraint, you may be able to offer access to a fertility benefits platform or a group-negotiated fertility coverage product that employees pay for entirely, with the employer facilitating access.

☐ Evaluate vendors offering voluntary fertility benefits products. Several platforms now offer group-accessed fertility benefits that require no employer contribution. Employees pay the cost, but access rates and service quality are better than individual market options., -

Section 4: Financial and Budget Assessment

☐ Estimate your likely take-up rate before projecting costs. Not every employee will use fertility benefits. For a 100-person company with 30 employees in the relevant age range, utilization rates typically run 1-5% annually depending on the benefit design and employee demographics. Model at low, mid, and high utilization scenarios.

☐ Determine your employer contribution approach and annual cap. Many employers fund fertility benefits up to a lifetime cap ($10,000, $25,000 is common) rather than offering open-ended coverage. This controls financial exposure while still providing meaningful support.

☐ Confirm that your stop-loss carrier will cover fertility claims if you are self-funded or level-funded. Some stop-loss policies exclude or limit fertility claims. Review your stop-loss agreement before adding this coverage.

☐ Run the cost against your benefits budget for the next plan year. Include premium increases, projected utilization-based costs, and any administrative costs. Compare against the anticipated retention and recruiting value., -

Section 5: Implementation Planning

☐ Determine your effective date and open enrollment timing. Adding a new benefit is most cleanly done at plan year renewal. Mid-year additions are possible but add complexity for enrollment, administration, and employee communication.

☐ Draft an employee communication plan. Fertility benefits are sensitive for some employees and meaningful to others. Communications should be clear, matter-of-fact, and focused on the practical details of how coverage works and how to access it. Avoid anything that feels invasive or presumptuous.

☐ Train HR team members on how to discuss fertility benefits. HR staff should be prepared to answer practical questions about eligibility, covered services, how to file claims, and confidentiality. They should not be expected to serve as clinical advisors.

☐ Update plan documents, SPDs, and any required ERISA notices. Adding coverage requires updated Summary Plan Descriptions and, for fully insured plans, potentially updated certificates of coverage. Work with your broker and legal counsel to ensure compliance.

☐ Set a review date. Plan to evaluate utilization and employee feedback after the first full plan year. Fertility benefits programs often take one to two years to reach stable utilization as employees learn about the coverage., -

Section 6: Decision Summary

After completing this checklist, document your decision:

Will your organization add fertility benefits this plan year?

☐ Yes: add to medical plan ☐ Yes: standalone excepted benefit ☐ Yes: voluntary/employee-funded access ☐ Not this year, revisit at next renewal ☐ No, not appropriate for our workforce at this time

If adding: Who owns implementation?

HR Lead: ______________________________ Broker Contact: ______________________________ Target Effective Date: ______________________________

Notes and follow-up items:

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_______________________________________________, -

Benefits Collective helps employers evaluate and design benefits programs that fit their workforce and budget. If you are working through a fertility benefits decision, schedule a consultation to talk through your options.