October 20, 2025
Fertility care has long existed in a gray area of employee benefits. While some employers offer generous coverage, others are constrained by legal, financial, or logistical hurdles. That’s starting to change.
On October 16, 2025, federal regulators took a major step toward modernizing fertility benefits. In Affordable Care Act (ACA) FAQs Part 72, the Departments of Labor, Treasury, and Health and Human Services laid out new ways for employers to expand fertility support, even for employees not enrolled in the company’s health plan.
This guidance doesn’t just tweak existing rules, it offers a blueprint for employers to think differently about reproductive health benefits. It acknowledges that family-building support is no longer a “nice-to-have,” but a strategic, inclusive investment in workforce well-being.
Let’s break down what’s new, and why it matters.
Stand-Alone Insurance for Infertility Now Allowed
For the first time, employers can sponsor stand-alone, specified disease insurance for infertility as an excepted benefit.
What does that mean? It means you can offer a separate, fully insured fertility policy, not tied to your company’s medical plan, that employees can access even if they’re not enrolled in health coverage. These plans must be:
- Fully insured (not self-funded)
- Not coordinated with your group health plan
- Compatible with Health Savings Accounts (HSAs)
This is a game-changer for employers who want to support family-building without overhauling their entire medical plan.
Why It Matters:
Employees who opt out of your group health plan, whether due to spousal coverage or affordability, may still be struggling with infertility. Now, they don’t have to be left behind.
Fertility Coaching Through Your EAP? Yes, You Can
Employee Assistance Programs (EAPs) have long offered support for mental health and substance use. Now, infertility navigation services can be added to that list.
Under the new guidance, an EAP can provide:
- Fertility coaching
- Personalized navigation tools
- Support for employees and dependents exploring options
Of course, the core EAP rules still apply: no cost-sharing, no significant medical care, no coordination with the medical plan, and the program must be 100% employer-funded.
Why It Matters:
Infertility isn’t just a medical issue, it’s emotional, logistical, and deeply personal. Having a human guide (not just a website) can make all the difference.
An Ambitious Push to Lower Drug Costs
In a related move, the Trump Administration announced a new partnership with fertility drug manufacturer EMD Serono, securing “Most Favored Nation” pricing for GONAL-F, one of the most commonly used fertility medications. Even more notably, EMD Serono has committed to building a U.S.-based manufacturing facility, potentially reducing both costs and supply chain delays for critical fertility medications.
Why It Matters:
This is the beginning of a broader effort to address one of the biggest barriers in fertility care: cost. It’s also a sign that fertility is no longer flying under the policy radar.
Tread Carefully: Compliance Still Counts
Before you start redesigning your fertility benefits, remember: when an employer reimburses or provides medical care, it generally creates a group health plan, with all the legal strings attached. This means:
- ERISA, COBRA, and other rules still apply
- Missteps can result in $100 per employee per day in ACA penalties
The key is that these fertility-related benefits, when offered correctly, are treated as excepted benefits, meaning they don’t trigger all the ACA’s requirements.
Final Thoughts
These new rules don’t just open the door to more inclusive fertility benefits, they invite employers to walk through it. Yes, compliance matters. But so does compassion. And this guidance shows that, finally, the two don’t have to be at odds.
As the regulatory landscape evolves, one thing is clear: fertility benefits are no longer optional perks. They’re core to a modern, inclusive benefits strategy, and employers who embrace that now will lead the way into the future.
Interested in redesigning your fertility benefits?
We help employers navigate the legal landscape while designing inclusive, compliant, and cost-effective solutions.