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Determining if your insurance covers In Vitro Fertilization (IVF) involves checking state mandates, your employer's plan type, and specific policy limits. As of 2026, several new state laws have taken effect to expand these benefits.
1. Check Your State's Mandates
Whether your plan is required to cover IVF often depends on where you live.
Mandatory IVF Coverage: As of 2025/2026, states and districts including Washington D.C., California (for large group plans starting January 2026), Illinois, New York (large group), Maryland, Massachusetts, Rhode Island, Connecticut, Delaware, Hawaii, Maine, and New Jersey have laws requiring various levels of IVF coverage.
Mandatory "Offer" States: Some states, like Texas and Louisiana, require insurers to offer fertility coverage to employers, but the employer is not forced to include it in their plan.
2. Identify Your Plan Type
Your employer's choice of plan determines if they must follow state laws.
Fully-Insured Plans: These plans must follow state-specific mandates. If you live in a state with a mandate, you are likely covered.
Self-Insured (Self-Funded) Plans: Common at large corporations, these are governed by federal law (ERISA) and are exempt from state mandates. Even if your state requires IVF coverage, a self-insured employer can choose not to offer it.
3. Review Your Policy Documents
Access your Summary of Benefits and Coverage (SBC) or "Evidence of Coverage" via your insurer's member portal.
Keywords: Search for "infertility," "IVF," "ART" (Assisted Reproductive Technology), or "gamete".
Exclusions: Look for language like "excludes infertility treatment and all related services".
Supplemental Benefits: Some employers offer specialized fertility benefits through third parties like Progyny, Carrot, or WINFertility.
4. Essential Questions to Ask Your Insurer
Call the member services number on your insurance card and ask:
Diagnostic vs. Treatment: Is coverage for "diagnosing infertility" only, or does it include treatment (IVF)?
Lifetime Maximums: Is there a dollar cap (e.g., $25,000) or a cycle cap (e.g., 3 retrievals)?
Pre-requisites: Must I try Intrauterine Insemination (IUI) or natural conception for a specific period before IVF is approved?
Medications: Are fertility drugs covered under the medical benefit or a separate pharmacy benefit?
Helpful Resources
RESOLVE: The National Infertility Association: Provides state-by-state mandate guides and advocacy tools.
HealthInsurance.org: Detailed breakdown of state laws and marketplace plan coverage.