Recent agency FAQs clarify that employers may offer fertility-related benefits (e.g., in-vitro fertilization) as an excepted benefit, provided the coverage is offered under a separate, fully insured policy and is not coordinated with another group health plan maintained by the same plan sponsor. The benefit would be treated similarly to a specified disease or fixed indemnity policy. Because excepted benefits are exempt from many ACA coverage mandates, they do not need to be integrated with the employer’s major medical plan and do not affect HSA eligibility.
The FAQs further explain that fertility benefits meeting the requirements of §213(d) may also be reimbursed through an Excepted Benefit Health Reimbursement Arrangement (EBHRA). An EBHRA may be offered to employees who are eligible for—though not necessarily enrolled in—the employer’s major medical plan, with annual reimbursement limited to $2,200 for 2026.
Outside of an EBHRA, employers currently cannot offer a stand-alone, self-funded reimbursement arrangement for fertility benefits that would qualify as an excepted benefit. However, the agencies have indicated an intent to pursue rulemaking that could expand how fertility benefits may qualify as “limited excepted benefits,” potentially allowing self-funded options in the future.
The FAQs can be found here: https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-72
Please contact your service team with any questions.
Unison Risk Advisors Compliance Team | benefitscompliance@unisonriskadvisors.com
Disclaimer: Materials are solely for informational purposes as an educational resource. Please contact counsel to obtain advice with respect to any specific issue.