TL/DR –
President Donald Trump has proposed a rule that would allow employers to offer standalone health insurance coverage for fertility benefits, such as in vitro fertilization (IVF) treatments and other fertility treatments. The rule, presented by the Departments of Labor, Health and Human Services, and Treasury, is in response to an executive order calling for reduction in the cost of IVF treatment. The supplemental insurance, not mandatory for employers to offer, would cover care related to diagnosing, mitigating, or treating infertility with a lifetime cap of $120,000 for the participant and their beneficiaries, adjusted for inflation for plans starting in 2028.
Trump Proposes New Rule for Fertility Benefit Coverage
President Donald Trump unveiled a proposed rule on Monday that would permit employers to offer standalone health insurance coverage for fertility treatments. This proposed rule is designed to create a supplementary insurance option, similar to vision or dental insurance, allowing for in vitro fertilization (IVF) services and other fertility treatments to be covered.
Unveiled by the Departments of Labor, Health and Human Services, and Treasury, this proposal follows a February executive order calling for policies to reduce the cost of IVF treatment.
Scope of the Proposed Rule
The supplementary insurance would cover infertility diagnosis, mitigation, and treatment. This includes lab tests, medications, genetic testing, and IVF. Care covered under the proposed rule would have a lifetime cap of $120,000, adjusted for inflation from 2028.
Working of the Supplemental Insurance
The proposed rule does not mandate employers to offer supplemental insurance. Currently, about a quarter of large companies voluntarily provide IVF coverage for their employees, according to KFF. This supplementary insurance would be categorized as a limited excepted benefit, allowing companies to potentially offer plans more economically.
Impact on Fertility Treatment Costs
While supplemental policies could help offset high fertility treatment costs, they may likely come at a high cost to employees as the employer seldom subsidizes them. In addition, the optional nature of these plans could lead to a lack of subsidization from those not seeking fertility care. This, in turn, could lead to higher out-of-pocket costs for IVF services.
Rule Proposal Not Requiring Congressional Oversight
The proposal to amend excepted benefits to include fertility care wouldn’t require congressional approval, hence part of the appeal for the administration. However, the rule does not apply to those enrolled under the Affordable Care Act.
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