Labor, HHS, Treasury propose ‘excepted fertility benefits’—comments due July 13, 2026

Proposed federal rules from the Departments of Labor, Health and Human Services, and the Treasury would create a new category of “limited excepted benefits” for certain fertility/infertility coverage. If finalized, the framework would apply to group health plans and group health insurance issuers for plan years beginning on or after January 1, 2027. The proposal is open for public comment through July 13, 2026.

What changed in the federal rules

The agencies propose defining “excepted fertility benefits” as a limited-excepted-benefit pathway—meaning fertility-related coverage that meets specific conditions could be handled differently than standard group market requirements.

The core conditions: a four-part checklist

Under the proposal, excepted fertility benefits would have to satisfy four requirements at the same time:

• Scope: Fertility-related items and services would have to be substantially all for diagnosing, mitigating, or treating infertility (or infertility-related reproductive health conditions), and substantially all provided by licensed or authorized medical professionals.
• Maximum lifetime dollar limit: Total lifetime benefits would be capped at $120,000 per participant (plus the participant’s eligible beneficiaries), with the $120,000 figure indexed for medical inflation for plan years after 2027.
• Separate policy or “not integral” structure: The fertility benefits must be provided under a separate policy/certificate/insurance contract or otherwise be not an integral part of the main group plan. To meet the “not integral” test, employers would need to offer participants access to a traditional group health plan that is not limited to excepted benefits and is not an account-based plan (like certain health FSAs or HRAs)—but participants would not need to enroll in that other plan to receive the fertility benefit.
• Notice to participants: Plans or issuers must provide a written notice to participants and beneficiaries describing the coverage (including benefits and limits), how to access in-network providers, and how to submit claims. The notice must be understandable to the average participant and provided at the first opportunity to enroll, annually thereafter, and upon request.

Who is affected—and when it would start

Group health plans and insurers: The proposal would apply to group health plans and to issuers offering group health insurance coverage for plan years beginning on or after January 1, 2027.

Participants: If a workplace plan adopts this structure, participants could see updates to how fertility benefits are described and how the required notices explain limits and access.

Employers and plan administrators: Employers would need to ensure the fertility benefit design meets all conditions simultaneously (scope, separate/not-integral structure, the lifetime cap with indexing, and the participant notice timing and content requirements).

Individual market: HHS is asking for input

Separately, HHS is seeking comment on whether similar “excepted fertility benefits” standards should apply in the individual insurance market for policy years beginning on or after January 1, 2027—so this portion is not yet a final nationwide individual-market rule.

What to watch next

July 13, 2026 is the main near-term milestone. Comments could shape the final rule, including how eligibility conditions, notices, and the lifetime-cap mechanics are implemented. If you have workplace fertility coverage, watch for plan document updates and new notice materials ahead of 2027.

Sources

• DOL fact sheet on the proposed “excepted fertility benefits” rule
• Federal Register proposed rule (FR Doc. 2026-09479)