August 11, 2026
PCMA recently submitted comments to HHS, DOL, and the Treasury (the Departments) in response to the proposed rule establishing a new category of limited excepted benefits for fertility services. PCMA supports the Departments’ goal of expanding access to fertility care while encouraging employer innovation but urged several targeted refinements to ensure the framework is operationally workable. PCMA recommended the final rule explicitly confirm that excepted fertility benefits are voluntary and do not establish a new federal coverage mandate.
Additional guidance on coordination with major medical coverage and existing state infertility mandates will be critical to avoiding conflicting coverage rules, duplicative administration, and participant confusion. Fertility care continues to evolve rapidly, and employers should retain the ability to determine benefit design, eligibility, cost-sharing, vendor arrangements, and administration while continuing to use evidence-based medical management tools.
A measured implementation timeline, coupled with additional regulatory guidance, will give employers, plans, PBMs, vendors, and state regulators the time needed to build systems, negotiate contracts, and operationalize these benefits successfully.
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