Tri-Departments release fertility excepted benefits proposed rule

June 10, 2026

marketplace medicaid

On May 10, the Departments of Labor, HHS, and Treasury (the Departments) issued a proposed rule that would create a new category of limited excepted benefits to allow employers to offer stand-alone fertility benefits to their employees, similar to dental, vision, and other supplemental coverage.

Benefits would be limited to fertility-related items and services for the diagnosis, mitigation, or treatment of infertility or infertility-related reproductive health conditions, provided by licensed or authorized medical professionals, and limited to a lifetime maximum of $120,000 per participant, together with their beneficiaries (indexed for medical inflation). The proposal follows a Feb. 2025 Executive Order that directed the Assistant to the President for Domestic Policy to submit a list of policy recommendations to protect access to IVF treatments and reduce costs. The Cigna Group will share feedback on the proposed rule with relevant trade associations by the July 13 deadline.

legislation

Bicameral Patients before Monopolies Act reintroduced

On May 13, bipartisan lawmakers in the House and Senate reintroduced the Patients Before Monopolies (PBM) Act (S.4509/H.R.8779), legislation that would prohibit common ownership of PBMs, insurers, and pharmacies. Sponsored by Sens. Warren (D-MA) and Josh Hawley (R-MO) alongside Reps. Diana Harshbarger (R-TN) and Jake Auchincloss (D-MA), the bill would require impacted organizations to divest […]
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June 10, 2026

EGWP marketplace medicaid Medicare

legislation

CMS announces ePA acceleration initiative, democrats seek to repeal WISeR Model

The Centers for Medicare & Medicaid Services (CMS) is advancing its electronic prior authorization (ePA) efforts through a newly established Electronic Prior Authorization Acceleration initiative to address key challenges and drive solutions ahead of 2027 requirements. To date, 29 health care organizations – including health systems, electronic health record developers, physician practices, networks, and digital health […]
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June 10, 2026

EGWP marketplace medicaid Medicare

legislation

Massachusetts issues final prior authorization rule

The Massachusetts Division of Insurance (DOI) has finalized its prior authorization regulations, which went into effect on June 5. Implementation will be phased, with the DOI indicating that additional guidance will be issued through educational sessions planned throughout June. Carriers must submit implementation plans by September. The regulations will prohibit prior authorization for several services, including […]
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June 10, 2026

EGWP marketplace medicaid Medicare

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