Federal Register #2026-09479

Proposed Regulatory Change: Establishment of Excepted Fertility Benefits as a New Category of Limited Excepted Benefits

This opportunity involves a proposed regulatory change by the Departments of the Treasury, Labor, and Health and Human Services to establish fertility benefits as a new category of limited excepted benefits under federal law. - Government Buyers: - Department of the Treasury (Internal Revenue Service) - Department of Labor (Employee Benefits Security Administration) - Department of Health and Human Services (Centers for Medicare & Medicaid Services) - Products/Services Requested: - Regulatory development to amend federal regulations, creating a new category for certain fertility benefits - Coverage includes diagnosis, mitigation, and treatment of infertility, such as IVF, IUI, fertility medications, surgery, and pre-conception care - Lifetime dollar limit of $120,000 per participant, indexed annually for medical inflation - Unique/Notable Requirements: - Fertility benefits must be offered under a separate policy, certificate, or contract of insurance, or not be integral to the main health plan - Exemption of these benefits from certain federal market requirements (e.g., HIPAA, ACA) - Employers must provide required participant notices - Public comments are solicited on the proposed regulatory changes - No specific OEMs or commercial vendors are named, as this is a regulatory proposal rather than a procurement of goods or services.

Description

This document contains proposed rules that would amend regulations under the Employee Retirement Income Security Act of 1974, the Internal Revenue Code, and the Public Health Service Act to establish certain fertility benefits as a new category of limited excepted benefits. These excepted benefits are generally exempt from market requirements added by laws such as the Health Insurance Portability and Accountability Act and the Patient Protection and Affordable Care Act. The proposal recognizes fertility benefits provided under a separate policy or contract or not integral to the main plan, reflecting the market reality that fertility benefits are often separately administered. Comments on the proposal must be received by July 13, 2026.

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