The Trump administration has proposed a federal rule that could significantly expand employer-sponsored fertility coverage by creating a new category of benefits exempt from many Affordable Care Act requirements. The proposal, issued jointly by the Departments of Labor, Health and Human Services, and Treasury, is designed to encourage more companies to offer infertility and reproductive health services to workers.
Under the proposed rule, fertility benefits would be classified as “limited excepted benefits,” placing them in the same category as vision and dental coverage. Because excepted benefits are treated separately from traditional health insurance plans, they are not required to comply with the ACA’s full coverage standards and consumer protections.
The rule would allow employers to provide fertility-related coverage specifically for the diagnosis, treatment, or mitigation of infertility and related reproductive health conditions. However, the plans would include a lifetime maximum benefit of $120,000 for each participant and eligible beneficiaries. Beginning with plan years after 2028, the cap would increase periodically to account for inflation.
Employers offering the coverage would also be required to provide workers with a clear notice explaining the scope and limitations of the benefits. Administration officials say the proposal is intended to make fertility services more accessible while giving employers greater flexibility in designing benefit packages.
According to estimates cited by Bloomberg, the number of employers offering fertility benefits could rise from roughly 268,000 to 523,000 if the rule is finalized. Federal officials also project that as many as 750,000 individuals could enroll in fertility coverage plans annually under the expanded framework.
The proposal builds on President Donald Trump’s earlier executive order aimed at expanding access to in vitro fertilization and fertility care. Administration officials have framed the effort as part of a broader strategy to support family growth and address declining birth rates in the United States.
At the same time, the proposal arrives amid criticism from some Democratic lawmakers who argue the administration’s support for fertility access has been inconsistent. Their concerns follow reports that the Equal Employment Opportunity Commission may revise guidance related to workplace accommodations for employees undergoing fertility treatments.
The debate comes as new data from the Centers for Disease Control and Prevention shows U.S. birth rates continue to decline. Federal statistics indicate the fertility rate has fallen by 23% since 2007, with significantly fewer births recorded in 2025 compared with the nation’s peak birth year. Analysts point to economic pressures, delayed family planning decisions, and lower teen pregnancy rates as contributing factors behind the long-term decline.
