Open enrollment is the window when you choose among the health plans your employer offers for the next year. If fertility care is anywhere on your radar, for PMOS, for any other cause of infertility, or just because you want the option someday, this is the time to check whether any plan available to you covers it, before you decide.
Enrollment windows vary by employer. Check your own deadline with HR or your benefits portal.
Most people never ask. Not because they don’t care, but because the question feels awkward, or because they assume the answer is already no. Sometimes it is. But coverage varies enormously by employer and by plan, and the only way to know is to ask, specifically, before your window closes, not after you are mid-cycle and paying out of pocket.
A single IVF cycle can cost $12,000 to $25,000 (White House Executive Order 2025).
Before you ask
- Pull up the Summary of Benefits and Coverage (SBC) for each plan available to you, not just your current one.
- Know that infertility diagnosis, fertility medications, and IVF are often three separate coverage questions, not one. A plan can cover one and exclude the others.
- Know there are two different conversations. During open enrollment, you can compare the plans your employer offers and choose among them. Asking your employer to add a benefit that no plan offers is a separate request, usually for the next renewal.
Five questions to ask HR
- Do any of the plans available to me cover fertility treatment?
- Does the plan cover a fertility workup and diagnosis?
- Are fertility medications covered under the pharmacy benefit?
- Is IVF covered as a medical benefit, and is there a lifetime maximum or cycle limit?
- If none of the plans cover it, would the company consider adding it at the next renewal?
What to say
“I’d like to understand what fertility coverage is available to me during open enrollment. Specifically: do any of the plans available to me cover fertility treatment? Does the plan cover a fertility workup and diagnosis? Are fertility medications covered under the pharmacy benefit? Is IVF covered as a medical benefit, and if so, is there a lifetime maximum or cycle limit? And if none of the available plans cover IVF, is it something the company would consider adding at the next renewal?”
If none of the plans cover it
“I understand that none of the available plans cover this right now. I wanted to flag it directly. Up to 1 in 5 Americans experience infertility (CDC), so this affects more of your workforce than people realize. I’d like fertility coverage considered for the next renewal.”
If you hear no, don’t stop there.
Join the Advocate Network for alerts when your voice can make a difference → sign up here.
FAQs, answered
“My plan doesn’t list IVF anywhere. Does that mean it’s not covered?”
Not necessarily. Fertility coverage is often buried under general “infertility services” or excluded entirely without being named. The only way to know for sure is to ask HR or your plan administrator directly, using the five questions above, rather than assuming from a benefits summary alone.
“What’s the difference between infertility diagnosis, medication, and IVF coverage?”
These are frequently three separate coverage decisions on the same plan. A plan can cover diagnostic testing and still exclude IVF as a treatment, or cover medication under the pharmacy benefit while excluding the procedure itself. Ask about all three by name.
“My employer doesn’t offer it. Is there anything I can do this cycle?”
During open enrollment you can compare the plans your employer offers and choose the one with the best fertility coverage, so check every option, not just your current plan. You generally can’t change which benefits your employer offers during this window. But you can ask HR to consider adding fertility coverage at the next renewal. HR and benefits teams build next year’s plan based partly on what employees ask for now, and the “If none of the plans cover it” language above gives you the words for that conversation.
“Does state law require my plan to cover this?”
It depends on your state and your plan type. Coverage mandates vary significantly, and most only reach state-regulated plans, not every self-funded employer plan, even in a state with a mandate. Ask directly rather than assuming state law settles it.
What you can do next
Asking HR helps you understand your options. Supporting the HOPE Act can help expand those options for more families. The HOPE with Fertility Services Act (H.R. 8119) would make infertility coverage a standard part of group health plans that already cover childbirth.
- Ask your representative to support the HOPE Act
- Join the Advocate Network. Members get alerts when their voice can make a difference on a live policy debate. You don’t need a personal connection to infertility to help and it takes about five minutes.
- Share your story with Americans for IVF. Personal experiences help lawmakers understand what coverage gaps mean for real families → share your story here.
