By Dalita Collins, Director, Policy
On July 13, 2026, PCMA submitted comments to the Departments of Health and Human Services (HHS), Labor (DOL), and Treasury in response to the proposed rule establishing a new category of limited excepted benefits for fertility services. The proposal would create a voluntary framework allowing employers to offer fertility benefits outside of traditional major medical coverage if certain statutory conditions are met.
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 for participants, employers, PBMs, plans, and vendors.
Our comments focus on preserving flexibility while reducing unnecessary administrative complexity.
First, we recommend that the final rule explicitly confirm that excepted fertility benefits are voluntary and do not establish a new federal coverage mandate. We also encourage the Departments to provide additional guidance on coordination with major medical coverage and existing state infertility mandates, both of which will be critical to avoiding conflicting coverage rules, duplicative administration, and participant confusion.
Another key theme throughout the comments is preserving flexibility. Fertility treatment 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. Likewise, the rule should recognize the multidisciplinary nature of fertility care by allowing covered services to be furnished by appropriately licensed health care professionals practicing within the scope of state law.
The proposed lifetime dollar cap also raises several operational questions. Tracking accumulations across multiple vendors, pharmacy benefit arrangements, and historical claims systems presents practical challenges, particularly when many existing state infertility mandates already rely on cycle-based treatment limits rather than fixed dollar thresholds. Allowing employers to use either approach would better reflect how fertility care is delivered while providing greater administrative simplicity and consistency with existing market practices. If a lifetime dollar limit is retained, additional guardrails—including clarification that the cap establishes only the maximum permissible amount for excepted-benefit status and a good-faith compliance safe harbor—would help reduce unnecessary compliance risk.
The comments also encourage the Departments to think beyond benefit design and consider the long-term sustainability of these offerings. Because fertility treatment is typically planned, thoughtful eligibility, enrollment, and coordination rules will be important to minimizing adverse selection while preserving access for participants. Similarly, extending this framework to the individual market before there is meaningful experience in the group market would introduce unnecessary uncertainty. 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.
Overall, our comments support the Departments’ efforts to expand access to fertility benefits while emphasizing that successful implementation will require a framework that is flexible, coordinated with existing benefit structures, and grounded in operational realities. Getting those details right will help ensure employers can offer these benefits with confidence while minimizing unnecessary complexity for the organizations responsible for administering them.
Read the full comment letter HERE.