Technical Analysis of the Proposed Regulations Establishing Excepted Fertility Benefits
REG-118484-25, May 11, 2026
The Department of the Treasury, the Internal Revenue Service (IRS), the Department of Labor, and the Department of Health and Human Services recently issued proposed regulations to amend 26 CFR Part 54, as well as corresponding regulations under ERISA and the Public Health Service (PHS) Act. The primary objective of these proposed rules is to establish specific fertility benefits as a new classification of "limited excepted benefits". By classifying these benefits as excepted benefits, they become "generally exempt from the market requirements" found in Chapter 100 of the Internal Revenue Code, Part 7 of ERISA, and Title XXVII of the PHS Act.
The rationale for this regulatory action is deeply rooted in demographic trends and recent executive policy directives. The preamble explicitly highlights a demographic shift, noting that the United States is currently experiencing a declining fertility rate where the "general fertility rate declined by 14 percent" between 2014 and 2024, remaining "below replacement level for over a decade". The total fertility rate has dropped to 1.6 births per woman in 2023, which is below the 2.1 replacement level necessary for a population to sustain itself.
Furthermore, the regulations are a direct response to Executive Order 14216, "Expanding Access to In Vitro Fertilization," which established that "as a Nation, our public policy must make it easier for loving and longing mothers and fathers to have children". The Executive Order seeks to ensure reliable access to in vitro fertilization (IVF) by "easing unnecessary statutory or regulatory burdens to make IVF treatment drastically more affordable". Separately, the regulations align with Executive Order 14192, "Unleashing Prosperity Through Deregulation," which prioritizes efforts to "alleviate unnecessary regulatory burdens placed on the American people".
Historically, most employer-sponsored major medical health plans have not covered fertility treatments, and where employers do offer such coverage, "many have claims for such benefits administered under a separate contract from their major medical coverage". The Departments recognize that "coverage for the diagnosis, mitigation, or treatment of infertility or infertility-related reproductive health conditions" is lacking and hope that creating this new limited excepted benefit will "reduce the regulatory burden for employers seeking to offer fertility benefits to their employees".
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