In October, the departments of Treasury, Labor and Health and Human Servies (the “agencies”) issued FAQs clarifying how stand-alone fertility benefits may be offered under existing excepted benefit rules. These FAQs were released in response to Executive Order 14216, Expanding Access to In Vitro Fertilization, issued by the Trump administration in early 2025. 

The FAQs do not change current rules or regulations. However, the agencies did indicate their intent to issue future regulations that could expand the ways fertility benefits can be offered as a type of limited excepted benefit.   

Background: 

Excepted benefits are intended to offer supplemental or limited coverage and are exempt from many group health plan mandates under: 

• HIPAA’s portability rules (e.g., special enrollment rights) 

• The Affordable Care Act (e.g., minimum essential coverage, minimum value, preventive services, enhanced claims and appeals, annual dollar-limit prohibition) 

• Other laws, including mental health parity requirements 

Under current regulations, there are four categories of excepted benefits: 

• Non-Health Related Benefits (auto insurance, workers’ compensation, accident/disability income insurance) 

• Independent, Non-Coordinated Excepted Benefits (fixed/hospital indemnity, specified disease/illness plans) 

• Limited Excepted Benefits (stand-alone dental/vision coverage, most health FSAs and EAPs) 

• Supplemental Excepted Benefit Plans (Medicare supplement plans) 

The FAQs address how stand-alone fertility benefits may fit into two of these categories: 

1. Independent, non-coordinated excepted benefits, and 

2. Limited excepted benefits. 

Independent, Non-Coordinated Excepted Benefits: 

Under existing regulations, an employer may offer fertility benefits as an independent, non-coordinated excepted if all of the following conditions are met: 

• The benefit is offered under a separate policy, certificate, or contract of insurance, meaning it must be fully insured.   

• There is no coordination between the provision of the fertility benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor. 

• The fertility benefits are paid regardless of whether such benefits are also provided by the group health plan maintained by the same plan sponsor. 

• Employees are not required to be enrolled in the plan sponsor’s group health plan.  

The FAQs also clarify that employees enrolled in fertility benefit coverage under this category may contribute to an HSA, because the benefit qualifies as permitted insurance for a specified disease or illness—as long as they are also enrolled in a high-deductible health plan and do not have other disqualifying coverage. 

Although fertility benefits cannot be offered under this option as a stand-alone self-funded plan, the agencies indicated their intent to address this in future regulations. 

Limited Excepted Benefits: 

The FAQs also clarify how employers may offer fertility benefits as a limited excepted benefit through: 

• a Health Reimbursement Arrangement (HRA), or 

• an Employee Assistance Program (EAP). 

HRA Requirements 

An HRA qualifies as an excepted benefit if it satisfies all of the following: 

• The HRA is not an integral part of the employer’s group health plan and is offered only to employees who are eligible for the employer’s medical plan. 

• Reimbursements must comply with annual dollar limits. For 2026, the maximum annual amount is $2,200 ($2,150 for 2025). 

• The HRA cannot reimburse major medical premiums but may reimburse premiums for excepted benefit plans. 

• The HRA is offered to all similarly situated employees, without regard to any health factor. 

EAP Requirements 

An EAP qualifies as an excepted benefit if all of the following conditions are met: 

• The EAP does not provide “significant” medical care. The FAQs note that coaching or navigator services that help individuals understand fertility options are not considered medical care. 

• The EAP does not coordinate with other benefits under the employer’s group health plan. 

• Participation in the EAP is not conditioned on enrollment in another group health plan. 

• Participants are not required to exhaust EAP benefits before accessing benefits under another plan. 

• The EAP is offered without employee premiums, contributions, or cost-sharing. 

Client Actions: 

Employers evaluating whether to offer a stand-alone fertility benefit should review this guidance to determine whether offering these benefits as an excepted benefit meets their needs and compliance objectives. 

Piper Jordan is here to help. If you have questions or would like support evaluating your options, please reach out to your consulting team. 

Information contained in this email is intended for general information purposes only and should not be considered legal or tax advice or legal or tax opinion on any specific facts or circumstances. Recipients are urged to consult their legal counsel and tax advisor concerning any legal or tax questions that may arise.