Does Illinois require IVF coverage?

Coverage Details

Illinois is a mandate-to-cover state for many fully insured group plans. 215 ILCS 5/356m requires group accident and health policies providing pregnancy-related benefits to include infertility diagnosis and treatment coverage, including IVF and related ART procedures, with carve-outs for religious employers and self-insured ERISA plans. The prior 25-employee threshold is removed for plans issued or renewed on or after January 1, 2026, and the amended section adds surgical sperm extraction and PGT-A and caps coverage at 4 completed oocyte retrievals lifetime (6 after a live birth). The same section also requires medically necessary standard fertility preservation services for iatrogenic infertility. Medicaid coverage is narrower and should not be read as equivalent to the private-market IVF mandate.

Coverage Summary

How to Verify Your Coverage

1. Ask your employer or plan administrator whether the plan is fully insured or self-funded.
2. Request the plan document for infertility diagnosis, treatment, fertility preservation, medication, and laboratory benefits.
3. Confirm prior authorization, network, age, diagnosis, cycle, and lifetime-limit requirements with the insurer.
4. Ask the clinic billing team to verify both the clinic and laboratory providers for the services you expect to use.

Clinics publishing insurance or employer-benefit information

These Illinois clinic profiles name at least one insurer or employer fertility-benefit program in a reviewed source. Inclusion does not guarantee that your plan, treatment, physician, or laboratory is covered.