Illinois Fertility Insurance Coverage

Partial coverage required

Overview of state insurance mandates and fertility coverage requirements for Illinois. Applies to fully-insured health plans regulated by the state.

Coverage Summary

Benefit	Required by State
Mandate to offer fertility coverage	No
Diagnosis coverage	Yes
Treatment coverage	Yes
IVF included	Yes
Fertility preservation included	Yes

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 and covering more than 25 employees to include infertility diagnosis and treatment coverage, including IVF and related ART procedures, with carve-outs for smaller employers, religious employers, and self-insured ERISA plans. 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.

Self-Funded Employer Plans (ERISA)

Self-funded employer health plans are generally governed by ERISA and may be exempt from state insurance mandates; verify benefits with the clinic and insurer.

Source & Dates

Source:: KFF State Health Facts
Data as of:: 2025-11-30
Next review:: 2026-08-09

Disclaimer

This is not legal or insurance advice. Verify coverage directly with your insurer and HR benefits team. Self-funded employer plans (ERISA) are generally exempt from state mandates. Information reflects the reviewed source as of the date noted above and may not reflect recent legislative or regulatory changes.

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