You can use healthcare benefits for both fertility treatments and maternity care, but how you access those benefits, and what's covered, depends on your health plan, your employer's specific benefit design, and where you live. Traditional employer-sponsored plans from major carriers typically cover prenatal, delivery, and postnatal maternity care. Fertility treatments like in vitro fertilization (IVF), intrauterine insemination (IUI), and egg freezing are a different story: coverage varies widely, and many plans either exclude these services outright or impose strict limits. That's where a Health-to-Wealth™ Benefit System like WellthCare™ comes in. It rewards preventive and proactive care and helps employees use their benefits more strategically. WellthCare™ automatically rewards every verified preventive action, like fertility-related labs or prenatal visits, with reward dollars and automatic retirement contributions. The reward dollars help offset out-of-pocket costs for family planning, and the system comes with no new employer out-of-pocket cost.
What's Usually Covered for Maternity Care?
Under the Affordable Care Act (ACA), all individual and small-group health plans must cover maternity and newborn care as an essential health benefit. Large-group and self-insured plans are required to cover pregnancy under the Pregnancy Discrimination Act of 1978, which applies to employers with 15 or more workers and requires pregnancy-related care to be treated like any other medical condition. What's included: prenatal visits and screenings, labor and delivery, postpartum care for both mother and baby, and breastfeeding support and supplies like breast pumps. But don't assume everything is free: deductibles, copays, and coinsurance still apply.
If you're enrolled in a self-funded plan, which many larger employers use, the same maternity benefits are often included, but your employer can customize the details. For example, some plans may offer lower deductibles for in-network maternity providers or require pre-authorization for certain services. Review your Summary Plan Description (SPD) or call your benefits administrator to confirm exactly what's covered and what your out-of-pocket costs will be. With traditional plans, those costs can still add up fast, because deductibles, copays, and coinsurance pile up during a high-utilization event like childbirth.
Fertility Treatments: The Coverage Gap
Fertility coverage is far less predictable. Some states, including Massachusetts, New York, and California, mandate that certain insurance plans cover fertility diagnostics and treatments, but many employer plans still exclude IVF, IUI, and fertility preservation like egg or sperm freezing. KFF's 2024 Employer Health Benefits Survey found that only about 27% of firms with 200 or more employees cover IVF, and 12% cover egg or sperm freezing. Even when IVF is covered, the terms vary: lifetime caps (for example, $15,000 total), age limits (for example, women under 40 only), requirements to try lower-cost treatments first, and coinsurance of 50% or more. Coverage, when it exists, usually comes with limits.
Many employers now offer fertility benefits through specialized vendors like Progyny, Carrot, or WINFertility as a way to attract and retain talent. These can integrate with your existing medical or pharmacy benefits but often require separate enrollment. If your employer offers a WellthCare-style system, note that the WellthCare Store™ provides real, spendable reward dollars for FSA-approved health purchases. Those dollars can cover some fertility-related products, like supplements, ovulation kits, or fertility monitors, that you might otherwise pay for out of pocket. It's a way to offset costs even when insurance doesn't cover the procedure itself.
What Fertility Treatment Costs Out of Pocket
A single IVF cycle in the United States runs about $15,000 to $30,000 when clinic fees, medications, monitoring, and lab work are included. Medications alone often add $2,000 to $7,000 per cycle. Many people need more than one cycle, which is why lifetime caps and cycle limits matter so much. Egg freezing carries its own out-of-pocket cost, charged per retrieval cycle plus annual storage fees. Those numbers make the coverage gap a real financial burden. They also show why preventive-first tools that reward labs, screenings, and supporting products can ease the path even when they don't pay for the procedure itself.
How a Health-to-Wealth System Like WellthCare Changes the Equation
WellthCare operates differently from traditional health plans. It works alongside your existing major medical plan and makes preventive care more rewarding:
- $0 co-pay care first: Employees use WellthCare's preventive care options, like health scans, lab work, and care coordination, before filing a claim with their major medical plan. This can help catch issues early and reduce out-of-pocket costs.
- Rewards for healthy actions: Completing recommended preventive actions tied to reproductive health, like prenatal vitamins, genetic carrier screening, or fertility-related labs, earns reward dollars at the WellthCare Store. The store carries more than 3,000 FSA-approved products, including pregnancy tests, prenatal vitamins, lactation supplies, and fertility aids.
- Guarding against waste: WellthCare's medical bill review and cost transparency tools can catch billing errors and reduce wasteful spending. That leaves more money for things your plan doesn't fully cover, like fertility treatment.
WellthCare won't replace your major medical coverage for fertility procedures, but it can reduce your financial burden for the preventive and supportive care around pregnancy and family planning.
Tips for Maximizing Your Benefits for Fertility and Maternity Care
First, review your plan documents. Request a copy of your employer's Summary Plan Description and check specifically for fertility treatment exclusions, lifetime limits, and pre-authorization rules. Second, ask about fertility-specific add-ons. Some large employers now offer separate fertility benefits through vendors like Progyny, Carrot, or WINFertility, layered on top of your medical plan. Third, use a Flexible Spending Account (FSA) or Health Savings Account (HSA). Both let you set aside pre-tax dollars for eligible expenses, and the WellthCare Store carries FSA-approved products. Fourth, check state mandates. If you live in a state with a fertility coverage mandate, your employer's plan might be required to cover certain treatments even if the Summary Plan Description says otherwise. Fifth, consider timing. If your employer is evaluating a self-funded plan or a WellthCare Complete™ model, the transition may open new coverage options. Ask your benefits administrator whether a change is coming and what it would mean for your family-planning costs.
Plan Your Next Step
Healthcare benefits cover maternity care broadly, but fertility treatments remain an expensive and often excluded benefit for many employees. The most practical approach is to combine your major medical plan with a Health-to-Wealth Benefit System like WellthCare, which rewards preventive behaviors and gives you real, spendable dollars for the supporting products you need. By understanding your plan's details and using every available tool, including FSAs, WellthCare Store reward dollars, and state mandates, you can reduce out-of-pocket costs and make family building more affordable. If your employer is considering WellthCare, now is a good time to ask how its preventive-first model can support your maternity and fertility goals without disrupting your existing coverage. Ask your employer: do we have a WellthCare Plan?