Key Takeaways
- 13+ states explicitly cover fertility preservation before surgery that could cause infertility — directly applicable to PAS hysterectomy
- All state mandates only apply to fully-insured, state-regulated plans — self-insured ERISA plans (roughly 65% of employer plans) are exempt
- Even in covered states, some insurers may interpret mandates narrowly — always verify with your specific plan
- No federal fertility preservation mandate exists yet, though several bills are pending in Congress
This guide provides general information about state fertility preservation mandates based on research conducted in March 2026. State laws change, and insurance coverage varies by plan, employer, and state. Always verify coverage directly with your insurance company and reference the specific state statute. This page is not legal advice and should not be used as a substitute for contacting your insurer or consulting with a benefits attorney.
Why This Matters for PAS Patients
Placenta Accreta Spectrum frequently results in hysterectomy (surgical removal of the uterus) as part of delivery. For patients who have not yet completed their families, this means a permanent loss of the ability to carry pregnancies. While the uterus is removed, the ovaries are typically preserved — meaning biological parenthood is still possible through egg or embryo cryopreservation (freezing) followed by gestational surrogacy.
This is where state fertility preservation mandates become critically important for PAS patients:
- Egg and embryo cryopreservation before surgery can preserve your biological parenthood options even after hysterectomy
- State mandates may require your insurer to cover these preservation services at no additional cost beyond your normal plan cost-sharing
- Many mandates were written with cancer patients in mind, but the strongest ones explicitly include any surgery that could cause infertility — which directly applies to PAS hysterectomy
- Fertility preservation procedures (ovarian stimulation, egg retrieval, freezing) typically cost $10,000–$20,000 without insurance coverage1
No state fertility preservation mandate covers the cost of gestational surrogacy. These laws cover preserving your eggs or embryos, but the subsequent use of a gestational carrier to carry a pregnancy involves separate, significant costs ($100,000–$200,000+) that are not addressed by any current mandate. That said, preserving your eggs or embryos now keeps the door open for the future, even if surrogacy must be self-funded later.
States With Strong PAS Coverage (Surgery Explicitly Named)
These states have the strongest case for PAS patients because their laws explicitly list surgery as a qualifying trigger for fertility preservation coverage. If your insurance is regulated in one of these states, you have a strong legal basis to request coverage for egg or embryo freezing before hysterectomy.
| State | Law Reference | Year | Key Provisions | PAS Applicability |
|---|---|---|---|---|
| Illinois | 215 ILCS 5/356m | 2018 | Covers fertility preservation when a medical treatment may cause iatrogenic infertility. Surgery is explicitly included in the definition. Ages 14–45. Applies to commercial plans and Medicaid. | Excellent. Surgery explicitly named. Medicaid coverage is rare and valuable. Broad age range. |
| New Hampshire | RSA 417-G | 2019 | Surgery listed as a qualifying trigger for fertility preservation coverage. Covers standard fertility preservation procedures. | Excellent. Surgery explicitly listed as qualifying event. Direct applicability to PAS hysterectomy. |
| District of Columbia | Law 25-49 | 2023 (effective 2025) | Surgery explicitly listed as qualifying trigger. Covers up to 3 egg retrievals and unlimited embryo transfers. Broad definition of medical necessity. | Excellent. Surgery named, generous retrieval limits, and one of the newest and most comprehensive mandates. |
| Delaware | HB 263 | 2018 | Broadest scope among state mandates. Surgery included as qualifying trigger. Covers up to 6 egg retrievals and unlimited embryo transfers. | Excellent. Broadest scope, surgery included, most generous retrieval limits of any state. |
If your fully-insured health plan is regulated in Illinois, New Hampshire, DC, or Delaware, you have the strongest legal basis for fertility preservation coverage before PAS hysterectomy. When contacting your insurer, reference the specific statute by name and note that surgery is explicitly included as a qualifying trigger for coverage.
States With Broad Language (Likely Covers PAS)
These states have fertility preservation mandates that use broad language such as "medically induced infertility" or "iatrogenic infertility" without limiting coverage to specific causes. While surgery may not be explicitly named in the statute text, the language is broad enough that PAS hysterectomy should qualify. You may need to work with your insurer to confirm coverage.
| State | Law Reference | Year | Key Provisions | PAS Applicability |
|---|---|---|---|---|
| California | SB 729 | Effective Jan 2026 | Employers with 100+ employees. Up to 3 egg retrievals. Covers fertility preservation for medically induced infertility. | Very likely. Broad medically induced infertility language. New law, so implementation is still developing. |
| Colorado | HB 20-1158 | 2022 | Covers "medically induced infertility" from treatments. Broad definition that does not limit to specific conditions. | Very likely. "Medically induced infertility" language should encompass surgery-caused infertility. |
| Connecticut | HB 7124 | 2017 | Broad fertility preservation mandate. No age limits (age restrictions have been deemed discriminatory). Covers medically necessary preservation. | Very likely. No age limits is beneficial. Broad language should cover surgical infertility. |
| Rhode Island | RIGL 27-20-20 | 2017 | Fertility preservation for medically induced infertility. Ages 25–42. | Likely. Age range may exclude some patients. Broad language otherwise. |
| Maine | LD 1539 | 2022 | Covers fertility preservation when medical treatment may cause infertility. | Likely. Broad medical treatment language. |
| Massachusetts | H.4930 | 2024 | Comprehensive fertility preservation coverage. Covers iatrogenic infertility from medical treatments. | Very likely. One of the most recent and comprehensive mandates. |
| New Jersey | S.2173 | 2017 | Covers fertility preservation for medically necessary treatments that may impair fertility. | Likely. "Medically necessary treatments" language is broad enough to include surgery. |
| New York | S.3462/A.5339 | 2019/2021 | Comprehensive fertility preservation. Covers preservation when medical treatment is expected to cause infertility. | Very likely. Well-established mandate with broad language. |
| Maryland | HB 908 | 2018 | Covers fertility preservation services for patients with medical conditions whose treatment may cause infertility. | Likely. Broad medical condition language should encompass PAS requiring hysterectomy. |
When contacting your insurer in a "broad language" state, frame your request carefully: the medical treatment (hysterectomy) is what causes the infertility, and the hysterectomy is medically necessary due to your PAS diagnosis. This framing aligns with the language used in most of these state mandates.
States That Do NOT Cover PAS
These states have fertility preservation mandates, but their laws are explicitly limited to specific diagnoses (typically cancer) and do not extend to surgical infertility from conditions like PAS.
| State | Covered Conditions | PAS Covered? |
|---|---|---|
| Georgia | Cancer, sickle cell disease, lupus only | No. Limited to named conditions. |
| Louisiana | Cancer only | No. Cancer-specific mandate. |
| Montana | Cancer only | No. Cancer-specific mandate. |
| Nevada | Breast cancer and ovarian cancer only | No. Limited to specific cancer types. |
| Oklahoma | Cancer only | No. Cancer-specific mandate. |
If you are in one of these states with a fully-insured plan, the state mandate will not help with PAS-related fertility preservation. However, your insurer may still have its own coverage policy (for example, Aetna CPB 0327 covers fertility preservation for iatrogenic infertility regardless of state mandate). Always check your insurer's own policies in addition to state law.
States With Uncertain Coverage
These states have mandates where PAS coverage is ambiguous — the law may apply depending on how your insurer interprets the language. If you are in one of these states, it is worth attempting to get coverage, but be prepared that the insurer may push back.
| State | Details | PAS Assessment |
|---|---|---|
| Florida | 2025 mandate. Cancer-emphasized language but includes broader provisions that could be interpreted to include other causes of medically induced infertility. | Uncertain. Cancer is emphasized, but broader language may apply. Worth pursuing. |
| Kentucky | 2023 mandate. Coverage depends on how "medically necessary treatment" is interpreted by individual insurers. | Uncertain. Depends on insurer interpretation. Get a determination in writing. |
| Texas | Mandate to offer fertility preservation coverage, not a mandate to provide it. Employers can choose whether to include this benefit. | Uncertain. Your employer must have opted in. Check with HR or your plan documents. |
| Utah | Limited detail available on the scope of coverage. May cover fertility preservation but specifics are unclear. | Uncertain. Limited information. Contact your insurer directly and request a written determination. |
Critical Limitation: Self-Insured Plans and ERISA
All state fertility preservation mandates only apply to fully-insured, state-regulated health plans. If your employer self-funds (self-insures) its health plan, state mandates do not apply to your coverage — even if you live and work in a state with a strong mandate. This is due to the federal Employee Retirement Income Security Act (ERISA), which preempts state insurance regulation for self-funded employer plans.
How to Check If Your Plan Is Fully-Insured or Self-Funded
This distinction is critical and not always obvious. Here is how to find out:
- Look at your insurance card. If it says the plan is "administered by" (rather than "insured by") a carrier like Aetna, UHC, or BCBS, the plan may be self-funded. "Administered by" often means the insurer handles claims but your employer bears the financial risk.
- Check your Summary Plan Description (SPD). This document, available from HR or your benefits portal, should state whether the plan is "fully-insured" or "self-funded" / "self-insured."
- Call your HR or benefits department. Ask directly: "Is our health plan fully-insured or self-funded?" They should know.
- Call your insurer. Ask them whether your plan is subject to state insurance mandates.
If your employer uses a Professional Employer Organization (PEO) like Rippling, Justworks, or TriNet, the health plan is typically fully-insured through the PEO's master policy. This means state mandates likely do apply to your coverage. For example, Aetna plans administered through Rippling PEO are typically fully-insured and subject to the insurance regulations of the state where the plan is issued.
What State Mandates Typically Cover vs. Do Not Cover
| Typically Covered | Typically NOT Covered |
|---|---|
| Egg (oocyte) cryopreservation | Gestational surrogacy (carrier fees, legal, agency) |
| Embryo cryopreservation | Experimental or investigational preservation methods |
| Sperm cryopreservation | Elective fertility preservation (no medical indication) |
| Ovarian stimulation medications | Donor eggs or donor sperm |
| Lab testing and monitoring | Long-term storage beyond initial period (varies by state) |
| Initial cryostorage (varies — some states mandate 1+ years) | Travel to fertility clinic |
Even when initial cryopreservation is covered, ongoing annual storage fees ($500–$1,000/year) may or may not be included depending on the state mandate and your plan. Ask your fertility clinic and insurer about storage coverage before starting the process. Some states (like DC) are more explicit about storage requirements than others.
Federal Landscape
No federal fertility preservation mandate currently exists. This means there is no nationwide requirement for health insurers to cover egg or embryo freezing, even when a medical treatment will cause infertility. Coverage depends entirely on your state's laws (if your plan is fully-insured) or your employer's plan design (if self-funded).
Pending Federal Legislation (119th Congress)
Several bills have been introduced in the 119th Congress that could create federal fertility preservation requirements:
- Right to IVF Act — Would establish a federal right to access IVF and fertility preservation services
- Access to Family Building Act — Would require group health plans to cover fertility preservation
- Veteran Families Health Services Act — Would expand VA fertility preservation coverage
- FAMILY Act — Would require coverage of fertility preservation for iatrogenic infertility
- Reproductive Health Care Coverage Act — Broad reproductive health coverage proposal
- Building Families Act — Would create tax credits for fertility treatment costs
- Protecting Access to Fertility Treatment Act — Would prevent restrictions on fertility treatment access
Executive Action
In October 2025, the President signed an executive order directing federal agencies to explore expanding IVF and fertility preservation coverage for federal employees and service members. While this does not create a universal mandate, it signals growing federal attention to fertility preservation as a health equity issue.3
As of March 2026, none of the above federal bills have been enacted into law. For now, state mandates and individual insurer policies remain the only paths to mandated fertility preservation coverage. We will update this page if the federal landscape changes.
How to Use This Information: Step-by-Step
If you are a PAS patient considering fertility preservation before your delivery, here is a practical guide to navigating insurance coverage using the information on this page.
Step 1: Check If Your State Has a Mandate
Use the tables above to determine if the state where your health plan is regulated has a fertility preservation mandate. Note that this is the state where your plan is regulated, which is usually the state where your employer is headquartered or where the insurance policy was issued — not necessarily the state where you live.
Step 2: Determine If Your Plan Is Fully-Insured or Self-Funded
This is critical. Check your Summary Plan Description, call HR, or call your insurer. If your plan is self-funded, state mandates do not apply (but your insurer may still have a coverage policy — see Step 3). If you are on a PEO plan (Rippling, Justworks, TriNet), it is likely fully-insured.
Step 3: Contact Your Insurer and Reference the Specific State Law
Call the member services number on your insurance card and ask specifically about fertility preservation coverage for medically induced infertility. Reference the state law by name (e.g., "I am calling about coverage under Illinois 215 ILCS 5/356m"). Ask for a written determination of coverage. Get a reference number for the call.
Even if your plan is self-funded or your state has no mandate, ask about the insurer's own fertility preservation policy. For example, Aetna CPB 0327 covers fertility preservation for iatrogenic infertility regardless of state mandates.
Step 4: Ask Your MFM to Document Medical Necessity
Have your maternal-fetal medicine specialist write a letter documenting:
- Your PAS diagnosis (with ICD-10 codes: O43.21x, O43.22x, or O43.23x)
- The medical necessity of hysterectomy as part of your delivery
- That hysterectomy will cause permanent loss of fertility (iatrogenic infertility)
- That fertility preservation before surgery is the standard of care for patients of reproductive age facing iatrogenic infertility
Step 5: If Denied, Appeal Citing the State Mandate
If your insurer denies coverage despite a state mandate:
- File a formal written appeal citing the specific state statute
- Include your MFM's medical necessity letter
- Contact your state's Department of Insurance to file a complaint if the insurer is not complying with the state mandate
- Consider reaching out to RESOLVE or Triage Cancer for help navigating the appeals process
- If your plan is governed by ERISA and the state mandate does not apply, focus your appeal on the insurer's own clinical policy and the medical necessity of the service
Fertility preservation (egg retrieval) must happen before your PAS delivery. The ovarian stimulation and retrieval process takes approximately 2–3 weeks and should ideally be completed well before your scheduled delivery date. Start this process as early as possible in your pregnancy — do not wait until the third trimester.
Key Resources
RESOLVE State Insurance Tracker
Comprehensive state-by-state listing of fertility insurance mandates, updated regularly by the National Infertility Association.
Alliance for Fertility Preservation
Resources and advocacy for patients facing medically induced infertility, including insurance navigation tools.
Triage Cancer
Free legal and practical resources for navigating insurance coverage for fertility preservation and cancer-related care.
ASRM State Infertility Laws
American Society for Reproductive Medicine's tracker of state infertility insurance laws and legislative updates.
References
- Patel P, Gomes Gouveia A, Gala D, et al. "Fertility Preservation Insurance Mandates: A Comprehensive Review of Legislation Across the United States." The Permanente Journal. 2025;29(1):1-12. doi:10.7812/TPP/24.117
- Kaiser Family Foundation. "2024 Employer Health Benefits Survey." KFF. 2024. kff.org
- White House. "Executive Order on Expanding Access to IVF and Fertility Services." October 2025.
- Cardozo ER, Huber WJ, Stuckey AR, Alvero RJ. "Mandating Coverage for Fertility Preservation — A Step in the Right Direction." JAMA Health Forum. 2021;2(5):e210360. doi:10.1001/jamahealthforum.2021.0360
- RESOLVE: The National Infertility Association. "Insurance Coverage by State." Accessed March 2026. resolve.org
- Alliance for Fertility Preservation. "State Legislation." Accessed March 2026. allianceforfertilitypreservation.org
- American Society for Reproductive Medicine. "State Infertility Insurance Laws." Accessed March 2026. asrm.org
- Illinois General Assembly. "215 ILCS 5/356m — Coverage for Fertility Preservation." 2018.
- New Hampshire General Court. "RSA 417-G — Fertility Preservation." 2019.
- District of Columbia Council. "Law 25-49 — Fertility Preservation Coverage." 2023.
- Delaware General Assembly. "HB 263 — Fertility Preservation." 2018.
This page is for informational purposes only and does not constitute medical or legal advice. State laws change, insurance plan terms vary, and individual coverage depends on your specific plan and circumstances. Always consult with your healthcare providers regarding medical decisions and with your insurer or a benefits attorney regarding coverage questions.