Colorado requires fully insured large-group plans (more than 100 employees) to cover infertility diagnosis and treatment including 3 completed egg retrievals with unlimited embryo transfers, plus fertility preservation, starting with plan years on or after January 1, 2023.
Your plan
What the law does
Fully insured, employers with more than 100 employees
Likely required to cover IVF — 3 egg retrievals, unlimited transfers. Applies when the plan renews on or after 2023-01-01.
Fully insured, smaller employer
Not covered by the law. Any benefit is voluntary plan design.
Individual / marketplace plan
Not covered by the law.
Self-funded employer plan (card says "administered by")
Exempt from state law (ERISA). Coverage, if any, is your employer's choice — check the Summary Plan Description for a fertility rider or lifetime maximum.
Medicaid
Does not cover IVF.
Free, 5 steps, nothing saved unless you choose to.
The one thing to check first: is your plan self-funded?
State fertility laws only reach fully insured plans. Most workers at large employers are in self-funded plans, which are governed by federal ERISA law and exempt from every state mandate — 67% of covered workers nationally, and about 80% at firms with 200+ employees (KFF 2025).
Look at your insurance card. If it says "administered by" (an insurer's name as the third-party administrator), your plan is probably self-funded. If it says "insured by" or "underwritten by," it is probably fully insured. The card is a strong hint, not proof — the only definitive answer comes from HR: "Is our medical plan self-funded or fully insured?"
This also decides where a denied claim goes: fully insured plans appeal to the state insurance regulator; self-funded plans appeal under ERISA rules to the U.S. Department of Labor.
What the law requires
Cycle cap: 3 completed egg retrievals with unlimited embryo transfers — 3 completed oocyte retrievals with unlimited embryo transfers in accordance with ASRM guidelines, using single embryo transfer when recommended and medically appropriate..
Who qualifies: the definition of infertility is inclusive — single people and LGBTQ+ patients qualify without a heteronormative 'unprotected intercourse' requirement.
Step therapy: the law does not require IUI before IVF (all — definition includes a person's inability to reproduce as an individual or with a partner, or a physician's finding based on history, age, physical findings or diagnostic testing) — but your plan's own clinical policy might; check the payer.
Medications: covered.
PGT-A genetic testing: not addressed by the law — plan-specific.
Embryo storage: not addressed by the law — plan-specific.
Donor eggs/sperm: not addressed by the law — plan-specific.
Surrogacy: not covered.
Fertility preservation before cancer treatment: required.
Where people get surprised
Small-group (100 or fewer employees) and individual/Connect for Health Colorado plans are NOT covered — coverage there awaits a federal HHS no-defrayal determination with no timeline.
Self-funded employer plans are exempt under ERISA.
Religious employers may request an exclusion if coverage conflicts with bona fide religious beliefs.
Health First Colorado (Medicaid) and CHP+ do not cover IVF.
PGT, embryo storage and donor gamete costs are not specified in the statute — confirm with the plan.
What may change
HB 24-1025 — Would have extended the fertility coverage mandate to individual and small-group plans; prompted the DOI's 2025 Milliman defrayal analysis. Status: Introduced 2024, did not pass; no enacted 2025/2026 successor confirmed.
How to appeal a denial
Internal appeal — you have 180 days from the denial to file. The plan must decide within 30 days (before service) or 60 days (after service); 72 hours if urgent.
External review — available for at least 4 months after the final internal denial, for medical-necessity and "experimental" denials (PGT-A, ICSI, step therapy). An independent reviewer decides within 45 days. Contractual exclusions are not eligible for external review — those go to the regulator as a complaint.
Regulator — Colorado Division of Insurance (DOI), Department of Regulatory Agencies. Colorado DOI Independent External Review (C.R.S. § 10-16-113.5) for medical-necessity and experimental denials File a complaint. Copy the regulator on every appeal letter; clinics report it speeds things up.
If your plan is self-funded, skip the state regulator: your appeal runs under ERISA and complaints go to the U.S. Department of Labor's Employee Benefits Security Administration.
Frequently asked
Is IVF covered by insurance in Colorado?
Colorado requires fully insured large-group plans (more than 100 employees) to cover infertility diagnosis and treatment including 3 completed egg retrievals with unlimited embryo transfers, plus fertility preservation, starting with plan years on or after January 1, 2023.
My employer is large but my card says 'administered by' — does the state law apply?
Probably not. 'Administered by' usually means a self-funded plan, which federal ERISA law exempts from state insurance mandates. Confirm with HR.
The law took effect but my plan doesn't cover IVF yet — why?
The requirement applies to plan years beginning on or after 2023-01-01. If your plan year renews mid-year, coverage starts at that renewal.
What if my claim is denied?
File an internal appeal within 180 days, request the exact policy language relied on, and copy the regulator. Medical-necessity and 'experimental' denials can go to external review.
This page explains public coverage rules and typical prices as of the dates shown. It is an estimate and an interpretation, not a coverage decision by your plan, and not legal, medical, tax, or insurance advice. Your plan documents control. We never store what you enter here unless you choose to save a plan.