IVF coverage in Georgia if your employer plan is self-funded
Georgia requires state-regulated individual, small-group, and large-group plans issued or renewed on/after January 1, 2026 to cover standard fertility preservation — egg, sperm, embryo, and ovarian tissue cryopreservation with up to one year of storage — for patients whose treatment for cancer, sickle cell disease, or lupus may impair fertility. IVF is not required.
Georgia's law requires coverage of fertility preservation (egg, sperm, or embryo freezing) when the infertility is caused by another medical treatment, such as chemotherapy — and even that narrower requirement only reaches fully insured plans. If your card says "administered by," your plan is probably self-funded, and federal ERISA law exempts it from the state requirement entirely.
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 you can still do
- Ask HR whether the plan voluntarily covers more than the state requires. Many large self-funded employers do, often through a carve-out (Progyny, Carrot, Maven, Kindbody) or a fertility rider.
- Ask for the Summary Plan Description and search for 'infertility', 'ART', and 'lifetime maximum'.
- Price the cash path: medications through manufacturer programs, multi-cycle packages, HSA/FSA dollars, and grants.
- Appeals for a self-funded plan run under ERISA, not the state regulator.