Washington currently has no law requiring insurers, the state employee (PEBB/SEBB) plans, or Apple Health (Medicaid) to cover infertility diagnosis, treatment, or IVF. Two consecutive attempts at a broad mandate — HB 1151/SB 5204 (2023-24) and HB 1129/SB 5121 (2025-26, the 'Washington State Building Families Act') — both died before reaching the Governor.
Your plan
What the law does
All plans
Washington has no law requiring IVF coverage. If your employer offers a fertility benefit, it is voluntary — check for a lifetime maximum and whether medications count against it.
Self-funded employer plan
Exempt from any state law regardless.
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.
Where people get surprised
Nothing is required of any Washington plan today — fully insured, self-funded, or individual-market. RCW 48.43.072 requires coverage of contraception and other reproductive health services but expressly excludes infertility treatment from that definition.
Washington's Reproductive Privacy Act (RCW 9.02.100) and 2023 Shield Law (ch. 7.115 RCW) protect the legal right to access IVF and other reproductive care in Washington and shield providers from out-of-state legal action — but neither one requires any insurer to pay for it. Don't confuse this legal-access protection with an insurance mandate.
HB 1129 / SB 5121 (2025-26, 'Building Families Act') would have required group health plans (other than small-group), PEBB/SEBB state and school-employee plans, and Apple Health Medicaid to cover standard fertility preservation starting 2026-01-01 and infertility diagnosis/treatment (two oocyte retrievals, unlimited embryo transfers, ASRM guidelines) starting 2027-01-01. HB 1129 passed the House Health Care & Wellness Committee but its companion SB 5121 died in a Senate fiscal committee during the 2026 session; a near-identical predecessor (HB 1151/SB 5204) died in the House in February 2024.
At least one Apple Health managed-care plan's published benefit grid lists diagnosis and treatment of infertility as a noncovered service.
What may change
WA HB 1129 / SB 5121 (2025-26, 'Washington State Building Families Act') — Would have required group health plans (excluding small-group), PEBB and SEBB state/school employee plans, and Washington Apple Health (Medicaid) to cover standard fertility preservation services for plans issued or renewed on or after 2026-01-01, and diagnosis/treatment of infertility (two completed oocyte retrievals, unlimited embryo transfers, ASRM guidelines, single-embryo transfer preferred when medically appropriate) for plans issued or renewed on or after 2027-01-01, at parity with other pregnancy-related benefits, with no separate deductible/copay/limitation. Status: HB 1129 passed out of House Health Care & Wellness (substitute bill, 'do pass', Jan 2026) and was referred to House Appropriations; companion SB 5121 died in a Senate fiscal committee during the 2026 session, reportedly over its fiscal note. Neither bill reached the Governor's desk.. Would take effect 2026-01-01.
WA HB 1151 / SB 5204 (2023-24) — Predecessor bill limited to large-group health plans (including public-employee plans); would have required coverage of diagnosis/treatment of infertility and standard fertility preservation, phased in similarly to the 2025-26 bill (four retrievals in the House committee substitute, later reduced to two in the Appropriations version). Status: Died; last recorded status 'Engrossed - Dead' as of 2024-02-20..
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 — Washington State Office of the Insurance Commissioner. Washington independent review organization process (RCW 48.43.535; RCW 48.43.537) 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 Washington?
Washington currently has no law requiring insurers, the state employee (PEBB/SEBB) plans, or Apple Health (Medicaid) to cover infertility diagnosis, treatment, or IVF. Two consecutive attempts at a broad mandate — HB 1151/SB 5204 (2023-24) and HB 1129/SB 5121 (2025-26, the 'Washington State Building Families Act') — both died before reaching the Governor.
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.
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.