Three policy shifts. One cost problem. Here's what benefits leaders need to know

Three significant policy shifts are reshaping how employers plan, pay for, and manage family-building benefits — all at the same time. IVF and other fertility coverage mandates at the state level are expanding faster than most benefit plans can track. Global maternity billing codes are being eliminated, effective January 1, 2027. And paid family and medical leave programs are multiplying across states, raising workforce planning complexity and employee expectations simultaneously.

Together, they compound into a single cost exposure problem — one that demands a unified management strategy. Here’s what you need to know before your next renewal.

Fertility coverage mandates are expanding across states

State fertility mandates are ever-changing, and benefits leaders are struggling to stay ahead. Twenty-five states and Washington, D.C. now have laws requiring some form of private insurance coverage for fertility care, and over half of all U.S. states introduced or carried over fertility-coverage legislation in 2026.

Among the most significant recent expansions: Colorado and Illinois broadened their mandates to include additional fertility preservation services; New York strengthened enforcement provisions for self-insured plans; and states including Missouri, and South Carolina introduced new fertility mandate legislation for the first time in 2026.

At the federal level, the Departments of Labor, HHS, and Treasury have proposed a rule that would establish excepted fertility benefits as a new category of limited excepted benefits, providing clarity around which services qualify as covered benefits, how dollar limits would be structured, and what notice would be required to employees as part of the benefit design.

Maven recently submitted a public comment supporting the proposed rule, which would establish a streamlined pathway for employers to offer standalone fertility benefits without the regulatory complexity and costs associated with traditional group health plan coverage. Maven urged prompt finalization of the rule and offered recommendations to encourage broad employer adoption. 

For fully insured employers in mandate states, compliance obligations are real and immediate. For self-funded employers, ERISA preemption means you're generally not legally required to cover IVF — but employees without employer-sponsored fertility coverage won’t stop trying to build families. Instead, they may self-fund, go into debt and undergo treatment without clinical oversight, often pursuing more aggressive protocols to reduce the number of cycles they can afford. This financial and emotional stress elevates clinical risk before a pregnancy even begins. The question for self-funded employers isn't whether fertility coverage costs money. It's whether you're managing that cost early — or paying more for it later. 

The majority of Fortune 500 employers now offer some form of fertility benefit, and employees evaluating offers increasingly treat it as a baseline expectation alongside medical, dental, and parental leave. The self-funded employers most at risk aren't just those with cost exposure from unmanaged IVF claims — they're also the ones losing high performers to organizations that decided not to wait for ERISA exemptions as a reason to defer. 

‍What this means for your benefits strategy: For self-funded employers absorbing the full cost of IVF-conceived pregnancies, the more important question is whether your benefit is intervening before treatment, or just paying for it.

‍Maven saves employers $9,600 per birth — a direct result of intervening early, managing risk, and supporting better outcomes from preconception through postpartum. Rather than reimbursement, Maven reduces the clinical events that drive cost in the first place. 30% of Maven fertility members achieve pregnancy without IVF or IUI through proactive coaching — and members who participate in fertility coaching are 55% more likely to conceive without treatment compared to members who don't. 

Explore a real-time interactive map of fertility coverage mandates by state.

Maternity care unbundling will make every high-risk pregnancy visible — Starting January 1, 2027

Today, a global OB code bundles prenatal visits, delivery, and postpartum care into a single payment. Starting next year, every one of those services becomes its own claim. For self-funded employers, this means direct claims visibility into every high-risk pregnancy in their population — costs that previously existed inside a bundled payment and are now exposed as individual line items. For fully insured employers, the same dynamics play out at renewal: carriers will have itemized visibility into maternity costs across your population, and they'll price accordingly.

The cost of a high-risk delivery with NICU will still be expensive. Delivery alone costs $16,000 to $29,000. NICU care averages about $3,700 per day, but can reach up to $60,000 daily. But what changes is that every complication now appears as a separately billable event. Employers who are managing those clinical risks earlier will have fundamentally fewer high-cost line items than employers who aren't.

If unbundled costs are passed through to members in the form of higher copays or out-of-pocket requirements, some employees will skip important prenatal care visits they can't afford. Deferred care leads to missed warning signs, delayed interventions, and the kind of complications that generate the very claim lines unbundling is making visible. 

‍What this means for your benefits strategy: The employers who come out ahead are the ones who've already reduced the clinical events that generate high-cost line items: preterm deliveries, C-sections, NICU admissions, high-risk pregnancies that weren't identified or managed early. That means the strategic priority before January 1, 2027 is asking whether your current maternity benefit actually reduces those outcomes, or just pays for them.

A clinical management model identifies risk early in pregnancy (and ideally before it), intervenes proactively, and maintains continuity through postpartum. Maven's validated maternity outcomes translate directly into fewer high-cost line items under unbundled billing: Up to 27% lower NICU admission rates and up to 15% lower C-section rates. 81% of eligible high-risk Maven members enroll in proactive coaching, and high-risk members who complete birth planning appointments show a 40% lower risk of a NICU admission compared to high-risk members who don't. Maven also maintains a 98% single embryo transfer rate, directly reducing the rate of multiple gestations, which are among the highest-cost, highest-risk pregnancies an employer will see under unbundled billing.

PFML complexity is raising the baseline for what employees expect

Thirteen states plus Washington, D.C. have enacted paid family and medical leave programs, with more under active legislative consideration. For employers with employees across multiple states, this creates mandatory compliance requirements that vary by market, administrative complexity that grows with each new enactment, and a shifting baseline for what employees expect from a family-building benefit.

PFML expansion normalizes extended leave-taking — which has real workforce planning implications. Comprehensive family-building support is becoming an expectation for employees in states with PFML protections. They increasingly expect that their employer also provides meaningful coverage for fertility, maternity, and postpartum care as a baseline. For employers managing multistate populations, this creates real pressure to maintain consistent benefit standards across geographies, not just comply with the mandate in each state where it applies.

‍What this means for your benefits strategy: PFML expansion raises the bar for what employees expect across their entire benefits package. Employees in states with protected leave increasingly assume their employer has matched that commitment with equally strong coverage for fertility, maternity, and postpartum care. A fragmented benefit — fertility here, maternity there, PFML compliance managed separately — fails that expectation and leaves benefit leaders managing multiple vendor relationships against a single compounding clinical risk.

Maven covers the complete continuum — fertility and family building, maternity and newborn care, parenting and pediatrics, and menopause and midlife health — on one platform, with one clinical model and one data record.

The case for a unified strategy

The employers who are well-positioned for all three shifts are the ones managing this as a connected pathway, not as a sequence of disconnected compliance obligations. They're supporting the full journey — from trying to conceive through postpartum recovery — with a consistent clinical model and a benefit their employees actually use.

Maven serves 2,300+ employer clients, including half of the Fortune 15, across 28M+ covered lives. Our outcomes are validated across 25,000+ pregnancies in 40+ peer-reviewed studies and 8 independent claims-based analyses. Leading employers aren't waiting for a federal mandate to finalize or for January 1, 2027 to arrive. They're building a strategy now — ahead of the mandate and ahead of the billing change.

Three things to do before your next renewal

1. Audit your fertility benefit for clinical management, not just coverage or compliance. Most fertility benefits are still built around reimbursement — dollars allocated, cycles authorized, claims processed. Before your next renewal, ask your fertility vendor what percentage of members conceive without IVF or IUI. If they can't answer, that's your answer.

2. Run a maternity cost scenario against unbundled billing codes. Work with your TPA or carrier to model what your current maternity claims look like under the new itemized CPT structure. Pay particular attention to NICU admissions, C-section rates, and high-risk pregnancy volume — those are the line items that will grow most visibly. If you don't have a clinical management program that actively drives those numbers down, January 1, 2027 is a hard deadline for putting one in place. Watch the unbundling webinar to learn more here. And we’ll be decoding even more later this summer. 

3. Map your PFML exposure across all operating states. If you have employees in 5+ states, you almost certainly have PFML obligations that vary by market — and at least one state with pending legislation that could change your compliance footprint before the end of the year. Document your current coverage and leave standards against each state's requirements, then pressure-test whether your benefits offering is consistent enough to meet the expectations employees in mandate states will bring to the table.

We can show you how Maven can support your population. Request a Maven fertility benefits consultation →