House Bill 635 would require most health benefit plans in North Carolina’s large group insurance market to cover fertility diagnostic care, fertility treatment, and fertility preservation services. The bill defines those terms broadly to include testing, imaging, medications, procedures, and storage of reproductive material, and it specifically requires coverage for at least three in vitro fertilization cycles per insured, including egg retrieval and fresh or frozen embryo transfer.
The bill limits the mandate in several ways. It would not apply to self-insured group health plans or to plans offered by religious institutions. It also excludes experimental fertility procedures and nonmedical costs associated with donor gametes, donor embryos, or surrogacy. Covered services must be performed at a licensed healthcare facility and follow American Society of Reproductive Medicine guidelines. The bill would take effect October 1, 2025, and apply to insurance contracts issued, renewed, or amended on or after that date.
HB635 would amend Chapter 58 of the North Carolina General Statutes by adding a new insurance coverage mandate for fertility-related services in the large group market. Its practical effect would be to expand required benefits in employer-sponsored large group health plans, while leaving self-insured plans and religious institution plans outside the mandate. Insurers subject to the law would need to adjust plan design, coverage determinations, and claims administration to include fertility diagnostics, treatment, and preservation services, including a minimum IVF coverage requirement.
The available record shows no committee transcript or recorded votes, so there is no direct evidence of debate or opposition in the materials provided. The bill’s introduction and referral pattern suggest it was treated as a substantive health insurance measure, but the absence of recorded discussion makes the overall sentiment difficult to gauge from the provided context. Based on the bill text alone, it appears to be a pro-access fertility coverage proposal.
The main likely points of contention are the scope and cost of the insurance mandate, especially the requirement to cover at least three IVF cycles and fertility preservation services. Potential objections may come from insurers, employers, or policymakers concerned about premium impacts, as well as from those who favor narrower benefit mandates. The bill also draws clear lines on exemptions and exclusions—particularly for self-insured plans, religious institutions, experimental procedures, and surrogacy-related costs—which may reflect efforts to limit controversy while still expanding access.