Does Anthem cover IVF?
What Anthem Blue Cross and Blue Shield (Elevance Health) publishes about covering IVF and other fertility treatment, in its own words, with the document each statement is in.
- Documents read · checked 4 d ago
It depends on your plan. Anthem's assisted reproduction guideline (published December 18, 2025) says federal and state mandates and plan language override it and that some plans exclude or limit infertility treatment. Where IVF is a benefit, the guideline sets the medical criteria, such as three failed IUI cycles first for unexplained infertility. Anthem is the Blue Cross plan in 14 states, and the law of the state your plan is issued in can require coverage: in California, large-group plans must now cover IVF, while Anthem's 2026 small-group contracts there exclude it.
What Anthem's guideline and California documents say
Read on Oct 22, 2026. The words in quotation marks are the source's own.
Depends on your plan
“Note: Federal and State mandates, as well as benefit language supersede the content of this document. Some plans may exclude or limit coverage of infertility treatment and other associated services. Please check benefit plan descriptions for details.”
“Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.”
Where Anthem is the Blue plan
Anthem sells individual and family plans as the Blue plan in 14 states: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. In Missouri it excludes 30 counties around Kansas City, in New York it covers 17 southeastern counties, and in Virginia it leaves out the City of Fairfax, the Town of Vienna and the area east of Route 123.
“Anthem offers Individual and Family health insurance plans in 14 states, including California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin.”
“In Missouri (excluding 30 counties in the Kansas City area):”
“In 17 southeastern counties of New York:”
“their service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123.”
How Anthem defines infertility
With a male partner: no pregnancy after a year under 35, or six months at 35 or older. Without one, as for a single woman or a same-sex couple: no pregnancy after 12 cycles of medically supervised IUI under 35, or 6 at 35 or older.
“The inability to conceive or produce a conception during a period of one year if the biological female is under the age of 35 years; or The inability to conceive or produce a conception during a period of six months if the biological female is age 35 or older, following exposure to fresh sperm.”
“If under the age of 35 years, the inability to conceive or produce a conception after 12 cycles of documented medically supervised stimulated intrauterine insemination (IUI); or If 35 years of age or older, the inability to conceive or produce a conception after 6 cycles of documented medically supervised stimulated intrauterine insemination (IUI);”
Steps before IVF
For unexplained infertility, three IUI cycles with oral drugs that did not lead to a birth. For ovulation disorders, six months of conservative treatment, three cycles of oral drugs and three IUIs with injectable FSH.
“Failure to have a live birth after 3 cycles of IUI with oral medications for unexplained infertility; or For ovulatory disorders, failure to have a live birth after 6 months of conservative treatment, oral agents for 3 cycles, and 3 follicular stimulating hormone (FSH) IUIs; or”
Frozen embryos first
Before another fresh cycle, a frozen embryo transfer must be tried when good-quality frozen embryos are available.
“Before proceeding to a fresh ART cycle, frozen embryo transfer (FET) using previously cryopreserved embryos must be attempted if a reasonable quality of cryopreserved embryo(s) is available.”
Donor eggs
Medically necessary when the ovaries are absent, after two IVF cycles with 5 or fewer eggs at maximum stimulation, or for premature ovarian insufficiency (FSH above 25 mIU/mL). Not for the decline in eggs that comes with normal aging.
“There have been at least two IVF treatment cycles in which 5 or fewer eggs were retrieved with maximum ovarian stimulation; or Ovaries are absent; or Premature ovarian insufficiency, defined by FSH > 25 mIU/mL not due to other disorders.”
“Donor eggs for a decline in egg quantity or quality as a result of normal aging.”
Embryo genetic testing (PGT)
IVF done to support medically necessary embryo genetic testing is one of the listed reasons for IVF.
“IVF is being performed to support medically necessary preimplantation genetic testing (PGT).”
Egg freezing
Medically necessary before cancer treatment, radiation, other treatment that harms fertility, or removal of both ovaries, for someone past puberty whose ovarian reserve makes it likely to work (for example, 45 or younger). Not appropriate to delay natural aging.
“Individual is a candidate based on ovarian reserve and likelihood for successful oocyte cryopreservation (for example, age 45 years or less); and Post-pubertal; and Facing anticipated infertility resulting from medical or surgical treatment, including chemotherapy, radiation therapy, other gonadotoxic therapies, or bilateral oophorectomy; and”
“Cryopreservation is not clinically appropriate when it is done for elective or voluntary sterilization, such as procedures chosen only for birth control, or to delay natural aging.”
Not medically necessary
Assisted hatching, embryo co-culture, reciprocal IVF and care for a gestational carrier who is not an Anthem member, among others. Some plans also exclude egg donor fees and buying donor eggs or embryos.
“Assisted embryo hatching Co-culture of embryos Direct intraperitoneal insemination (DIPI) Egg harvesting or other infertility treatment performed during an operation not related to an infertility diagnosis Embryo toxic factor test (ETFL) Genetic engineering Human zona binding assay (hemizona test) In vitro maturation of oocytes IVF or other infertility treatment for gender selection”
“Ovulation kits Percutaneous Epididymal Sperm Aspiration (PESA) Peritoneal ovum and sperm transfer (POST) Post-coital testing Reciprocal IVF”
“Health services provided to a gestational carrier who is not a member, including, but not limited to embryo transfer, pregnancy costs, or cryopreservation of embryos.”
“Note: Some plans may exclude or limit coverage of fees related to the payment of the egg donor; donor identification; legal services; or selection, purchase and transportation of frozen donor eggs, including the purchase of donated frozen eggs or donated frozen embryos.”
Anthem Blue Cross in California
California's 2026 IVF law reaches some Anthem Blue Cross plans and not others. What Anthem's own California documents say.
Large employers, fully insured
Must cover IVFAnthem's California provider news summarizes the state's rule: large-group contracts must cover the diagnosis and treatment of infertility, including up to three completed egg retrievals with unlimited embryo transfers, with cost sharing no different from other care. No Anthem large-group contract we found spells out its own IVF terms.
“Requires plans’ large group healthcare service plan contracts issued, amended, or renewed on or after July 1, 2025, to provide coverage for the diagnosis and treatment of infertility and fertility services, including a maximum of three completed oocyte retrievals with unlimited embryo transfers in accordance with the guidelines of the American Society of Reproductive Medicine (ASRM), using single embryo transfer when recommended and medically appropriate.”
“Imposing any deductible, copay, coinsurance, benefit maximums, waiting period, or any other limitation on coverage for the diagnosis and treatment of infertility that is different than those imposed upon benefits for services not related to infertility.”
Small businesses (2026 contracts)
Excludes IVFThe 2026 small-group Evidence of Coverage booklets we read say benefits do not include assisted reproduction such as insemination or IVF, or the drugs for it. They cover tests to find the cause of infertility and fertility preservation when medically necessary. California requires small-group plans to be offered the coverage, not to include it.
“Important Note: Although this Plan offers limited coverage of certain Infertility services, it does not cover all forms of Infertility treatment. Benefits do not include assisted reproductive technologies (ART) or the diagnostic tests and Drugs to support it. Examples of ART include artificial insemination, in-vitro fertilization, zygote intrafallopian transfer (ZIFT), or gamete intrafallopian transfer (GIFT).”
“Covered Services include diagnostic tests to find the cause of Infertility, such as diagnostic laparoscopy, endometrial biopsy, and semen analysis, and services to treat the underlying medical conditions that cause Infertility (e.g., endometriosis, obstructed fallopian tubes, and hormone deficiency). These services are provided on the same basis, at the same Cost Shares, as any other medical condition.”
“Fertility preservation services to prevent iatrogenic infertility are covered when Medically Necessary.”
“Requires plans’ small group healthcare service plan contracts issued, amended, or renewed on or after January 1, 2026, to offer coverage for the diagnosis and treatment of infertility and fertility services.”
CalPERS Select HMO Basic (state employees)
IVF excluded in 2026The 2026 plan covers infertility treatment except IVF, egg transplant, GIFT and ZIFT. California's IVF rule reaches CalPERS plans on July 1, 2027.
“Your plan covers all infertility treatments, except for in-vitro fertilization, ovum transplant, gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT) procedures.”
“Compliance with Section 1374.55 for CalPERS products takes effect on July 1, 2027.”
Whether your Anthem plan covers IVF
The Anthem policy says how it pays for IVF when a plan includes it. Three things decide whether yours does.
- 1.Your employer's choice
Most people with Anthem coverage get it through work, and the employer picks the benefits. About 50% of employers with 500 or more workers now cover IVF.
- 2.Your plan type
A fully-insured plan follows the law of the state it is issued in. A self-funded plan, which 67% of covered US workers have, does not: it covers whatever the employer chose.
- 3.Your state's law
Some states require fully-insured plans to cover IVF, some require insurers only to offer it, and most require nothing. Your state's line is below.
What specific employers publish about their fertility benefits, including which insurer or benefit company runs them: companies that cover IVF.
Does Anthem cover IVF in your state?
Each state's insurance law applied to a Anthem plan issued there. A state law reaches plans issued in that state, usually your employer's state, not where the clinic is.
Anthem in California
Often, on fully-insured plans: California requires some fully-insured health plans to cover IVF, and that includes Anthem plans issued in California unless one of the law's limits or exemptions applies. New for 2026: SB 729 requires large-group fully-insured plans to cover IVF. A self-funded employer plan that Anthem only administers is not bound by state law and covers IVF only if the employer chose to. California law and clinics
Anthem in Colorado
Often, on fully-insured plans: Colorado requires some fully-insured health plans to cover IVF, and that includes Anthem plans issued in Colorado unless one of the law's limits or exemptions applies. Fully-insured large-group plans must cover fertility, including IVF. A self-funded employer plan that Anthem only administers is not bound by state law and covers IVF only if the employer chose to. Colorado law and clinics
Anthem in Connecticut
Often, on fully-insured plans: Connecticut requires some fully-insured health plans to cover IVF, and that includes Anthem plans issued in Connecticut unless one of the law's limits or exemptions applies. Fully-insured plans must cover IVF (cycle limits apply). A self-funded employer plan that Anthem only administers is not bound by state law and covers IVF only if the employer chose to. Connecticut law and clinics
Anthem in Maine
Often, on fully-insured plans: Maine requires some fully-insured health plans to cover IVF, and that includes Anthem plans issued in Maine unless one of the law's limits or exemptions applies. Fully-insured plans must cover fertility care, including IVF. A self-funded employer plan that Anthem only administers is not bound by state law and covers IVF only if the employer chose to. Maine law and clinics
Anthem in New Hampshire
Often, on fully-insured plans: New Hampshire requires some fully-insured health plans to cover IVF, and that includes Anthem plans issued in New Hampshire unless one of the law's limits or exemptions applies. Fully-insured plans must cover fertility care, including IVF. A self-funded employer plan that Anthem only administers is not bound by state law and covers IVF only if the employer chose to. New Hampshire law and clinics
Anthem in New York
Often, on fully-insured plans: New York requires some fully-insured health plans to cover IVF, and that includes Anthem plans issued in New York unless one of the law's limits or exemptions applies. Large-group fully-insured plans must cover IVF (up to 3 cycles). A self-funded employer plan that Anthem only administers is not bound by state law and covers IVF only if the employer chose to. New York law and clinics
Anthem in Ohio
Not because of state law: Ohio requires some infertility coverage but not IVF, so IVF under an Anthem plan there depends on what the employer chose. Ohio law and clinics
Anthem in Georgia
Not because of state law: Georgia does not require insurers to cover IVF, only fertility preservation for some patients, so IVF under an Anthem plan there depends on what the employer chose. Georgia law and clinics
Anthem in Kentucky
Not because of state law: Kentucky does not require insurers to cover IVF, only fertility preservation for some patients, so IVF under an Anthem plan there depends on what the employer chose. Kentucky law and clinics
Anthem in Nevada
Not because of state law: Nevada does not require insurers to cover IVF, only fertility preservation for some patients, so IVF under an Anthem plan there depends on what the employer chose. Nevada law and clinics
Anthem in Indiana
Not because of state law: Indiana has no law requiring private plans to cover IVF, so IVF under an Anthem plan there depends entirely on what the employer chose (or, for a plan you buy yourself, on the plan's own terms). Indiana law and clinics
Anthem in Missouri
Not because of state law: Missouri has no law requiring private plans to cover IVF, so IVF under an Anthem plan there depends entirely on what the employer chose (or, for a plan you buy yourself, on the plan's own terms). Missouri law and clinics
Anthem in Virginia
Not because of state law: Virginia has no law requiring private plans to cover IVF, so IVF under an Anthem plan there depends entirely on what the employer chose (or, for a plan you buy yourself, on the plan's own terms). Virginia law and clinics
Anthem in Wisconsin
Not because of state law: Wisconsin has no law requiring private plans to cover IVF, so IVF under an Anthem plan there depends entirely on what the employer chose (or, for a plan you buy yourself, on the plan's own terms). Wisconsin law and clinics
State laws as summarized by RESOLVE Insurance Coverage by State, read Oct 1, 2026.
How to see what your Anthem plan covers
A policy or program page is a summary. Your own plan's documents are what it pays by.
- 1Read the infertility section and the exclusions list of your Evidence of Coverage or benefit booklet: some Anthem plans exclude assisted reproduction entirely.
- 2Call the customer service number on your Anthem card and ask whether IVF is covered, whether it needs review first, and what the limits are.
- 3Ask HR whether your plan is fully insured or self-funded: a state IVF law reaches only fully insured plans issued in that state.
- 4In California, check which kind of plan you have: large-group plans must cover IVF, while the 2026 small-group contracts we read exclude it.
Anthem and IVF: common questions
Does Anthem cover IVF?
It depends on your plan and your state. Anthem's guideline, published December 18, 2025, says mandates and plan language override it and that some plans exclude or limit infertility treatment. Where IVF is a benefit, the guideline sets the medical criteria.
Does Anthem Blue Cross cover IVF in California?
On fully insured large-group plans, California law now requires IVF coverage, including up to three completed egg retrievals with unlimited embryo transfers. Anthem's 2026 small-group contracts we read exclude assisted reproduction, and the CalPERS Select HMO Basic plan excludes IVF until California's rule reaches CalPERS plans on July 1, 2027.
Does Anthem require IUI before IVF?
For unexplained infertility, its guideline lists three IUI cycles with oral drugs that did not lead to a live birth as one route to IVF. Other listed reasons include tubal or male-factor infertility, stage III or IV endometriosis and IVF for medically necessary embryo genetic testing.
Does Anthem cover egg freezing?
Before treatment that may cause infertility, such as chemotherapy or radiation, its guideline treats egg freezing as medically necessary for a good candidate. It says freezing to delay natural aging is not clinically appropriate.
Which states is Anthem the Blue Cross plan in?
Anthem sells individual and family plans as the Blue plan in 14 states: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin, except parts of Missouri, New York and Virginia.
- CG-MED-103 Assisted Reproductive Technology (Clinical UM Guideline) (Anthem, Publish Date 12/18/2025; Last Review Date 11/06/2025)
- Anthem Individual and Family Health Insurance Plans (Anthem Blue Cross)
- CG-MED-66 Cryopreservation of Oocytes or Ovarian Tissue (Clinical UM Guideline) (Anthem, Publish Date 07/01/2026; Last Review Date 05/14/2026)
- California Department of Managed Health Care All Plan Letter 24-023 (Anthem Blue Cross California Provider News, Commercial) (Anthem Blue Cross, January 1, 2026)
- Anthem Platinum HMO 20 (901E) Evidence of Coverage, small group (CASGHMO 1/26) (Anthem Blue Cross, Plan year 2026 (January 1, 2026))
- Anthem Blue Cross Select HMO Basic Plan, Combined Evidence of Coverage and Disclosure Form (Anthem Blue Cross, Effective January 1, 2026)