Does Highmark cover IVF?
What Highmark Blue Cross Blue Shield (Highmark Inc.) 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
Only if your plan has an assisted reproduction benefit. Highmark's live Pennsylvania commercial policy on assisted reproductive technology says those services, IVF included, are generally excluded from standard contracts and are not covered when the member has no such benefit; tests and treatment short of IVF may be covered unless the contract excludes infertility. Where a plan has the benefit, the policy sets IVF criteria for people 34 and younger and 35 and older. Employers can also add Highmark's optional Fertility and Family-Building program.
What Highmark's own documents say
Read on Oct 22, 2026. The words in quotation marks are the source's own.
Only if your plan has an IVF benefit
“Assisted reproductive technology services are generally excluded from standard medical-surgical contracts and are only eligible for reimbursement as noted below.”
“Such services are non-covered when the individual does not have an assisted reproductive technology benefit.”
Where Highmark is the Blue plan
Delaware, northeastern and western New York, Pennsylvania and West Virginia.
“We help members in Delaware, Northeastern & Western New York, Pennsylvania, West Virginia and across the nation.”
Tests and treatment short of IVF
Services to diagnose and treat infertility short of assisted reproduction may be covered unless your contract excludes infertility.
“However, all medical, surgical, and diagnostic services performed to diagnose and treat infertility short of assisted reproductive technologies as defined above may be covered unless the individual's contract contains exclusion with regard to the diagnosis and treatment of infertility.”
How the policy defines infertility
A disorder of the reproductive tract that keeps an individual or a couple from conceiving or carrying a pregnancy to delivery, or a doctor's diagnosis of infertility.
“For the purpose of this policy infertility is defined as an interruption, cessation, or disorder of body functions, systems, or organs of the reproductive tract which prevents an individual or couple from the conception of a child or the ability to carry a pregnancy to delivery after regular, unprotected sexual intercourse without medical intervention”
IVF criteria where the benefit exists
IVF may be medically necessary with any one of the conditions the policy lists, with one list for people 35 and older and another for 34 and younger; diminished ovarian reserve is one of them. IVF outside the criteria is not medically necessary.
“IVF may be considered medically necessary for an individual age 35 or older with ANY ONE (1) of the following conditions:”
“IVF may be considered medically necessary for an individual age 34 and younger with ANY ONE (1) of the following conditions:”
“Diminished ovarian reserve; or”
“IVF not meeting the criteria as indicated in this policy is considered not medically necessary.”
Freezing eggs, sperm or embryos
May be medically necessary before treatment that harms fertility, such as cancer treatment; freezing outside the policy's criteria is not medically necessary.
“Assisted reproductive technology for the purpose of gamete (oocyte or sperm) or embryo cryopreservation may be considered medically necessary when ANY of the following criteria are met: - Individual is preparing for gonadotoxic therapies due to cancer or other medical diseases; or”
“Gamete or embryo cryopreservation not meeting the criteria as indicated in this policy is considered not medically necessary.”
Not medically necessary or experimental
Reversing a voluntary sterilization, surrogate fees, travel and living costs, embryo co-culture and sperm DNA tests.
“Reversal of voluntary sterilization (tuboplasty, or vasoplasty, or epididymovasostomy); or - Payment for surrogate service fees for purposes of childbirth.; or - Expenses related to living or travel”
“Co-culture of embryos; or - Tests of sperm deoxyribonucleic acid (DNA) integrity”
Fertility drugs on a group PPO
On the Highmark group PPO plan we read, infertility counseling, testing and treatment of a physical or medical problem are covered, and infertility drugs may or may not be covered depending on the group's prescription drug program.
“Treatment includes coverage for the correction of a physical or medical problem associated with infertility.”
“Infertility drug therapy may or may not be covered depending on your group's prescription drug program.”
Fertility and Family-Building program
An optional program employers can add, with a network of accredited, double-board-certified reproductive specialists.
“Highmark continues to expand our integrated benefits portfolio with optional programs, including our new Fertility and Family-Building solution.”
“Members can choose from a network of high-quality, cost-efficient providers featuring accredited, double-board-certified reproductive specialists.”
Whether your Highmark plan covers IVF
The Highmark 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 Highmark 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 Highmark cover IVF in your state?
Each state's insurance law applied to a Highmark plan issued there. A state law reaches plans issued in that state, usually your employer's state, not where the clinic is.
Highmark in Delaware
Often, on fully-insured plans: Delaware requires some fully-insured health plans to cover IVF, and that includes Highmark plans issued in Delaware unless one of the law's limits or exemptions applies. Fully-insured plans must cover IVF. A self-funded employer plan that Highmark only administers is not bound by state law and covers IVF only if the employer chose to. Delaware law and clinics
Highmark in New York
Often, on fully-insured plans: New York requires some fully-insured health plans to cover IVF, and that includes Highmark 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 Highmark only administers is not bound by state law and covers IVF only if the employer chose to. New York law and clinics
Highmark in West Virginia
Not because of state law: West Virginia requires some infertility coverage but not IVF, so IVF under a Highmark plan there depends on what the employer chose. West Virginia law and clinics
Highmark in Pennsylvania
Not because of state law: Pennsylvania has no law requiring private plans to cover IVF, so IVF under a Highmark plan there depends entirely on what the employer chose (or, for a plan you buy yourself, on the plan's own terms). Pennsylvania law and clinics
State laws as summarized by RESOLVE Insurance Coverage by State, read Oct 1, 2026.
How to see what your Highmark plan covers
A policy or program page is a summary. Your own plan's documents are what it pays by.
- 1Look for an assisted reproductive technology benefit in your plan documents: without one, Highmark's policy says IVF is not covered.
- 2Ask HR whether your employer added Highmark's Fertility and Family-Building program.
- 3Check your group's prescription drug program for fertility drugs, which may be covered separately.
- 4Call the member service number on your Highmark card to confirm your benefit and whether IVF needs approval first.
Highmark and IVF: common questions
Does Highmark cover IVF?
Only if your plan has an assisted reproduction benefit. Highmark's policy says those services, IVF included, are generally excluded from standard contracts and are not covered without the benefit. Where a plan has it, IVF may be medically necessary with one of the conditions the policy lists.
Does Highmark cover fertility drugs?
It depends on your group's prescription drug program, the Highmark group PPO plan we read says.
Does Highmark cover egg freezing?
Its policy says freezing eggs, sperm or embryos may be medically necessary before treatment that harms fertility, such as cancer treatment, and is not medically necessary outside its criteria.
- Medical Policy U-5-027: Assisted Reproductive Technology (Highmark commercial, Pennsylvania policy site) (Highmark, Effective Date: July 5, 2021; Last Revision Date: June 2021; Annual Review: June 2021 (live version on the policy site))
- Highmark.com home page (Highmark)
- Summary of PPO Blue $500 100/80 Gold Benefits (plan code 24_H_PPO_PA) (Highmark, Printed 10/22/2026)
- Fertility and family-building benefits for employees (Highmark employer page) (Highmark)