Does Presbyterian Health Plan cover IVF?
What Presbyterian Health Plan (New Mexico) publishes about covering IVF and other fertility treatment, in its own words, with the document each statement is in.
- Documents read · checked 11 h ago
No, not on its group plans. Presbyterian's 2026 large group HMO, large group PPO and small group agreements say infertility services are not covered unless they treat the underlying cause, as New Mexico's HMO rule requires; the benefit is diagnosis and medically indicated treatment of physical conditions causing infertility. GIFT and ZIFT, drugs used with IVF or artificial insemination, drugs to promote pregnancy, donor sperm and storing eggs, sperm or embryos are not covered. Self-funded employer plans can set their own benefits.
What Presbyterian's agreements say
Read on Oct 27, 2026. The words in quotation marks are the source's own.
Not on its group plans: only diagnosis and treating a physical cause
“Infertility services, listed below, are not Covered unless for treatment of the underline cause of infertility, to comply with 13.10.21.8(M)(7) NMAC.”
“Prescription Drugs/Medications used in conjunction with In-vitro fertilization and artificial insemination are not Covered.”
What is covered
Diagnosis and medically indicated treatments for physical conditions causing infertility, the basic service New Mexico's HMO rule requires.
“Diagnosis and medically indicated treatments for physical conditions causing infertility.”
“(c) diagnosis and medically indicated treatments for physical conditions causing infertility except as required to reverse prior voluntary sterilization surgery.”
What is not covered
Infertility services other than treating the underlying cause, including GIFT and ZIFT, oral and injectable fertility drugs given by a provider, drugs used with IVF or artificial insemination, drugs to promote pregnancy, donor sperm, storage or banking of sperm, eggs or embryos, and reversal of sterilization.
“Infertility services, listed below, are not Covered unless for treatment of the underline cause of infertility, to comply with 13.10.21.8(M)(7) NMAC.”
“In-vitro Gamete Intra Fallopian Transfer (GIFT) and Zygote Intrafallopian Transfer (ZIFT) fertilization are not Covered”
“Prescription Drugs Oral and Injectable for the treatment of infertility when provided by a Practitioner/Provider”
“Prescription Drugs/Medications used in conjunction with In-vitro fertilization and artificial insemination are not Covered.”
“Oral or injectable medications used to promote pregnancy are not Covered.”
“Donor sperm is not Covered”
“Storage or banking of sperm, ova (human eggs), embryos, zygotes or other human tissue is not Covered”
Every group plan type
The same wording is in its 2026 small group HMO metal plans and its large group PPO plans.
“Infertility services, listed below, are not Covered unless for treatment of the underline cause of infertility to comply with 13.10.21.8(M)(7) NMAC.”
“Infertility services, listed below, are not Covered unless for treatment of the underline cause of infertility to comply with 13.10.21.8(M)(7) NMAC.”
Self-funded employer plans
Presbyterian notes that self-funded employers can be free of state-mandated benefits, so a self-funded plan's own documents decide.
“Self-funded is an arrangement whereby the employer assumes some or all of the risk in providing health benefits for the employees. In New Mexico, self-funding can save the employer 2-6% in premium taxes which do not apply in self-funded plans, potential freedom from costly state-mandated benefits”
Whether your Presbyterian Health Plan plan covers IVF
The Presbyterian Health Plan 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 Presbyterian Health Plan 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 Presbyterian Health Plan cover IVF in New Mexico?
New Mexico's insurance law applied to a Presbyterian Health Plan plan issued there. A state law reaches plans issued in that state, usually your employer's state, not where the clinic is.
Presbyterian Health Plan in New Mexico
Not because of state law: New Mexico has no law requiring private plans to cover IVF, so IVF under a Presbyterian Health Plan plan there depends entirely on what the employer chose (or, for a plan you buy yourself, on the plan's own terms). New Mexico law and clinics
State laws as summarized by RESOLVE Insurance Coverage by State, read Oct 1, 2026.
How to see what your Presbyterian Health Plan plan covers
A policy or program page is a summary. Your own plan's documents are what it pays by.
- 1Read the infertility section of your group agreement and your Summary of Benefits and Coverage, as the agreement asks.
- 2On a self-funded employer plan, ask HR for your plan document: those plans can set their own benefits.
- 3Ask Presbyterian whether a planned test or treatment counts as treating the underlying cause of infertility.
Presbyterian Health Plan and IVF: common questions
Does Presbyterian Health Plan cover IVF?
Not on its 2026 group plans: infertility services are not covered unless they treat the underlying cause, and drugs used with IVF or artificial insemination are excluded.
Does Presbyterian cover infertility testing?
Yes: diagnosis and medically indicated treatment of physical conditions causing infertility are covered, as New Mexico's HMO rule requires.
Does Presbyterian cover egg or sperm freezing?
Storage or banking of sperm, eggs or embryos is not covered on its 2026 group plans.
- Presbyterian Health Plan, Inc. Group Subscriber Agreement and Guide to Your Managed Care Plan: Large Group Benefit Plans, HMO (MPC022607) (Presbyterian Health Plan, Beginning on or after 1/1/2026)
- 13.10.21 NMAC: Health Maintenance Organizations, basic health care services (New Mexico Administrative Code) (New Mexico (NMAC), 13.10.21.8 NMAC, effective 09/01/2009)
- Presbyterian Health Plan Small Group HMO Metal Plan Group Subscriber Agreement (MPC122516) (Presbyterian Health Plan, 01.01.2026-12.31.26)
- Presbyterian Insurance Company, Inc. Group Subscriber Agreement and Guide to Your PPO Plan: Large Group Benefit Plans, PPO Plans (MPC022629) (Presbyterian Health Plan, Beginning on or after 01.01.2026)
- Group Insurance Plans (Presbyterian Health Plan employer page) (Presbyterian Health Plan)