Does Priority Health cover IVF?
What Priority Health (Michigan, Indiana, Ohio, Wisconsin) publishes about covering IVF and other fertility treatment, in its own words, with the document each statement is in.
- Documents read · checked 22 h ago
Only if your plan has an infertility rider or fertility benefit. Priority Health's infertility policy (effective September 1, 2026) says IVF and other assisted reproduction, and artificial insemination, are eligible only when your plan includes a specific infertility rider, an assisted reproduction benefit or another supplemental reproductive benefit; even infertility testing and treatment need reproductive services benefits. Where covered, cycle, age and dollar limits can apply. Freezing eggs or sperm, including before cancer treatment, is not a covered benefit under the policy.
What Priority Health's policy says
Read on Oct 25, 2026. The words in quotation marks are the source's own.
Only with an infertility rider or fertility benefit
“Care and services related to Assisted Reproductive Technologies (ART) and Artificial Insemination are eligible for coverage only when the member’s benefit plan includes a specific infertility rider, assisted reproductive technologies (ART) benefit, or other supplemental reproductive services benefit.”
Even testing needs the benefit
Diagnostic testing and treatment for infertility are eligible only when your plan includes reproductive services benefits.
“Diagnostic testing and treatment services for the evaluation and management of infertility are eligible for coverage only when the member's benefit plan includes reproductive services benefits.”
Limits where it is covered
Covered assisted reproduction can carry cycle limits, age limits, lifetime and dollar maximums, quantity limits, network rules and prior authorization, and coverage varies by product, employer group, rider and line of business. Self-funded plans follow their own plan documents.
“Coverage may be subject to cycle limits, age limitations, lifetime maximums, dollar maximums, quantity limits, network requirements, and prior authorization requirements”
“Meeting medical necessity criteria does not guarantee benefit eligibility. Benefit coverage, eligible procedures, covered medications, quantity limits, and frequency limits vary by product, employer group, rider, and line of business.”
“ASO: For self-funded plans, consult individual plan documents.”
Who counts as infertile
Not getting pregnant after 12 months of regular unprotected intercourse under 35, or 6 months at 35 or older; without exposure to sperm, after enough donor insemination cycles under ASRM guidelines, typically six. The definition may not be used to deny treatment because of relationship status or sexual orientation.
“Failure to achieve pregnancy after 12 months of regular, unprotected intercourse when the female member is younger than 35 years of age. ii. Failure to achieve pregnancy after 6 months of regular, unprotected intercourse when the female member is 35 years of age or older.”
“Female member without sperm exposure i. Failure to achieve pregnancy following a sufficient number of therapeutic donor insemination cycles in accordance with current ASRM clinical practice guidelines (typically after 6 unsuccessful cycles). Note: Nothing in this definition shall be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation.”
Fertility drugs
Drug coverage depends on your pharmacy benefit and formulary. The 2026 MyPriority individual plans list infertility drugs at 50% coinsurance per prescription, and cover diagnostic, counseling and planning services for the cause of infertility.
“Pharmacy benefits may vary by product and line of business. Please check benefit plan descriptions and formularies for details on which specific medications are covered if any.”
“50% co-insurance/ prescription for infertility drugs.”
“Infertility treatment - diagnostic, counseling and”
Freezing eggs, sperm or ovarian tissue
Retrieving and storing semen, eggs or ovarian tissue before cancer treatment is not a covered benefit, and the policy lists all retrieval, preservation, storage or thawing of semen, eggs or ovaries as not covered.
“The retrieval and storage of semen, oocytes or ovarian tissue prior to cancer treatment are not a covered benefit.”
“All services for retrieval, preservation, storage or thawing of semen, oocytes, or ovaries are not covered benefit.”
Federal employees
Priority Health's plan for federal employees covers diagnostic, counseling and planning services, prescription drugs, assisted reproduction and artificial conception for the cause of infertility.
“Your medical plan through FEHB includes coverage for diagnostic, counseling, planning services, prescription drugs, assisted reproduction, and artificial conception related to the treatment of the underlying cause of infertility.”
Not covered
Reversing a voluntary sterilization, fertility treatment when infertility is due only to one, and surrogacy expenses, agency and legal fees.
“Services performed to reverse voluntary sterilization 3. ART or other fertility treatment when infertility is solely attributable to a prior voluntary sterilization procedure”
“Surrogacy-related expenses, agency fees, legal fees, and non-medical donor expenses”
Whether your Priority Health plan covers IVF
The Priority Health 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 Priority Health 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 Priority Health cover IVF in your state?
Each state's insurance law applied to a Priority Health plan issued there. A state law reaches plans issued in that state, usually your employer's state, not where the clinic is.
Priority Health in Ohio
Not because of state law: Ohio requires some infertility coverage but not IVF, so IVF under a Priority Health plan there depends on what the employer chose. Ohio law and clinics
Priority Health in Indiana
Not because of state law: Indiana has no law requiring private plans to cover IVF, so IVF under a Priority Health 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
Priority Health in Michigan
Not because of state law: Michigan has no law requiring private plans to cover IVF, so IVF under a Priority Health plan there depends entirely on what the employer chose (or, for a plan you buy yourself, on the plan's own terms). Michigan law and clinics
Priority Health in Wisconsin
Not because of state law: Wisconsin has no law requiring private plans to cover IVF, so IVF under a Priority Health 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 Priority Health plan covers
A policy or program page is a summary. Your own plan's documents are what it pays by.
- 1Read your plan documents, including any riders, for an infertility rider or fertility benefit: Priority Health says they decide.
- 2Ask HR whether your employer added an infertility rider or a fertility program, and what cycle or dollar limits it has.
- 3Check your formulary for fertility drugs and their cost share before treatment.
Priority Health and IVF: common questions
Does Priority Health cover IVF?
Only if your plan includes an infertility rider, an assisted reproduction benefit or another supplemental reproductive benefit, its policy effective September 1, 2026 says. Cycle, age and dollar limits can apply.
Does Priority Health cover IUI?
Artificial insemination, including IUI, is eligible on the same terms as IVF: only with an infertility rider or fertility benefit.
Does Priority Health cover egg freezing?
No, under its policy: retrieval and storage of eggs, semen or ovarian tissue before cancer treatment is not a covered benefit, nor is other egg or sperm freezing.
Does Michigan require insurance to cover IVF?
No Michigan law requires private plans to cover IVF, so a Priority Health plan covers it only with a rider or fertility benefit.
- Priority Health Medical Policy No. 91163: Infertility Diagnosis and Treatment/Assisted Reproduction (Priority Health, Effective 09/01/2026; committee review 08/12/2026)
- Summary of Benefits and Coverage, MyPriority Balanced Silver (HMO) (Priority Health, Coverage period beginning on or after 01/01/2026)
- Priority Health Federal Employee Membership Benefits page (Priority Health)