CommercialCoverageMedium impact
New District of Columbia Infertility Legislation Effective January 1, 2025
CareFirst BlueCross BlueShield·DC · OB-GYN, Endocrinology·Provider News
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
District of Columbia requires fully insured health plans to cover infertility diagnosis and treatment effective January 1, 2025, including artificial insemination, IVF (limited to 3 egg retrievals per lifetime), and fertility preservation services. Providers must complete an Assisted Reproductive Technology Pre-Treatment Request form to adjudicate claims and apply benefits appropriately.
Action Required
By January 1, 2025: Billing team must implement new DC infertility coverage requirements by completing Assisted Reproductive Technology Pre-Treatment Request forms for all infertility treatments. Update billing workflows to track IVF egg retrieval limits (3 per member lifetime) and ensure proper surrogate designation on embryo transfer forms. Verify patient eligibility for DC fully insured plans and apply same cost-sharing as other like services.