How does Washington, DC fertility insurance law affect how clinics market IVF in Washington, DC?

Yes. Since January 1, 2025, DC law requires health insurers to cover the diagnosis and treatment of infertility, including IVF and standard fertility preservation, when consistent with a physician's overall plan of care. The law sets a floor of at least three complete egg retrievals with unlimited embryo transfers, and bans arbitrary limits on age, attempts or dollars.

The requirement is D.C. Official Code § 31-3834.06, added by D.C. Law 25-49, the Expanding Access to Fertility Treatment Amendment Act of 2023, which took effect September 6, 2023. Subsection (a) covers large group plans. Subsection (b) applies the same rules to individual and small group plans, also from January 1, 2025.

The core coverage floor

• At least 3 complete oocyte retrievals, with unlimited embryo transfers from those retrievals or from any retrieval done before January 1, 2025.
• ASRM guidelines apply, including single embryo transfer when recommended and medically appropriate.
• Third-party transfer: the medical costs of transferring an embryo to a gestational carrier or surrogate are covered for the enrollee; the carrier's own medical costs after transfer are not.
• Standard fertility preservation is included for people facing treatment that may impair fertility, following ASRM or ASCO guidelines.

What the law leaves to the physician and the plan

The statute ties coverage to a physician's overall plan of care and to ASRM guidance, and it states that nothing in the section interferes with a physician's clinical judgment. That means the clinic's own treatment recommendations carry real weight in what gets covered. It also means marketing should describe treatment as individualized, not as a fixed package of cycles every patient will receive. The Mayor was directed to issue implementing rules, so check for any that add detail.

This page reflects the Code as of October 2026. Confirm the current text, and any implementing rules, with counsel before publishing coverage claims.

It reaches fully insured plans issued in the District, across large group, small group and individual markets. Self-funded employer plans are generally governed by federal ERISA rules instead, and the federal employee program follows its own rules. In a city full of federal workers and large employers, that distinction decides who actually has the state benefit.

Individual and small group: a note on funding

The 2023 Act made subsection (b), for individual and small group plans, depend on its cost being included in an approved budget. The Code's notes say a later law, D.C. Law 25-217, repealed that condition, but the same page carries an older note saying the provision was not yet implemented. Separately, DISB's benchmark plan notice from April 2024 explains that DISB planned to add the new infertility services to the District's essential health benefits benchmark plan for plan year 2026, which individual and small group plans must include. Ask DISB or counsel to confirm the status for a given plan year.

Religious accommodation

The 2023 Act also expanded which services an eligible employer with a religious objection can seek an accommodation for. DISB Bulletin 26-IB-001-1/6, dated February 11, 2026, confirms that group issuers must handle accommodation requests covering the fertility section, using DISB's self-certification forms, and report accommodations to DISB each quarter. So even a fully insured DC group plan may lack the benefit.

Medicaid and the DC Healthcare Alliance

From January 1, 2024, the Alliance program covers infertility diagnosis and ovulation-enhancing drugs, with at least three lifetime cycles of medication. The law directed the Department of Health Care Finance to seek a matching Medicaid change and to report on IVF coverage options. It does not itself extend IVF to Medicaid.

Ask two questions on every enquiry: which state or program issued the plan, and is it fully insured or self-funded. Those answers decide whether DC law applies at all. Then check the plan's own terms and reply in writing. A clinic that answers within a day turns the District's new benefit into booked consultations.

A five-step verification script

1. Plan source: "Is your insurance through a DC employer, a federal agency, a Maryland or Virginia employer, or one you bought yourself?"
2. Plan funding: the member card or employer HR can tell you whether it is insured or self-funded.
3. Consent: explain why you need plan details and how you store them, and record the patient's agreement.
4. Benefit check: confirm retrievals, transfers, drugs, preservation and any accommodation the employer has claimed.
5. Written answer: send a plain summary of what appears covered, what is not, and what the patient may owe under normal cost-sharing.

What to measure

Tag each enquiry by plan type and source. Over a few months, that shows which campaigns bring insured DC patients, which bring federal or self-funded patients, and which bring self-pay patients from outside the District. Budget decisions get much easier once those groups are visible. Keep the tags inside your scheduling or CRM system under a BAA, and never send them to advertising platforms.