Zora Health / Employer guide / United States
Support employees through fertility treatment, and keep the talent you have invested in.
Fertility treatment rarely fits around a work calendar, and most employees go through it quietly, often while doing some of their best work. Zora Health helps you build practical fertility support, from policies and manager guidance to confidential care navigation and access to 128+ partner clinics in 16 countries, around your workforce and budget. Companies including Hilton, LinkedIn, Sanofi, HSBC, Mastercard, Carousell and Singapore Management University work with us.
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Five things US HR leaders should know
- RESOLVE counts 15 states with IVF insurance mandates (October 2026). They bind fully insured plans only; 67% of covered workers were in self-funded plans in 2025 (KFF).
- California’s SB 729 requires large group, fully insured plans issued or renewed from 1 January 2026 to cover IVF, up to three egg retrievals, including for single people and same-sex couples.
- The White House put IVF at US$12,000 to 25,000 per cycle in October 2025. In Mercer’s 2024 survey, 47% of employers with 500 or more staff covered IVF; the median lifetime limit was US$20,000.
- There is no federal fertility leave, and FMLA leave is unpaid. The EEOC plans to propose narrowing its 2024 PWFA rule, which names fertility treatment.
- A May 2026 proposed federal rule would allow standalone fertility benefits capped at up to US$120,000 a lifetime from 2027, if finalised.
Why fertility is a business problem for employers
Fertility treatment runs on the clinic’s timetable. Scans are booked at short notice, egg collection falls about 36 hours after a trigger injection, and many people need more than one cycle. Managers see missed meetings and unexplained absences.
The World Health Organization estimates that about 1 in 6 people worldwide are affected by infertility, and the CDC says about 1 in 5 married women aged 15 to 49 with no prior births cannot get pregnant after 1 year of trying. In a 2023 Carrot Fertility survey of 5,000 people in Canada, India, Mexico, the UK and the US, 79% felt uncomfortable discussing fertility openly at work.
- Resignations. 39% of employees in Ferring‘s 2025 survey of more than 3,600 people in Australia, France, Japan, Poland and the UK had left or considered leaving a job during treatment. The survey did not cover the US.
- Lower performance. 55% in the Carrot 2023 survey, which included the US, said fertility challenges had hurt their work (Carrot).
- Unequal access. In 2024, 70% of employers with 20,000 or more staff covered IVF, against 47% of those with 500 or more (Mercer, via HR Dive).
What employers gain
Keep the people you spent the most to develop
Replacing an employee costs one-half to two times their annual salary, according to Gallup. IVF success falls through the late 30s, often the years when employees move into senior roles. A written policy, paid time off and a funded allowance give them reasons to stay.
Stand out in a tight labour market
73% of employees with fertility challenges would be drawn to a role offering fertility support (Ferring, 2025), and 65% said they would change jobs for fertility benefits (Carrot, 2023). In 2024, the International Foundation of Employee Benefit Plans reported that 42% of US employers offered fertility benefits, up from 30% in 2020. Since 2025, two nationwide federal employee health plans have offered US$25,000 in IVF benefits (Government Executive).
Make fertility support financially predictable
Annual or lifetime allowances and a defined list of eligible treatments keep spend predictable. Mercer’s preliminary 2026 survey expects health benefit cost per employee to rise 8.2% in 2027 after planned cost cuts (Mercer, September 2026).
Zora structures benefits around local treatment costs, state law and plan funding, within an agreed budget.
Want to see what this would look like for your US workforce?
What IVF costs, and what the state pays
There is no national public funding for IVF. RESOLVE counts 25 states with some infertility insurance law, 15 with IVF mandates and 22 with fertility preservation mandates (RESOLVE, October 2026). Self-insured employers are exempt from these laws.
| Item | Typical price (US$) | Notes |
|---|---|---|
| IVF, one cycle | 12,000 to 25,000 | White House, October 2025; multiple cycles may be needed. Mercer cites a FertilityIQ estimate of 25,000 to 35,000 |
| Fertility drugs, one cycle | Often over 5,000 | White House; almost 20% of a cycle’s cost |
| Egg freezing, one cycle | 10,000 to 20,000 | Cofertility, updated July 2026; medication 2,500 to 8,500 of this |
| Egg storage, per year | 600 to 1,000 | Cofertility; some clinics charge more |
| Employer plan lifetime limit (median) | 20,000 | Mercer; below the typical cost of one cycle |
Sources: White House fact sheet, 16 October 2025; Mercer, March 2025; Cofertility, egg freezing costs (updated July 2026). Prices vary widely by clinic and city.
| Item | Public support (or own savings) | What the employee still carries |
|---|---|---|
| Fully insured plan in a state with an IVF mandate | State mandate, not a subsidy; scope varies. California SB 729 covers up to three completed egg retrievals on large group plans | Deductibles, co-insurance and any cycles beyond plan limits |
| Self-funded ERISA plan | None; state mandates do not apply | The full price if the plan excludes IVF |
| Fertility drugs bought through TrumpRx.gov | Discounted direct prices on EMD Serono’s Gonal-f; CMS estimates savings of up to US$2,200 per cycle | The rest of the drug cost and all clinic fees |
| Tax relief | IVF can count as a deductible medical expense, above 7.5% of adjusted gross income | Most of the cost, paid up front |
Sources: RESOLVE; Carrot, California SB 729 update; White House fact sheet, October 2025; IRS Publication 502 (2025); Cofertility.
Age strongly predicts IVF success. In SART’s final 2023 national data, live births per intended egg retrieval using the patient’s own eggs, counting all embryo transfers from that retrieval, were 53.2% under 35, 39.9% at 35 to 37, 26.2% at 38 to 40, 13.2% at 41 to 42 and 4.1% over 42 (SART).
A US$20,000 limit can go on one cycle, so the size of an allowance and when employees can use it both matter.
Give Employees Access to Fertility Specialists
Help employees navigate fertility care with access to doctors and clinics, treatment information, and clear guidance on IVF, egg freezing and other fertility options. Employees can explore their options privately, without needing to go through HR.
Fertility support that fits your workforce and budget
You do not need to overhaul your existing health insurance to support employees through fertility treatment. Start with awareness and manager education, add confidential one-to-one support, or introduce a funded allowance across your offices. There is no minimum company size.
Where included in the employer programme, eligible employees can use talks and care navigation without paying Zora a separate fee. Care navigation allowances are set in each proposal. Treatment and other third-party costs are paid separately, either by employees or through the fertility allowance their employer provides.
Companies starting the conversation
Essentials
Expert-led talks for employees and managers, fertility and menopause policy templates, manager guides and full access to the Zora app. Up to 2 talks a year.
Employees supported one to one
Navigation
Everything in Essentials, plus confidential one-to-one care navigation and access to our partner clinic network.
Large and multi-country teams
Complete
Everything in Navigation, plus quarterly anonymised reporting, a dedicated account manager and scheduled review meetings with HR.
Optional add-ons can be added to any programme, subject to availability: hormone and fertility diagnostics and telehealth with specialists. Pricing is tailored to your headcount, your countries and the services you choose. Most companies start with a single talk.
Request a proposal See how Zora works for employers
Comparing fertility benefit providers? Use our RFP question bank
Our RFP question bank has 40 questions, with why each one matters, what a good answer looks like and a scoring sheet for three providers. Six of the questions for the United States:
- Are local-plan employees covered, or only staff on international health plans?
- Do you require an infertility diagnosis before support starts?
- Which US states and cities does your clinic network cover, and what support do employees get in states without an IVF mandate?
- How does the benefit work alongside our self-funded ERISA plan or a fully insured plan subject to state mandates such as California SB 729?
- Could the programme be structured as an excepted fertility benefit if the May 2026 proposed rule is finalised, and what would change for us?
- What health information do you share with us as plan sponsor, and how do you handle it under HIPAA?
Your download link appears here as soon as you submit. Zora Health may contact you about employee benefits; see our privacy policy.
Plan your fertility benefit budget
Fertility benefit budget planner
Model the annual claims budget for a fertility allowance. Change any number.
This is a claims budget, not a Zora quotation. Zora’s programme fees, implementation and optional services are separate.
Illustration only. Utilisation is an editable assumption, not observed Zora data. The calculation assumes each user claims their full annual allowance, and excludes programme fees and setup costs. For a tailored model, request an employer proposal.
Estimate the potential workforce impact of fertility challenges
A rough planning scenario. It applies a global infertility estimate to your headcount, so it is not a prediction for your workforce, a measured loss or a forecast of savings from any programme.
Range: US$375,833 to USclass=”zc-note o-rng”>Range: ,063,333 a year, depending on replacement cost.
Assumptions: infertility affects about 1 in 6 adults (World Health Organization, 2023), applied to employees aged 25 to 44. Replacing an employee costs one-half to two times their annual salary (Gallup, 2019); the headline uses the low end. Absence is valued at salary divided by 250 working days. Exit rate and days lost are your own assumptions.
This is a hypothetical cost scenario, not a prediction of actual employee departures, an estimate of Zora’s financial impact or a guaranteed saving from fertility benefits.
Already have corporate health insurance? Here is where Zora fits
Your medical plan may cover some consultations and tests, but fertility treatment is often limited or excluded, so check your policy wording. Employees still need to understand their options, the public funding they qualify for and which clinic suits them.
Zora works alongside your existing insurance and benefits. We help employees get reliable information, navigate their care options and reach suitable specialists, and we give HR manager guidance, policy templates and, on the Complete programme, anonymised reporting. You strengthen fertility support without replacing your medical plan.
How Zora works
For your employees
Employees join the Zora app with a company code, or single sign-on for larger teams. They can learn about fertility and egg freezing, understand what your benefit covers, book a confidential care navigation call and find partner clinics and specialists.
For HR
- Kick-off, week 1. Agree goals, countries and which employees are eligible.
- Policy and benefit design, weeks 2 to 4. Draft or update your fertility policy using our templates.
- Launch, typically weeks 4 to 6. A launch talk for employees and managers, plus a communications pack for HR to send.
- Live support. Employees book care navigation calls and use the Zora app.
- Reporting, every 3 months, on the Complete programme. Anonymised usage, common themes and our recommendations, reviewed with your account manager.
Privacy
Employee privacy is central to our programmes. On the Complete programme, routine employer reports contain aggregated engagement and utilisation information, with safeguards to prevent identification of individual employees. On every programme, personal health information is not included in standard HR reporting, and employees can get help without telling their manager. Where eligibility checks or claims administration need individual-level data, access is limited to authorised parties for defined purposes, as agreed in writing before launch. Employee data is handled in line with Singapore’s Personal Data Protection Act and, where it applies, the US Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, which limits the health information group health plans and covered providers may disclose to an employer without the employee’s authorisation.
Clinics and doctors in the United States
Zora’s clinic and doctor directory does not list providers in the United States yet. It lists 421 clinics and 1,185 doctors across 25 countries, mostly in Asia Pacific and the Middle East (browse clinics or browse doctors). Employees in the United States can still use Zora’s education and the Zora app. Ask us how your team in the United States would use Zora before you launch. See Zora’s employer guides for every country.
Rules and eligibility in the United States
Who can use assisted reproduction
No federal statute sets who may use IVF. Clinics must report success rates under a 1992 federal law; the CDC team that published them was eliminated in 2025, and SART still publishes member clinic data (ASRM). States set surrogacy and parentage law. Michigan’s law ending its ban on compensated surrogacy took effect in April 2025 (Michigan Public). In March 2024, Alabama gave IVF providers civil and criminal immunity for death of or damage to embryos, after its Supreme Court ruled in February 2024 that frozen embryos are “extrauterine children” under its wrongful death law (AHLA).
Legal, and usually self-paid
ASRM dropped the experimental label from egg freezing in 2012, and its 2023 ethics opinion calls planned egg freezing ethically permissible (ASRM). We found no federal age or storage limit. SB 729 covers egg freezing when medically necessary, for example before cancer treatment (Carrot).
Unpaid leave, and no fertility leave
The Family and Medical Leave Act gives up to 12 workweeks of unpaid, job-protected leave in 12 months, with group health cover continued, at private employers with 50 or more employees, to employees with 12 months of service, 1,250 hours in the past 12 months and at least 50 colleagues within 75 miles (Department of Labor). Some states add their own leave rules.
Pregnancy discrimination and accommodation
The Pregnancy Discrimination Act bars discrimination over current, past or potential pregnancy at employers with 15 or more staff (EEOC). The Pregnant Workers Fairness Act, in force since 27 June 2023, requires reasonable accommodation for known limitations related to pregnancy (EEOC). The EEOC’s rule, effective 18 June 2024, defines pregnancy to include potential or intended pregnancy, which can include infertility and fertility treatment (29 CFR 1636.3); a federal judge vacated its abortion provision in May 2025 (HR Dive). The EEOC’s agenda lists a proposed rule, estimated for November 2026, to revise “related medical conditions” (J. J. Keller). As of 3 November 2026 it was unpublished, and reports said it could narrow the list of covered conditions and remove explicit protections for workers who are not pregnant, which could affect fertility treatment (New York Times, via Inquirer, 2026).
Federal moves on fertility benefits
On 16 October 2025, the Departments of Labor, Health and Human Services and the Treasury issued guidance on offering fertility cover through existing excepted benefits (ACA FAQs Part 72). In May 2026 they proposed a new category of excepted fertility benefits, with a lifetime cap of up to US$120,000, offered only to people also offered the employer’s main plan, for plan years from 1 January 2027 (Department of Labor, WTW). Comments closed 13 July 2026 (IFEBP); we found no final rule as of November 2026.
Why employers choose Zora
Companies including Hilton, LinkedIn, Sanofi, HSBC, Mastercard, Carousell and Singapore Management University work with Zora Health. We work alongside your existing insurance, helping employees use the cover they already have and find suitable specialists based on their needs.
Trying to conceive with a heavy workload took a toll on my husband and me. It helped us understand our options.
Questions HR teams ask us
Is fertility leave mandatory in the United States?
No. No federal law provides fertility or IVF leave. Eligible employees can take up to 12 weeks of unpaid, job-protected FMLA leave for qualifying reasons, and the Pregnant Workers Fairness Act requires reasonable accommodation for limitations related to pregnancy, which the EEOC’s 2024 rule says can include fertility treatment. The EEOC plans to propose narrowing that rule. Some states add their own leave rules, so time off for treatment often depends on employer policy.
Do US employers have to cover IVF?
It depends on the state and the plan. RESOLVE counts 15 states with laws requiring insurers to cover IVF, but these apply to fully insured plans. Self-funded ERISA plans, which covered 67% of insured workers in 2025 according to KFF, are exempt, so the employer decides. In California, SB 729 requires large group, fully insured plans issued or renewed from 1 January 2026 to cover IVF.
Is egg freezing covered or allowed in the US?
Egg freezing is legal, and we found no federal age or storage limit. RESOLVE counts 22 states with fertility preservation insurance mandates, but elective egg freezing is usually self-paid unless an employer plan or fertility benefit covers it. Cofertility (updated July 2026) puts one cycle at US$10,000 to 20,000, plus US$600 to 1,000 a year for storage.
Does Zora replace our health insurance?
No. Zora works alongside your insurance. We help employees understand their options, find suitable specialists and use the cover they already have.
How much does a fertility benefit cost an employer?
It depends on the allowance, eligibility and expected uptake. Use the budget planner on this page for a first estimate, then ask us for a tailored proposal based on your headcount and countries.
How quickly can we launch?
Typically 4 to 6 weeks from contract to launch, depending on scope and countries. Most companies start with a single talk.
Related guides for US employers
Build a fertility benefit for your team
Whether you are introducing fertility benefits for the first time or improving an existing programme, tell us your headcount, countries and priorities. We will come back within two working days with suitable services, an indicative budget and a practical rollout plan for your US team. No obligation.
Not ready to talk yet? Explore how Zora works
Sources
- RESOLVE, Insurance coverage by state (updated October 2026)
- Carrot Fertility, California SB 729: updates, benefits and effective date
- CDC NCHS, U.S. births down 1% in 2025, April 2026
- CDC, Infertility FAQs
- ASRM, For the first time more than 100,000 babies born through IVF in the U.S. in a single year, March 2026
- SART, Final national summary report for 2023
- ASRM, The U.S. federal government and reproductive health
- HR Dive, Where IVF benefits stand (Mercer 2024 National Survey of Employer-Sponsored Health Plans)
- Mercer, Delivering efficient and affordable IVF coverage to employees, March 2025
- Mercer, Employers expect health benefit costs to jump in 2027, September 2026
- KFF, 2025 Employer Health Benefits Survey
- White House, Fact sheet on lowering costs and expanding access to IVF, 16 October 2025
- Departments of Labor, HHS and the Treasury, ACA FAQs Part 72, October 2025
- Department of Labor, News release on proposed rule for excepted fertility benefits, May 2026
- Federal Register, Excepted fertility benefits (proposed rule), 13 May 2026
- IFEBP, Departments issue proposed rules on excepted fertility benefits; comments due July 13, May 2026
- WTW, Proposed rule to classify fertility benefits as a new category of excepted benefits, May 2026
- Cofertility, Egg freezing costs, updated July 2026
- Government Executive, Multiple FEHBP carriers will offer comprehensive IVF coverage next year, September 2024
- IRS, Publication 502 (2025), Medical and dental expenses
- U.S. Department of Labor, Family and Medical Leave Act
- EEOC, What you should know about the Pregnant Workers Fairness Act
- eCFR, 29 CFR 1636.3 Definitions (PWFA regulation)
- HR Dive, Judge vacates PWFA abortion accommodation provision, May 2025
- J. J. Keller, The EEOC’s 2026 regulatory agenda includes changes to the PWFA, July 2026
- The Philadelphia Inquirer (New York Times), Trump administration said to plan to roll back pregnancy-related job protections, 3 November 2026
- EEOC, Pregnancy discrimination
- HHS, Employers and health information in the workplace (HIPAA)
- ASRM, Planned oocyte cryopreservation: an Ethics Committee opinion (2023)
- Michigan Public, Michigan law lifts 38-year-old surrogate parent ban, April 2025
- American Health Law Association, Alabama enacts legislation to protect IVF, March 2024
- IFEBP via HR Dive, Fertility benefits on the rise, August 2024
- Ferring Pharmaceuticals, Fertility Matters at Work and This Can Happen, workplace fertility survey, November 2025
- Carrot Fertility, Global Fertility at Work report, 2023
- Gallup, This fixable problem costs US businesses $1 trillion, 2019
- World Health Organization, 1 in 6 people globally affected by infertility, April 2023
Information on this page is correct as of 5 November 2026. Laws, public funding, insurance rules and treatment costs change often, so check current rules with the relevant authority, insurer or a qualified adviser before making decisions. This page is general information, not legal, financial, tax or medical advice.