How Illinois Health Insurance Can Cover Egg Donation and Surrogacy

Introduction

If you’re building a family through egg donation or surrogacy in Illinois, you already know how quickly the costs can add up: from fertility treatments to legal paperwork to the medical care itself. And while our recent blog on California’s SB 729 explains how California expanded its fertility coverage, the Illinois legislature enacted SB 773 (Public Act 103‑0751) in 2024. For group policies issued or renewed on or after January 1, 2026, any Illinois group policy that provides pregnancy‑related benefits must also include infertility coverage.

Illinois readers, depending on your health plan, you may already have insurance benefits that cover key parts of your fertility or surrogacy journey, including egg retrievals, IVF, and some services furnished to donors or a gestational surrogate as part of treating the member’s infertility. Whether you're just starting IVF, planning to work with a gestational surrogate, or using an egg donor, understanding your insurance options in Illinois is a critical step. This article walks through what the law covers, what it doesn’t, and how to protect yourself from the unexpected.

Illinois insurance mandates: what they cover

Illinois is one of the few states that legally requires many fully insured group health plans to cover infertility diagnosis and treatment. The mandate arises from Section 356m of the Illinois Insurance Code, which sets definitions, eligibility, and parity protections. Through December 31, 2025, it applies to fully insured group policies with more than 25 employees; beginning January 1, 2026, it applies to all Illinois group policies that provide pregnancy‑related benefits.

If your insurance plan is fully insured (as opposed to self‑funded) and your employer has 25 or more employees, your plan is likely required—today—to cover a broad range of fertility‑related services. This includes but is not limited to:

• In vitro fertilization (IVF)

• Uterine embryo lavage and embryo transfer

• Artificial insemination (IUI)

• Gamete intrafallopian transfer (GIFT)

• Zygote intrafallopian transfer (ZIFT)

• Low tubal ovum transfer

Those procedures remain in the statute for 2026 and beyond, and surgical sperm extraction procedures are expressly referenced under the 2026 expansion.

The IVF, GIFT, and ZIFT coverage requires that the covered individual has been unable to attain, maintain, or sustain a viable/successful pregnancy through reasonable, less costly medically appropriate treatments for which coverage is available.

Illinois law defines infertility broadly—including individuals who cannot reproduce without medical intervention, regardless of partnership status. That means single individuals and LGBTQ+ intended parents can qualify.

The law currently has a lifetime limit of up to four completed oocyte (egg) retrievals, with the potential for two additional retrievals if a live birth occurs. For group policies issued or renewed on or after January 1, 2026 under new subsection 356m(a‑5), that statutory retrieval cap is removed.

All covered procedures must be performed at qualified facilities. For plan years before 2026, procedures must be performed at facilities meeting ASRM/ACOG standards; for group policies issued or renewed on or after January 1, 2026, procedures must be medically appropriate under ASRM/ACOG/SART guidelines and performed at facilities that are SART members in good standing.

Perhaps most notably, Illinois law prohibits insurers from applying stricter deductibles, co‑pays, coinsurance, waiting periods, or coverage caps to infertility diagnosis/treatment (and standard fertility preservation) than apply to other medical care under the plan.

Egg donation & retrieval coverage

Under state law, qualifying plans must cover the medical aspects of egg donation and retrieval, including donor screening that an insurer requires (for example, physical exam, lab and psychological screening, and prescription drugs). If an oocyte donor is used, the completed retrieval counts toward the covered member’s retrieval limit. Non‑medical donor costs—like compensation, travel within 100 miles, agency fees, and legal fees—may be excluded.

In short, Illinois law supports coverage for the donor’s medical retrieval and related infertility services—but not the full cost of using a third‑party egg donor. This is where legal planning and private financial arrangements become essential.

Surrogacy‑related medical coverage

Surrogacy introduces complexities when it comes to insurance. Under Illinois’ infertility mandate and Department of Insurance rules, an intended parent’s qualifying plan must cover infertility services that are delivered to a surrogate to treat the member’s infertility—subject to the plan’s medical‑necessity and network rules. That includes at least one embryo‑transfer procedure after the final covered retrieval and related infertility services until the surrogate is discharged to routine obstetrical care. After discharge to OB care, ongoing prenatal and delivery services may be excluded from the intended parent’s infertility benefit and are typically billed to the surrogate’s own policy.

If the surrogate is in Illinois, her insurance does not have to be “surrogacy‑friendly,” but the Gestational Surrogacy Act requires that, at the time of signing, the surrogate has a health insurance policy covering major medical and hospitalization that remains in effect through the pregnancy and for at least eight weeks after birth. The policy can be procured by the intended parents. (codes.findlaw.com)

Key Points:

• Mandated coverage: Illinois law requires qualifying group policies to cover infertility services furnished to a surrogate that treat the covered individual’s infertility (including embryo transfer), with parity in cost‑sharing, until the surrogate is discharged to OB care.

• Policy for surrogate must be in place: The surrogate must have her own policy covering major medical/hospitalization through the pregnancy and eight weeks postpartum.

• Your responsibility: Intended parents remain responsible for plan deductibles, copays/coinsurance, and any items not covered by either policy (for example, non‑medical surrogate costs).

• Setting up a policy: If the surrogate’s existing plan excludes or limits coverage, you may need to help her obtain a policy (often via the Marketplace during open enrollment) that satisfies the Act’s requirement and your contract terms.

• Specialist consultation: Consulting a surrogacy‑savvy insurance broker helps determine whether a secondary policy is prudent and how claims should be routed.

Note: Some carriers have formally clarified operational details. For example, BCBSIL instructs providers to indicate “surrogate” or “donor” on claims and notes that infertility benefits applying to a member also apply to a surrogate until discharge to OB care; coverage details still vary by plan. (bcbsil.com)

To learn more about Illinois surrogacy contracts—read our breakdown of the state’s surrogacy agreement requirements

Need legal guidance?

If you're pursuing egg donation, surrogacy, or both in Illinois, Tsong Law Group can help you protect your family and finances. Our attorneys are licensed in California, New York, Illinois, Washington, Arizona, and Oklahoma—and we’ve helped families nationwide navigate fertility law with confidence.

This article is for informational purposes only and does not constitute legal advice. It does not create an attorney‑client relationship with the reader.