Blue Cross Blue Shield plans generally do not cover surrogacy. Across most BCBS affiliates, services performed on a gestational carrier — the embryo transfer, prenatal visits, labor and delivery — are explicitly excluded, even when the intended parent is a plan member in good standing. A few narrow exceptions exist for the intended parent’s own fertility workup, and a handful of state laws now force broader coverage, but the default answer for most members is no.
How the exclusion applies to you depends on three things: which BCBS affiliate issues your policy, the state that regulates the plan, and whether your employer self-insures.
What BCBS Plans Typically Exclude
The standard exclusion covers everything tied to the surrogate’s pregnancy. Blue Cross Blue Shield of Massachusetts excludes egg or embryo transfer to a gestational carrier, the carrier’s pregnancy-related costs, and maternity services for known surrogates.1Blue Cross Blue Shield of Massachusetts. Assisted Reproductive Services Infertility Services Medical Policy Blue Cross Blue Shield of Michigan’s medical policy excludes “all services related to gestational surrogacy / gestational parent / gestational carrier,” even for employer groups that have purchased assisted reproductive technology as an added benefit.2Blue Cross Blue Shield of Michigan. Assisted Reproductive Techniques Medical Policy
The BCBS Federal Employee Program, which covers millions of federal workers and retirees, takes the same position. Its 2025 benefits brochure lists “services, supplies, or drugs provided to individuals not enrolled in this Plan, including surrogates” as not covered, and its utilization management guidelines separately exclude “services requiring the use of a surrogate.”3FEP Blue. Standard and Basic Options Benefits Brochure4FEP Blue. UM Guideline – Infertility Services
Blue Shield of California’s assisted reproductive technology rider uses similar language: “no benefits are provided for services incident to or resulting from procedures for a surrogate mother.” There is one practical carve-out. If your surrogate happens to carry her own Blue Shield of California plan, her pregnancy care is covered under that separate policy — not yours.5Blue Shield of California. Assisted Reproductive Technology Rider (A55869)
What May Still Be Covered for You as the Intended Parent
Even plans that exclude surrogacy often cover part of the intended parent’s own fertility treatment. BCBS of Massachusetts will pay for the member’s infertility evaluation, ovarian stimulation, egg retrieval, fertilization, and embryo freezing when the member has a documented medical contraindication to pregnancy, uses her own eggs, and pays separately for the gestational carrier. For same-sex male couples or single men, the plan covers the embryology services needed to create an embryo but will not pay for transferring it into a carrier.1Blue Cross Blue Shield of Massachusetts. Assisted Reproductive Services Infertility Services Medical Policy
Anthem, one of the largest BCBS licensees, takes a comparable approach. Infertility evaluation, ovarian stimulation, oocyte retrieval, and fertilization are considered medically necessary for a covered member with a confirmed medical contraindication to pregnancy. Any services performed on a gestational carrier who is not herself an Anthem member — including the transfer and all pregnancy costs — are classified as not medically necessary.6Anthem. Assisted Reproductive Technology Clinical UM Guideline (CG-MED-103)
Where State Law Changes the Answer
State mandates can override the default exclusion, but only on fully insured plans. If your employer self-insures its health plan, federal ERISA rules apply instead of state insurance law, and the state mandates below do not reach you.7RESOLVE: The National Infertility Association. Insurance Coverage by State Most large employers self-insure, so the majority of BCBS members get coverage shaped by their employer’s benefit design rather than their state’s law.
For fully insured plans, the state picture varies.
- Illinois. Since January 1, 2022, state law requires that infertility benefits applying to a member also apply to a surrogate. BCBS of Illinois covers physical exams, lab screenings, prescription drugs, and up to four oocyte retrievals per year for the covered member, and covers the surrogate’s fertility treatment and medications through embryo transfer. Coverage of services for the surrogate ends once the reproductive endocrinologist transfers care to an obstetrician or fetal heart activity is detected; obstetrical care from that point is the surrogate’s own responsibility. Blue Precision and BlueCare Direct HMO members are excluded from surrogacy coverage.8Blue Cross Blue Shield of Illinois. New Illinois Laws9Blue Cross Blue Shield of Illinois. Infertility/Fertility Treatment HMO Scope of Benefits
- Delaware. The only state whose statute explicitly requires coverage for IVF when the embryo is transferred to a gestational carrier. The law covers the medical and laboratory procedures but not monetary payments to the carrier. Egg retrievals must be completed before age 45 and transfers before age 50. Employers with fewer than 50 employees, self-insured employers, and religious employers are exempt.10State of Delaware. Session Laws, Volume 81, Chapter 28411FindLaw. Delaware Code Title 18, Section 3556
- California (SB 729). Effective January 1, 2026, large group health plans cannot exclude or deny fertility services based on a covered individual’s participation in services involving a “third party,” a term that explicitly includes gestational carriers and surrogates. Anthem (operating as Blue Cross of California) and Blue Shield of California must comply. Small group contracts follow the same rule on renewal if the employer opts in. Self-funded plans remain exempt.12Anthem. California Department of Managed Health Care All Plan Letter13Blue Shield of California. Mandates
- New York. The state Department of Finance requires insurers to cover surrogate pregnancies to the same extent as other pregnancies.14NY Surrogacy Center. Insurance
- Maine. The state’s fertility coverage law goes the other way, explicitly excluding “any nonmedical costs related to donor gametes, donor embryos or surrogacy.”7RESOLVE: The National Infertility Association. Insurance Coverage by State
Massachusetts, Connecticut, and several other states mandate IVF coverage but do not specifically address whether that coverage extends to procedures involving a gestational carrier.15Kaiser Family Foundation. Infertility Coverage
Can You Fight a Denial?
Rarely, with success. In Roibas v. EBPA, LLC, a plan participant argued she was a “gestational carrier,” not a “surrogate,” and the plan’s “expenses for surrogacy” exclusion did not reach her. The court agreed the term was undefined and ambiguous but, applying arbitrary-and-capricious review, upheld the administrator’s reading. It called it “inconceivable” that the drafters intended to cover one type of expense but not the other.16GovInfo. Roibas v. EBPA, LLC, No. 1:17-cv-00020-NT In Moon v. Tall Tree Administrators, LLC, the Tenth Circuit reviewed de novo and held that an exclusion for “pregnancy charges acting as a surrogate mother” was unambiguous on its face, refusing to read in words that would create ambiguity.17Westlaw. Tenth Circuit Upholds Health Plan’s Denial of Surrogacy Expenses Standard exclusion language has held up under both deferential and de novo review.
How to Check Your Specific Plan
Coverage varies so widely across BCBS affiliates, plan types, and employer groups that the only reliable answer comes from the plan document itself.
- Read the exclusions section of the benefits handbook or Evidence of Coverage. Look for the words surrogacy, gestational carrier, or third-party reproduction. Silence is not a guarantee of coverage; insurers can still deny claims when the plan does not address the topic.18Physicians Surrogacy. Surrogate Insurance Lien Guide
- Ask the right question. Rather than “Does my plan cover surrogacy?” ask whether the policy contains any clawback clause, reimbursement right, or exclusion for compensated surrogacy. Get the answer in writing; verbal reassurances from customer service are not reliable.18Physicians Surrogacy. Surrogate Insurance Lien Guide
- Find out whether your plan is fully insured or self-funded. If self-funded, state mandates do not apply and the plan document controls entirely.
- Consider an insurance review from a surrogacy agency or attorney. Many retain specialists who audit the policy line by line for exclusions, lien rights, and reporting obligations that a general insurance agent might miss.19Surrogate.com. Health Insurance and Surrogacy Contracts
What You’ll Pay If BCBS Doesn’t Cover It
When the plan excludes surrogacy, intended parents pay for the surrogate’s pregnancy-related medical care themselves. A U.S. surrogacy journey runs roughly $100,000 to $200,000 overall, and insurance is one of the biggest variables inside that number.20Today. Surrogacy Costs21Illume Fertility. Average Cost of Surrogacy in the United States
If your surrogate carries her own health insurance and that policy does not exclude surrogacy, you generally pay her premiums, deductibles, copays, and coinsurance. That piece typically runs $3,000 to $8,000. If her plan excludes surrogacy or she is uninsured, you buy a dedicated surrogacy maternity policy, which runs $15,000 to $35,000 or more.22Fertile.com. US Surrogacy Cost Full Breakdown and Payment Timeline
Two providers dominate the supplemental surrogacy insurance market. ART Risk Solutions offers customized plans typically costing $25,000 to $35,000 that include maternity and delivery coverage for the surrogate, complication coverage, and newborn insurance.23Yunda Surrogacy. Surrogacy Insurance: A Coverage Guide New Life Agency’s Surrogate Maternity Care policy, underwritten by Lloyd’s of London, acts as a contingent backup that activates when the surrogate’s primary insurance denies maternity claims; all-in costs for a singleton pregnancy run roughly $45,500 to $47,000, with maximum benefits of $250,000 to $750,000 depending on tier.24New Life Agency / ART Risk Solutions. Surrogate Maternity Care Contingent Insurance Policy
Check Whether Your Employer Added a Fertility Benefit
Some employers layer a third-party fertility benefit on top of the BCBS medical plan, and these platforms often cover what the medical plan will not. Progyny includes surrogacy coverage as part of its fertility program.25Progyny. Progyny Home Carrot Fertility offers a gestational surrogacy pathway with access to a network of surrogacy agencies and attorneys and a payment card for reimbursements.26Carrot Fertility. Gestational Surrogacy BCBS Global Solutions has partnered with Carrot to offer surrogacy and other family-building services to members.27Fierce Healthcare. Blue Cross Blue Shield Global Solutions Launches Fertility Benefit With Carrot BCBS of Michigan offers a Family Building program through Maven Clinic that includes a reimbursement tool self-funded employers can configure for adoption and surrogacy expenses.28PR Newswire. Blue Cross Blue Shield of Michigan Offers Integrated Family Building Maternity Care Program Blue Cross NC confirms that some employers provide surrogacy and adoption benefits beyond the standard medical plan.29Blue Cross NC. Infertility Coverage 101 Before assuming you are on your own financially, ask human resources whether a benefit of this kind is part of your package.