Progyny, Carrot & Maven: Who Sets the BMI Rule, the Benefit or the Clinic?
Employer fertility benefits such as Progyny, Carrot Fertility, Maven Clinic, WIN / WINFertility pay for treatment; they do not perform it. Whether a clinic will do an egg retrieval at a given BMI is decided by that clinic and its anesthesia provider. Below is what each benefit administrator states publicly, quoted from its own website and checked Nov 2026.
Progyny
How coverage works - Smart Cycle“The Smart Cycle is Progyny’s unique benefit currency. All of the individual services, tests and medications needed for a particular type of treatment are bundled together and assigned a Smart Cycle value.”Source: progyny.com/smart-benefits/smart-cycle · checked Nov 2026
What a Smart Cycle contains“Every aspect of a member’s comprehensive fertility treatment is contained within the Smart Cycle, including diagnostics, testing, lab services, treatment and medications.”Source: progyny.com/smart-benefits/smart-cycle · checked Nov 2026
Member works with doctor to choose treatment“Progyny members can work with their doctor to choose the most effective treatment for them without worrying about running out of coverage mid-treatment.”Source: progyny.com/smart-benefits/smart-cycle · checked Nov 2026
Member chooses an in-network doctor (worked example)“Katherine chooses an in-network reproductive endocrinologist with the help of her Patient Care Advocate and does an initial consultation.”Source: progyny.com/smart-benefits/smart-cycle · checked Nov 2026
Benefit design and clinical decisions“A strong fertility benefit preserves access to clinically appropriate options without imposing a fixed treatment sequence or unnecessary administrative barriers.”Source: progyny.com/topics/benefit-trends/right-care-right-time-h… · checked Nov 2026
Care guided by provider recommendation“Care should be guided by the patient’s clinical circumstances, goals, and provider recommendation — not a fixed, predetermined sequence.”Source: progyny.com/topics/benefit-trends/right-care-right-time-h… · checked Nov 2026
In-network doctor (blog worked example)“With the help of her Progyny Care Advocate (PCA) , Katherine chooses an in-network reproductive endocrinologist and completes an IVF Fresh Cycle.”Source: progyny.com/blog/fertility-family-building/what-is-a-smar… · checked Nov 2026
Carrot Fertility
How the benefit works - reimbursement of eligible expenses“As part of the Service, you may submit requests for reimbursements from your Employer for certain eligible expenses.”Source: get-carrot.com/terms-conditions · checked Nov 2026
Carrot may withhold ineligible reimbursements“We reserve the right to withhold a reimbursement payment in the event we determine the expense is not eligible for reimbursement.”Source: get-carrot.com/terms-conditions · checked Nov 2026
Infertility HRA / medical necessity wording“While Carrot is not a Covered Entity, it does set up an infertility HRA through which reimbursements of “infertility expenses” or “fertility expenses tied to medical necessity” are processed.”Source: get-carrot.com/trust-center/customer-faqs · checked Nov 2026
Medical decisions are discussed with treating providers“You are solely responsible for discussing all clinical matters, including diagnosis, treatment options, and medical decisions, with your treating providers.”Source: get-carrot.com/terms-conditions · checked Nov 2026
Carrot's stated role“Carrot supports you in making informed health care decisions in partnership with your treating providers.”Source: get-carrot.com/terms-conditions · checked Nov 2026
Provider network“Carrot has significantly expanded its nationwide network of high-performing fertility clinics and providers, adding 4,200 new contracts across all 50 states.”Source: get-carrot.com/blog/carrot-fertility-provider-expansion-2025 · checked Nov 2026
Maven Clinic
How the benefit works - Maven Wallet versions“Both give you access to funds from your employer for eligible expenses. The main difference is how payments are handled.”Source: support.mavenclinic.com/hc/en-us/articles/41948465965587-… · checked Nov 2026
Maven Green - pay and get reimbursed“you’ll pay upfront using a personal payment method. Then, depending on your employer’s Wallet benefits, you can submit for reimbursement.”Source: support.mavenclinic.com/hc/en-us/articles/41948465965587-… · checked Nov 2026
Maven Gold - direct payment at partner clinic“preservation services at a Maven Partner Clinic, you can use your Maven Benefit ID to have your Wallet pay the clinic directly.”Source: support.mavenclinic.com/hc/en-us/articles/41948465965587-… · checked Nov 2026
Member selects the clinic“The Maven fertility member receives an initial consultation with their Maven Care Advocate, who provides recommendations for fertility clinics and makes the member aware of their MavenRx benefit and specialty pharmacy. The member selects a fertility clinic and schedules an appointment.”Source: mavenclinic.com/post/new-maven-fertility-rx · checked Nov 2026
Treatment protocol and prescription come from the clinic“When a fertility treatment protocol is determined, the member directs the clinic to send the prescription to their specialty pharmacy.”Source: mavenclinic.com/post/new-maven-fertility-rx · checked Nov 2026
WIN / WINFertility
WIN's description of itself (Boeing FAQ)“WIN is the largest, most experienced fertility benefit management company in the country.”Source: managed.winfertility.com/wp-content/uploads/2023/03/Boein… · checked Nov 2026
Prior authorization against benefit policy (Boeing FAQ)“WIN receives treatment information from your provider during the Prior Authorization process to review against the benefit policy.”Source: managed.winfertility.com/wp-content/uploads/2023/03/Boein… · checked Nov 2026
In-network providers in this employer plan (Boeing FAQ)“Use of in-network providers, facilities and/or labs will”Source: managed.winfertility.com/wp-content/uploads/2023/03/Boein… · checked Nov 2026
WIN helps the member find a provider“WINFertility’s Nurse Care Managers or professionally-trained Patient Specialists can help you find an excellent reproductive endocrinologist in your area and get discounted treatment packages and financing options.”Source: winfertility.com/blog/weight-loss-infertility-treatment/ · checked Nov 2026
Fertility specialist helps decide options (blog)“Your fertility specialist will help you decide which options are best for you to be healthy and have a family.”Source: winfertility.com/blog/weight-loss-infertility-treatment/ · checked Nov 2026
BMI statement - educational blog, not a coverage rule“If your BMI is 40+, you may be advised to consider weight loss surgery before starting fertility treatment.”Source: winfertility.com/blog/weight-loss-infertility-treatment/ · checked Nov 2026
BMI vs age statement - educational blog“Age and the time needed for weight loss may trump BMI if the window for successful IVF treatment is narrow.”Source: winfertility.com/blog/weight-loss-infertility-treatment/ · checked Nov 2026
Member-facing description of fertility support“WIN provides 1:1 clinical guidance through IVF, IUI, egg and sperm freezing, embryo freezing, genetic testing, and financial coaching, so members can navigate their unique path to parenthood with confidence.”Source: winfertility.com/members/ · checked Nov 2026
What to do if a clinic says your BMI is too high
- Ask the clinic for the policy in writing, including where retrievals are performed.
- Contact your benefit’s member support and ask for other in-network clinics, including hospital-based programs.
- Check which clinics publish their BMI policy and call with the questions checklist.
Frequently asked questions
Does Progyny have a BMI limit?
We did not find a BMI requirement stated on Progyny’s public website when we checked in Nov 2026. What Progyny does publish is quoted on this page. A clinic in its network can still apply its own BMI policy for sedation.
If my benefit covers IVF, can a clinic still turn me away for BMI?
Yes. A benefit pays for covered treatment; the treating clinic and its anesthesia team decide whether they will perform a procedure. If one in-network clinic declines, ask your benefit’s member support which other in-network clinics you can use.
Know a clinic’s published policy?
Send the official page or a dated clinic letter and we will add it with its source. [email protected] · how submissions work