Progyny Terms of Service

Item: Progyny
Rating: 35
Author: Terms.Law Editorial Team

Last updated: January 2025 | Reviewed: February 2026

Leading employer-sponsored fertility benefits platform with "Smart Cycles" model. Coverage determination processes and embryo storage terms require careful scrutiny.

Grade D

Bottom Line: Progyny's terms heavily favor the platform in coverage disputes. The "Smart Cycles" bundling model can obscure what treatments are actually covered, and their coverage determination process gives Progyny significant discretion to deny or limit treatments. Embryo storage liability ultimately falls on patients despite platform intermediation.

Category Scores

Coverage Determination 32/100

Embryo Storage Liability 30/100

Treatment Disputes 35/100

Service Termination 42/100

Dispute Resolution 38/100

Key Findings

⚠ Opaque Coverage Determination

Progyny retains broad discretion to determine what treatments qualify under your employer's plan. The "Smart Cycles" model bundles services but the exact scope of coverage can be unclear until you need a specific treatment.

"Coverage determinations are made by Progyny based on medical necessity criteria and your employer's plan design. Progyny's determination is final and binding."

⚠ Embryo Storage Responsibility Shifts to Patient

While Progyny may cover initial storage, long-term embryo storage liability transfers to patients. Storage facility relationships, abandonment provisions, and disposition decisions become patient responsibilities.

"Embryo storage beyond the benefit period is the member's responsibility. Members must maintain direct agreements with storage facilities."

⚠ Limited Appeal Mechanisms

If Progyny denies coverage for a treatment your doctor recommends, appeal options are limited. The process favors Progyny's medical necessity determinations over your treating physician's judgment.

"Appeals of coverage determinations will be reviewed by Progyny's medical team. External review may be available as required by applicable law."

⚠ Employer Plan Changes Risk

Your employer can modify or terminate Progyny benefits mid-treatment cycle. While this is standard for employer benefits, it creates unique vulnerability during multi-cycle fertility treatments.

"Benefits are subject to your employer's plan terms and may be modified or terminated at your employer's discretion."

Comparison: Fertility Platforms

Feature	Progyny	Kindbody	Carrot
Coverage Model	Smart Cycles	Hybrid	Reimbursement
Appeal Process	Limited	Arbitration	Internal Only
Embryo Storage	Limited Period	Varies	Not Covered
Clinic Choice	Network	Preferred Own	Any Clinic
Mid-Cycle Protection	None	None	None

Recommendation

For Patients: Document all coverage representations before starting treatment. Get specific treatment approvals in writing. Understand exactly what happens to embryo storage when your benefit period ends or if you change employers.

Financial Protection: Have backup funding for potential coverage denials mid-cycle. Establish direct relationships with storage facilities early. Review your employer's plan documents, not just Progyny's marketing materials.