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Introduction
On September 29, 2024, California Governor Gavin Newsom signed Senate Bill (SB) 729 into law, creating a significant shift in reproductive health policy for employers statewide by expanding fertility insurance coverage in California. Effective January 1, 2026, SB 729 mandates that fully insured, large group health plans (those with 101 or more covered employees) must provide coverage for the diagnosis and treatment of infertility, including in vitro fertilization ("IVF"). These changes reflect California's efforts to expand access to fertility care and mirror policies in select other states—which we have previously discussed here.
Background
Previously, California's Knox-Keene Health Care Service Plan Act did not mandate coverage for infertility or IVF. Insurers typically provided optional riders that employers could purchase, and IVF was frequently excluded from these options. Additionally, coverage was limited by the prior definition of infertility—which did not include LGBTQIA+ couples, single parents, and those with non-traditional paths to parenthood (e.g., surrogacy). Self-funded plans remained outside the scope of these requirements, governed only by federal ERISA law.
SB 729, authored by Senator Caroline Menjivar, was intended to fill these coverage gaps and expand access to fertility benefits for California workers. Advocates for SB 729 emphasized the need for inclusivity and for updating the definition of infertility. Opposition to SB 729 focused primarily on the costs and administrative burden placed on large employers and carriers, as well as concern about the complexity and ambiguity of coverage, particularly for nontraditional family structures.
Details of SB 729
Definition of Infertility
Under SB 729, the definition of infertility has been expanded to include persons who are unable to reproduce—either as individuals or with their partners—without medical intervention. The law also extends coverage to same-sex couples, single parents by choice, certain individuals who have been unable to conceive, and those who experience repeated miscarriages. Additionally, a licensed physician's diagnosis based on medical, sexual, or reproductive history establishes eligibility for coverage.
Large Group Plans
For fully insured large group health plans covering 101 or more employees, SB 729 requires coverage for the diagnosis and treatment of infertility. Required benefits include up to three completed oocyte (egg) retrievals and unlimited embryo transfers, as well as fertility medications, diagnostic testing, ultrasounds, blood work, artificial insemination, IVF procedures, and medically indicated fertility preservation.
Cost sharing for infertility services must be applied in the same manner as for other covered medical benefits under the plan. While deductibles, copayments, and coinsurance may apply, they may not be more restrictive or applied differently to infertility care. Similarly, the law does not impose a blanket ban on benefit limits but requires parity—meaning infertility benefits may not be subject to limitations or exclusions that are more restrictive than those applicable to other medical services. All benefits must be provided without discrimination based on gender, marital or relationship status, sexual orientation, or similar characteristics.
Small Group Plans
For small group plans with 100 or fewer employees, SB 729 requires carriers to offer at least one plan option that provides comprehensive infertility benefits, though it does not mandate the inclusion of infertility coverage in every small group plan. If employers elect coverage under such a plan, the same standards for benefits and cost sharing apply as for large group policies.
Exceptions
SB 729 does not apply to self-funded or level-funded plans, which are governed by federal law. The mandate also exempts religious employers, specialized health plans, Medi-Cal, certain state contracts, and CalPERS contracts until July 1, 2027. Importantly, the mandate applies to any fully insured plan that covers California employees, regardless of whether the policy is issued in California or in another state.
Impact for Employers
Employers with fully insured large group plans should take steps to confirm that their insurance carriers are complying with SB 729. Employers may also consider educating their employees about eligibility and benefits. Companies that currently provide separate fertility programs should review their offerings to determine whether there is any overlap due to the new mandate. Although self-funded employers are not required to comply with SB 729, they may want to reassess their benefits plans in response to evolving market norms and employee expectations.
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