On September 29, 2024, California Governor Gavin Newsom signed bill SB 729 into law, which requires fully insured, large group health plans to cover infertility treatment and in-vitro fertilization (IVF) in insurance contracts and policies that are issued, amended, or renewed on or after July 1, 2025. The law will also expand the definition of infertility to be more inclusive of LGBTQ+ individuals looking to start a family.
Effective Date
Currently (and as stated above), SB 729 will apply to insurance contracts and policies issued, amended, or renewed on or after July 1, 2025. However, Governor Newsom signaled his intent to request that the California Legislature change the effective date to January 1, 2026. This additional time would allow the state to update its “benchmark” plan with new coverage for infertility treatment and IVF, which will serve as a model for commercial insurance health coverage.
Mandated IVF Coverage
Under current California law, insurance carriers are required to offer employers the option to add infertility treatment to their plan. The current mandate to offer this coverage does not require carriers to include IVF treatment in the offer.
SB 729 will drastically change carrier requirements by mandating large group health plans (those covering 100+ employees) to provide coverage for the diagnosis and treatment of infertility and fertility services, including IVF, with a maximum of three (3) completed oocyte retrievals and unlimited embryo transfers.
It is important to highlight that the law does not impose this coverage mandate on small group plans. Rather, carriers of small group plans must offer employers the option to add coverage for the diagnosis and treatment of infertility and fertility services, including IVF.
In addition, both large group and small group plans are prohibited from imposing different coverage limitations or cost sharing on infertility diagnosis or treatment, as compared to other treatment unrelated to infertility.
Revised Definition of Infertility
The law also expands the definition of infertility to include a condition or status characterized by any of the following:
- A licensed physician’s findings, based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
- A person’s inability to reproduce either as an individual or with their partner without medical intervention.
- The failure to establish a pregnancy or to carry a pregnancy to live birth after regular, unprotected sexual intercourse (i.e., no more than 12 months of unprotected sexual intercourse for a person under 35 years of age or no more than 6 months of unprotected sexual intercourse for a person 35 years of age or older).
Exceptions
- Generally, SB 729 applies to fully insured plans written out of California (i.e., subject to California insurance law). The mandate would not apply to level funded and self-insured plans, as these plans are not subject to state insurance regulations.
- SB 729 also explicitly states that it does not apply to religious employers, as defined in Section 1367.25 of the California Health and Safety Code.
Impact on Employers
Employers with fully insured large group health plans written out of California should expect policies renewed after July 1, 2025, to incorporate the mandated coverage. It is also expected that this newly mandated coverage will have an effect on healthcare premiums, meaning employers are likely to see an increase in plan cost.
Employers with fully insured small group health plans written out of California will have the option to choose plans with IVF coverage and should determine whether they will want to offer these additional benefits to their employees and/or how the additional benefits will affect their healthcare premiums.
Additional Resources
Connect with a Sequoia consultant to learn how Sequoia’s compliance services are integrated in our benefits services and tailored solutions.
And if you’re already a Sequoia client, stay on top of your employer obligations with your Compliance Checklist that highlights important compliance dates, action items, and resources.
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