Last updated: January 28, 2026
Originally published October 4, 2024
Update: On June 30th, Governor Newsom signed AB 116, the health omnibus bill, as part of the 2025-2026 state budget. It includes a provision to delay the implementation of SB 729 to January 1, 2026 (originally to take effect July 1, 2025).
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 (now delayed to January 1, 2026 per AB 116). The law will also expand the definition of infertility to be more inclusive of LGBTQ+ individuals looking to start a family.
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 at least 101 covered 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.
Per SB 729, “coverage for the treatment of infertility and fertility services shall be provided without discrimination on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation.” At this time, it is unclear if coverage for biological donor materials, gestational carriers or surrogacy services, or medical costs for using gestational carriers or surrogates would be required.
The law also prohibits a policy from including:
- Any exclusion, limitation, or other restriction on coverage of fertility medications that are different from those imposed on other prescription medications.
- Any exclusion or denial of coverage of any fertility services based on a covered individual’s participation in fertility services provided by or to a third party. For purposes of this section, “third party” includes an oocyte, sperm, or embryo donor, gestational carrier, or surrogate that enables an intended recipient to become a parent.
- Any deductible, copayment, coinsurance, benefit maximum, waiting period, or any other limitation on coverage for the diagnosis and treatment of infertility, except as provided in subdivision (a)* that are different from those imposed upon benefits for services not related to infertility.
*Subdivision (a) provides, specific to a large group health care service plan, that it shall provide coverage for the diagnosis and treatment of infertility and fertility services, including a maximum of three completed oocyte retrievals with unlimited embryo transfers, using single embryo transfer when recommended and medically appropriate.
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 on or after January 1, 2026, 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.
*Subdivision (a) provides, specific to a large group health care service plan, that it shall provide coverage for the diagnosis and treatment of infertility and fertility services, including a maximum of three completed oocyte retrievals with unlimited embryo transfers, using single embryo transfer when recommended and medically appropriate.
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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