News

Senate Bill 729 (SB 729) is a California law that mandates certain health insurance plans to cover the diagnosis and treatment of infertility, including in vitro fertilization (IVF). It expands access to fertility coverage for fully insured employer groups, particularly in the small and large group lines of business. The bill aims to make fertility care more inclusive by broadening the definition of infertility to include nonmedical reasons, such as those related to same-sex relationships and single parenthood.
 

Implementation Timeline Updates:

• SB 729 effective date: January 1, 2026
• SB 729 coverage will start Jan 1, 2026, at the next plan renewal.

Key Takeaways for Employers & Employees: 

• Large-group fully insured plans (101+ employees): Once effective, must cover infertility treatments up to 3 egg retrievals and unlimited embryo transfers, with parity in cost sharing.
• Small-group fully insured plans (≤100 employees): Must offer such infertility coverage via riders; coverage is optional to include.
• SB 729 does not apply to self-funded or level-funded plans. These arrangements are governed by federal ERISA law only and are not subject to the state-mandated insurance requirements enforced by CDI and DMHC.
• Religious employers and certain groups (like Medi-Cal, CalPERS until 2027) are exempt.

What You Should Do: 

• Check your plan type: Large-group, fully insured: Expect automatic inclusion of infertility benefits at renewal.
• Small-group: Review plan options to include an infertility rider.
• Self-funded: SB 729 likely won’t apply; voluntary coverage remains an option.

Carrier Updates

Aetna	SOBs plan names will include 'wINF', and a new updated ER application is coming January 1, 2026.  Coverage Includes: Comprehensive Infertility Services: IVF, ZIFT, GIFT, cryopreserved embryo transfers, ICSI, ovum microsurgery, ovulation induction, and artificial insemination. Coverage is limited to 3 completed egg retrievals per lifetime and unlimited embryo transfers
Anthem Blue Cross	Anthem will be releasing a new infertility rider in SOBs. Cost: $90/month per subscriber Coverage Includes: Includes IVF, GIFT, ZIFT, artificial insemination, reconstruction surgery (except sterilization reversal), supplies & appliances, and medications given in a doctor’s office.
Blue Shield	Large Group: Any increase in plan premiums will take place in 2026 depending on the group’s population and specific plan designs. Groups that already renewed with a July 1, 2025, to December 31, 2025, effective date with originally mandated fertility benefits will see an adjusted rate. On July 1, 2025 ART riders were updated to comply with the requirements of SB 729, ensuring parity between medical and ART benefit cost shares. Small Group: Customers that chose to offer coverage under SB 729 will see coverage changes take effect upon new enrollment or renewal. Coverage Includes: Natural AI (without ovum stimulation), Stimulated AI (with ovum stimulation), Oocyte retrieval, GIFT, and Cryopreservation of embryos, oocytes, sperm, reproductive tissues.
California Choice	The Department of Managed Health Care has determined that products offered through the CaliforniaChoice Program are not required to include options covering infertility benefits, as employer groups may access such options directly from the health plan.
Covered California	If you offer infertility benefits to your employees, all health insurance plans available to your employees will include infertility benefits. If you choose not to offer infertility coverage to your employees, the health insurance plans available to your employees will not include infertility benefits. Previously, infertility coverage guidelines were based on the number of eligible employees and the selected product (HMO, PPO, etc.)
Health Net	Two SBCs per plan now available (one with infertility, one without). When the IVF/fertility rider is needed for small groups, it is added at a group level to all members/plans. Coverage Includes: Artificial Insemination; Office Visits (professional services); GIFT; Follicle ultrasounds; sperm washing; prescription drugs (oral); Inpatient and outpatient care; IVF, ZIFT, or any process that involves harvesting, transplanting, or manipulating a human ovum; services or supplies (including injections and injectable medication) which prepare the member to receive the service; treatment by injections (only when provided in connection with services that are covered by the plan); medically necessary services and supplies for established fertility preservation treatments in connection with iatrogenic infertility are covered. Iatrogenic infertility is infertility that is caused by a medical intervention, including reactions from prescribed drugs or from medical or surgical procedures for conditions such as cancer or gender dysphoria. There is a lifetime maximum of 3 oocyte retrievals.
Kaiser Permanente	Large Group: Customers renewing between July and December 2025, the benefit will be included as part of the renewal.  As a contract renews and SB 729 coverage is included, this expanded benefit will act as a benefit reset. A covered member will be eligible for SB 729 services, regardless of whether the member has accessed or exhausted any previous supplemental fertility services coverage. Small Group: All existing employers and brokers with INF plans, both ACA-metal and grandfathered, will receive a one-time email notification informing them of the benefit enhancements at time of renewal, beginning mid-June (pending DHMC approval). Coverage Includes: Diagnosis and treatment of infertility and fertility services, including artificial insemination, IVF, and fertility drugs as medically indicated.
Medi Excel	Infertility/Fertility requirements under SB 729, effective 7/1/25, do not apply to MediExcel Health Plan given its licensure under the Knox-Keene Act, Section 1351.2
Sharp Health	The ART C rider will no longer be offered. Plans will now be available with or without Infertility, built into the plan designs, available for all group sizes. New INF SOBs are available on carrier website Coverage Includes: Treatment of diagnosed infertility coverage including but not limited to Assisted Hatching, In Vitro Fertilization (IVF), Gamete Intrafallopian Transfer (GIFT), Intracytoplasmic Sperm Injections (ICSI), and Zygote Intrafallopian Transfer (ZIFT). Up to a maximum of three completed oocyte retrievals (egg retrievals) with unlimited embryo transfers in accordance with the guidelines of the American Society for Reproductive Medicine (ASRM), using single embryo transfer when recommended and medically appropriate.
United Healthcare	Large Group: UnitedHealthcare has designated infertility, including IVF as a Benefit Standard effective January 1, 2026 for large fully insured groups sitused in CA. Small Group: It will be available only if purchased. The extraterritorial coverage requirement is delayed until January 1, 2026. Coverage Includes:  HMO: Covers insemination procedures (artificial insemination (AI) and intrauterine insemination (IUI)); Gamete Intrafallopian Transfer (GIFT); clomid and other approved Injectable medications and syringes. PPO: Covers Ovulation induction; insemination procedures (Artificial Insemination [AI] and Intrauterine Insemination [IUI]); Assisted Reproductive Technologies (ART); outpatient pharmaceutical products for infertility treatment. ART Definition: procedures involving manipulation of reproductive materials (e.g., sperm, eggs, embryos) to achieve pregnancy, including IVF, GIFT, PROST, TET, and ZIFT.

*For Key Implementation Details Click Here

If You Have Any Questions or Would Like More Information, Please Contact Your Dickerson Sales Representative.