A significant shift is coming to California’s health insurance market: starting July 1, 2025, infertility services—including in vitro fertilization (IVF)—will become a standard feature in fully insured Large Group health plans. Senate Bill 729 (SB 729), signed by Governor Gavin Newsom in 2024, mandates that health plans issued, amended, or renewed on or after this date must cover both the diagnosis and treatment of infertility, including IVF and other related services that were often previously optional.
Additionally, carriers serving the Small Group market must offer at least one plan that mirrors the same level of infertility benefits required for Large Group plans, effective on the same date.
The law applies specifically to fully insured plans regulated by the California Department of Insurance (CDI) or the Department of Managed Health Care (DMHC). It does not apply to self-funded or level-funded plans, which are regulated federally and fall outside California’s jurisdiction.
Requirements for Large Group Plans
For employers with 101 or more employees, SB 729 sets clear expectations: all fully insured health plans must include infertility coverage. This encompasses:
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Diagnosis and treatment of infertility
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Assisted reproductive technologies, including artificial insemination, IVF, gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT)
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Up to three oocyte retrievals per lifetime
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Unlimited embryo transfers
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Coverage for medically necessary prescription drugs and related services
Cost-sharing such as copays and coinsurance will apply just as they do for other medical services under the plan. Notably, the law prohibits lifetime or annual dollar caps on infertility benefits and requires that coverage be provided without discrimination based on gender, marital status, sexual orientation, or similar personal factors.
Impact on Small Group Plans
In the Small Group market, insurers are not required to embed infertility coverage in every plan. Instead, they must make at least one plan available that includes comprehensive infertility benefits consistent with the Large Group requirements. Small Group employers are not obligated to select this plan but must have access to it if they choose.
Any Small Group plan offering infertility benefits must follow the same standards—covering diagnosis, treatment, IVF, and unlimited embryo transfers without benefit caps.
Expanded Definition of Infertility
SB 729 also updates how infertility is defined. Under the law, infertility can be diagnosed:
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Based on a person’s medical, sexual, or reproductive history
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After 12 months of unprotected intercourse (or six months if the individual is over 35)
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In cases where individuals cannot conceive without medical assistance or experience recurrent pregnancy loss
What About Self-Funded and Level-Funded Plans?
Importantly, SB 729 does not apply to self-funded or level-funded employer plans, which are governed solely by federal law under ERISA. Carriers offering level-funded products in California are not required to comply with the new infertility coverage mandates.
However, as infertility coverage becomes standard among fully insured plans, there could be growing pressure on self-funded employers to voluntarily align their benefit offerings with the new expectations in the marketplace.
Additional Exemptions
The law does provide specific exemptions. Plans sponsored by religious organizations, as well as coverage under Medi-Cal, Medicare, and CalPERS, are exempt. However, CalPERS plans will be required to comply beginning July 1, 2027.
Final Thoughts
SB 729 establishes one of the strongest state mandates for infertility coverage in the U.S. For fully insured Large Group employers, offering robust fertility and IVF benefits will no longer be optional after mid-2025. Small Group employers will see new plan offerings and additional considerations during renewal discussions. Meanwhile, self-funded employers should stay attuned to evolving market expectations.
With July 2025 approaching quickly, now is the time for brokers, employers, and HR teams to prepare for how these changes will impact health plan strategies and employee benefits.