August 2025
Diana Craig, Director, Benefits Compliance
Summary
During the 2023/2024 legislative cycle, California Governor Gavin Newsom signed SB 729, which requires large group insured plans (100+ employees) to cover up to three cycles of oocyte (egg) retrievals for in vitro fertilization (“IVF”) purposes. The law originally applied to policies issued, amended, or renewed on or after July 1, 2025, but as of mid-June, the effective date has been delayed to January 1, 2026.
This delay was accomplished through a “trailer” to the 2025/2026 California Budget Bill and done at the request of the Governor. This means that the IVF benefit mandate that was originally included on July 1, 2025, renewals is no longer mandated coverage for those non-calendar year plans. For calendar year plans, the law will continue to apply to January 1, 2026, plan year. For non-calendar year plans it will apply with their 2026 renewal cycle. It does not apply to self-funded plans.
Importantly, the law attempts to regulate any insurance policy issued in any state that covers California residents (extraterritorial application), which can be difficult to enforce. Otherwise, this will largely be about increased costs to insured large group plans and whether insured plans that have partnered with fertility vendors want to continue those relationships. SB 729 also mandates that small employer policies offer employers the option to supplement policies to include the diagnosis and treatment of infertility and fertility services, now effective for policies issued, amended, or renewed on or after January 1, 2026. However, some carriers in the small group market are currently offering this option to employers. Note that other states, including Colorado, New York, and Vermont, have similar coverage mandates.
Governor Newsom, through the Department of Managed Health Care (“DMHC”), has also submitted an application to the Centers for Medicare & Medicaid Services (“CMS”) to expand coverage under California’s benchmark plan beginning in 2027 for essential health benefits (“EHBs”) offered in the individual and small group markets to include fertility treatments. This is in addition to requiring coverage of hearing aids and certain mobility devices.
Employer Action Items
- Understand the consequences. Consult your client experience leader or insurance issuer to understand whether any rate increase already included in July 1 renewals will be addressed. Continue to explore how this mandate could increase the cost of your healthcare offerings for renewals on or after January 1, 2026.
- Stay informed. Follow the latest state legislative changes and related agency guidance concerning coverage of fertility treatments.
- Communicate. Update employee communications so that employees understand changes in healthcare policies and covered services.
- Evaluate vendor support. Review the role of any outsourced fertility point solutions and/or related vendors offering infertility and fertility treatments.
Additional Information and Resources
- Governor Newsom SB-729 Signing Message
- California applies to expand essential health benefits to include IVF, hearing exams | Governor of California
For more information
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