California Expands Fertility Coverage Requirement

On September 29, 2024, California Governor Gavin Newsom signed Senate Bill 729 (SB 729) into law, requiring large group health insurance plans to provide coverage for fertility services, including in vitro fertilization (“IVF”). The legislation is expected to impact countless families across the state, including LGBTQ+ individuals and single people. With the passage of SB 729, California becomes the 15th state to mandate insurance coverage for IVF.

Key Provisions of SB 729

IVF Coverage Mandate: Large group health insurance plans in California must now cover fertility treatments, including IVF.

Expanded Definition of Infertility: The law broadens the definition of infertility to include individuals or couples unable to conceive without medical intervention. This inclusive language recognizes the family-planning needs of same-sex couples, single individuals, and others historically excluded from such coverage.

How SB 729 Changes Existing Law

Prior to SB 729, California law required insurers to offer fertility treatment coverage, but employers were not mandated to provide it, and IVF was often excluded. This led to several challenges:

• Employers could opt out of offering fertility coverage.
• Fertility coverage, if offered, might exclude IVF.
• Patients often faced high out-of-pocket costs due to minimal restrictions on co-pays and deductibles.
• The legal definition of infertility excluded same-sex couples and single individuals.

What’s New Under SB 729

• Mandatory Coverage: Large group health plans (employers with 50+ employees) must now cover both the diagnosis and treatment of infertility, including IVF.
• Cost Protections: Insurers cannot impose higher costs, such as co-pays or deductibles, for fertility care than for other medical services.
• Inclusive Definition of Infertility: The new definition recognizes infertility as a health issue affecting anyone seeking to build a family, regardless of sexual orientation or marital status.

Who Is Affected?

SB 729 applies to health plans covering approximately 9 million Californians. However, it does not extend to the state’s Medi-Cal program or health plans provided by religious employers.

Concerns and Benefits

While some opponents worry about potential premium increases, advocates highlight the law’s role in expanding access to safe and effective fertility care, particularly for underserved groups like low-income families, women of color, and LGBTQ+ individuals.

Implementation Timeline

SB 729 is set to take effect on July 1, 2025, for large group health plans. However, Governor Newsom has requested a six-month delay to align the state’s Essential Health Benefits (“EHB”) benchmark plan with SB 729’s requirements. The California Public Employees’ Retirement System (“CalPERS”) Health Program must comply by July 1, 2027.

Looking Ahead

The state’s next legislative session will determine whether the EHB benchmark plan aligns with SB 729. While this could expand IVF coverage to all insured Californians, there are concerns about potential revisions to address budgetary and cost-related issues.

Conclusion

SB 729 represents a significant step forward for fertility care in California, potentially providing millions with access to IVF and related services. While the implementation delay may present hurdles, the coming months will be pivotal in shaping the future of fertility coverage in the state.