SB 729: Infertility Coverage Requirements for Employer-Sponsored Health Plans

Please note: All small group carriers we work with have said they will be compliant with this law but we are waiting for additional details. Click here to view our Small Group Infertility Benefits comparison that shows information about the current infertility riders, we will be updating this document as new information becomes available.

California Senate Bill 729 (SB 729), signed into law by Governor Gavin Newsom on September 29, 2024, represents a significant shift in reproductive health policy. The bill mandates expanded coverage for infertility diagnosis and treatment, including in vitro fertilization (IVF), under certain health insurance policies.

Prior to SB 729, existing law required insurers to offer employers the option to add general infertility treatment to their policies but did not mandate coverage for IVF. SB 729 aims to alleviate the financial burden associated with fertility treatments for many Californians.

SB 729 specifies that large group health plans must “provide” coverage and small groups must “offer” coverage, with some variations in what is to be covered. It also expands the definition of infertility and is more inclusive of people looking to start a family.

Effective Date

The new requirements under SB 729 apply to large and small group health plans issued, amended, or renewed on or after July 1, 2025.

Governor Newsom requested the Legislature delay SB 729 to January 1, 2026, to allow more time to update the state’s benchmark plan. However, it is unclear if the Legislature will grant the delay as the initial July 1, 2025 effective date is quickly approaching.

CalPERS will be subject to the same requirements as large group health plans, however, the CalPERS effective date is July 1, 2027.

Infertility Coverage Updates

Large Groups Must “Provide”

A large group health care service plan must provide coverage for the diagnosis and treatment of infertility and fertility services, including up to three completed oocyte retrievals and unlimited embryo transfers, using single embryo transfer when recommended and medically appropriate.

Small Groups “Must Offer”

A small group health care service plan must offer coverage for infertility diagnosis and treatment of infertility and fertility services. 

Reminder: “must offer” refers to the small group insurance carrier offering plans that meet SB 729 requirements; it does not mean that the employer needs to offer such a plan to their employees.

Benefit Amounts & Limitations

Under the new law, contracts cannot include:

• 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) applies to large group health plans, and includes the limitations of a “maximum of three completed oocyte 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.”

Additionally, SB 729 states, “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.”

Updated Definition of Infertility

SB 729 expands on the definition of infertility to mean a condition 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. For purposes of this section, “regular, unprotected sexual intercourse” means 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. Pregnancy resulting in miscarriage does not restart the 12-month or 6-month time period to qualify as having infertility.

Exceptions

SB 729 does not apply to religious employers. A “religious employer” is an entity for which each of the following is true:

    (A) The inculcation of religious values is the purpose of the entity.

    (B) The entity primarily employs persons who share the religious tenets of the entity.

    (C) The entity serves primarily persons who share the religious tenets of the entity.

    (D) The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.

SB 729 also does not apply to level funded or self-funded plans.

Small Group Carrier Updates

All carriers have stated they will be compliant with the law, however, as of this document’s publishing date, we are still waiting for carriers to provide more details on any changes they are making and impact to their infertility rider rates.

It’s worth noting that carriers are all or nothing when it comes to their infertility riders, meaning if a group wants to offer a plan with the infertility rider, then all plans must have the infertility rider. Carriers will not allow a group to offer some plans with the infertility rider and other plans without the infertility rider.

Disclaimer: The information contained herein is for informational purposes only and is not intended as legal or tax advice.