Large Group Health Plan IVF & Fertility Services Mandate Delayed Until 2026

Legal Update

Brought to you by: Hammett Health, Inc.

Large Group Health Plans Must Cover IVF & Fertility Services Starting July 1, 2025

In 2024, Gov. Gavin Newsom signed Senate Bill (SB) 729, which requires large group health care service plans to cover infertility and fertility services, including in vitro fertilization (IVF), beginning July 1, 2025. However, Assembly Bill 116, signed on June 30, 2025, delays the effective date of this mandate. As a result, large group health care service plans issued, amended, or renewed on or after Jan. 1, 2026, will be required to comply with the coverage mandate.

Highlights

The new fertility services mandate:

Revises the definition of infertility and removes the exclusion of IVF from coverage;
Requires coverage for a maximum of three completed oocyte retrievals;
Eliminates a requirement that a health plan provide infertility treatment under agreed-upon terms that are communicated to all group contract holders and policyholders; and
Prohibits a health plan from placing different conditions or coverage limitations on fertility medications or services than those that would apply to other conditions.

Definition of Infertility

For purposes of the coverage mandate, “infertility” means a condition or status 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 (no more than 12 months of unprotected sexual intercourse for a person under 35 years of age or no more than six months for a person 35 years of age or older). Miscarriage does not restart this timeframe and testing or diagnosis may occur earlier.

Provided to you by Hammett Health, Inc.

Covered Health Care Plans

Large group health care service plans are generally those that cover over 100 people.
While small group plans will not be required to cover such services, they will be required to offer such coverage beginning Jan. 1, 2026.
The coverage mandate does not apply to plans sponsored by religious employers, or to Medi-Cal managed health care service plans.

Large group health plans issued, amended, or renewed on or after Jan. 1, 2026, must cover infertility and fertility services.

This Legal Update is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. ©2025 Zywave, Inc. All rights reserved.