Carrier Infertility Comparison
A new law in California (SB 729, effective January 01, 2026) requires health plans to offer product options which cover infertility diagnosis and treatment services. Under this law, large group health care service plan contracts must provide infertility benefits. Small group health care service plan contracts must offer these benefits, although small employer groups are not obligated to provide them.
Aetna
SB 729 Fertility and Infertility Coverage
Pending
Coverage
All plans standardly cover state mandated fertility preservation services. Plans may also be purchased with a buy-up option with comprehensive infertility services for an additional premium.
Plans with additional Infertility include: Infertility Treatment - Artificial Insemination or Ovulation Induction: Coverage is limited to 6 courses of treatment for AI and 6 courses of treatment for OI per lifetime.
Advanced Reproductive Technology: Can include GIFT, ZIFT, IVF, ICSI, ovum microsurgery and cryopreserved embryo transfers, see the Certificate of Coverage for full details. Coverage is limited to IVF for fertility preservation. GIFT is limited to 2 cycles per lifetime.
Rider
N/A
Rider Cost
N/A
Rider Lifetime Maximum
N/A
Rider Benefit
N/A
Rider Exclusions
N/A
Anthem Blue Cross
SB 729 Fertility and Infertility Coverage
Anthem Blue Cross’s Infertility Rider currently complies with SB 729 for the Small Group market. Consequently, there will be no changes in how this rider is offered to Small Group clients and members.
Coverage
Diagnosis and treatment of underlying medical cause of Infertility is covered for all plans.
Rider
Infertility Rider available. $2,000 lifetime maximum for services (in- and out-of-network combined) for the following: Medications given in a doctor’s office, Reconstructive Surgery, except for sterilization reversal, artificial insemination, supplies and appliances, IVF, GIFT, ZIFT. Separate $1,500 lifetime maximum for drugs prescribed for treatment of infertility.
Rider Cost
$90 per subscriber per month, regardless of area or age.
Rider Lifetime Maximum
$2,000 for services, and separate $1,500 for infertility drugs, per subscriber.
Rider Benefit
50% coinsurance. Benefits are subject to deductible and accrue to the OOP max.
Rider Exclusions
See EOC
Blue Shield of California
SB 729 Fertility and Infertility Coverage
General
Small Business
Large Group - Fully-Insured
Self-funded Impacts
On September 29, 2024, Governor Newson Signed SB 729 which expands access to fertility coverage for fully insured employer groups in the small group line of business. Blue Shield of California is required to offer coverage (Assisted Reproductive Technology -ART Rider) for the diagnosis and treatment of infertility and fertility services in the Small Business Market, for plans issued, amended, or renewed on or after July 1, 2025. The mandate required that cost shares applied to diagnosis and treatment of infertility services may not differ the cost shares applied to other covered services. For Plans with an effective date on or after July 1, 2025, Blue Shield will offer the required infertility coverage (Assisted Reproductive Technology -ART Rider) for each medical plan in compliance with this mandate.
Coverage
Offer HMO and PPO/HSA/HDHP plans with and without Infertility.
Plans with Infertility include: Six (6 lifetime) natural (without ovum [egg] stimulation) artificial inseminations, three (3 lifetime) stimulated (with ovum [egg] stimulation) artificial inseminations, one (lifetime) GIFT, cryopreservation is limited to one (lifetime) retrieval and one year of storage.
PPO & HSA/HDHP Plans: Services are subject to the Calendar Year Medical Deductible and do count towards the Calendar Year Out-of-Pocket Maximum.
EXCLUDES: Assisted Reproductive Technology and associated services related to ICSI, ZIFT, IVF and more.
Services are not subject to any applicable deductible and do not count towards the Calendar Year Out-of-Pocket Maximum
Rider
Available on all plans. Coverage in-network for:
- Natural/Stimulated AI
- Cryopreservation
- Prescription drugs
Rider Cost
Cost will be applied per enrollee per month, and varies by plan and age (including children).
Rider Lifetime Maximum
Lifetime limit of:
- 6 natural/3 stimulated AI
- 1 GIFT
- 1 Cryopreservation of embryo, oocytes, ovarian tissue, and sperm (1 retrieval & 3 year storage per person/lifetime)
Rider Benefit
The mandate provides that the cost shares or other limitations applied to the coverage of the diagnosis and treatment of infertility must not differ from those applies to benefits for services not related to infertility. See specific plan design benefit summary for details.
Please use the following link to the Summary of Benefit (SOBs):
https://www.blueshieldca.com/en/broker/small-business/medical/summary-of-benefits-2026
Rider Exclusions
ZIFT; IVF; ICSI; surrogacy services; the collection, purchase, or storage of the sperm/eggs/frozen embryos from donors other than the member; and anything not specifically listed as a covered service in the Family Planning and Infertility Services section of the EOC.
CaliforniaChoice
SB 729 Fertility and Infertility Coverage
Pending
Coverage
All groups in the CaliforniaChoice® Program operate under small group health care service plan contracts.The Department of Managed Health Care has determined that products offered through the CaliforniaChoice Program are not required to include options covering infertility benefits, as employer groups may access such options directly from the health plan.
Rider
N/A
Rider Cost
N/A
Rider Lifetime Maximum
N/A
Rider Benefit
N/A
Rider Exclusions
N/A
Health Net
SB 729 Fertility and Infertility Coverage
What is the updated guidance on quoting the IVF/fertility rider option for small group (SG) plans starting July 1, 2025?
No changes. When the rider is needed, it is added at a group level to all members/plans.
2. Will it be quoted as a separate line item or as part of a dual-rate package (standard vs. IVF)? – Included in the rate when the rider is selected.
3. Are there multiple rider options available (e.g., basic vs. enhanced)? – No, just one rider.
Are you providing any materials or summaries for brokers and employers that explain this new rider? If so, please provide.
Yes, everything has been posted on our forms and brochures page.
Portfolio Guide – July 1, 2025 effective date – English (PDF)
Will your coverage include:
ASRM clinical standards, such as single embryo transfer? –
What’s covered: In vitro fertilization (IVF), zygote intrafallopian transfer (ZIFT), or any process that involves harvesting, transplanting or manipulating a human ovum.
Provisions for same-sex couples or third-party reproduction (donors, surrogates)? – No
Large group has different requirements, and the benefits are embedded vs. offered as an optional rider.
Coverage
HMO:Plans are offered with or without Infertility benefits
Plans with Infertility include: $8,500 Lifetime benefit maximum for medical benefits, $1,500 lifetime benefit maximum for Rx benefits. Includes artificial insemination and GIFT.
Infertility benefits DO NOT apply to out-of-pocket maximum for HMO plans.
PPO & HSA:
Plans are offered with or without Infertility benefits
Plans with Infertility include: $2,000 Lifetime benefit maximum for medical benefits, separate $2,000 Lifetime benefit maximum for Rx benefits. Includes artificial insemination and GIFT.
Infertility benefits do not apply to the calendar year out-ofpocket
Rider
Available on all plans. Coverage in-network for:
- Artificial Insemination
- Gamete intrafallopian transfer (GIFT)
- Follicle ultrasounds
- Sperm washing
- Prescription drugs (oral)
- Office visits (Professional services)
- Inpatient and outpatient care
- Treatment by injections
- Medically necessary services and supplies for established fertility preservation treatments in connection with iatrogenic infertility
Rider Cost
Rates will vary by rating region and age. If the employer chooses the infertility benefit, all plans offered will have the infertility benefit and the additional premium will be applied to each person on the policy.
Rider Lifetime Maximum
HMO Plans
$8,500 for medical, $1,500 for prescription benefits.
PPO Plans
$2,000 for medical, $2,000 for prescription benefits.
Rider Benefit
50% coinsurance. Benefits do not apply to the OOP Max (except on PPO HDHP plans)
Rider Exclusions
- Conception by medical procedures (IVF and ZIFT), or any process that involves harvesting, transplanting or manipulating a human ovum, other than GIFT; services or supplies (including injections and injectable medications) which prepare the member to receive these services
- The collection, storage or purchase of sperm
- Gamete or embryo storage
- Use of frozen gametes or embryos to achieve future conception
- Pre-implantation genetic diagnosis
- Donor eggs, sperm or embryos
- Gestational carriers (surrogates)
Kaiser Permanente
SB 729 Fertility and Infertility Coverage
Kaiser Permanente is awaiting final regulatory approval from the DMHC for benefit offerings and implementation timing. There is a possibility that implementation may be delayed from July 1, 2025, to January 1, 2026. Kaiser will release an update if any changes are required from the DMHC.
Large Group Update:
Access to fertility care will be expanded because of the new California Senate Bill 729. With a current effective date of July 1, 2025, as contracts renew, Kaiser Permanente will provide coverage for the diagnosis and treatment of infertility/fertility treatments.
Coverage details are currently being reviewed by the Department of Managed Health Care (DMHC). Once the DMHC approves Kaiser Permanente’s implementation approach, plan documents such as EOCs will be updated accordingly for all fully insured large employer groups that offer fertility service in accordance with SB 729.
Kaiser Permanente will continue to provide additional information as it becomes available. In the meantime, you can review the coverage details below (pending DMHC approval).
SB 729 offers coverage for the following fertility treatments and procedures, including:
- Diagnosis and treatment of infertility
- Artificial insemination (IUI)
- In Vitro Fertilization (IVF)
*If the lifetime maximum for egg retrievals is reached, Kaiser Permanente will not cover any future services related to egg retrievals including prescription drugs.
Cost share and accumulations for fertility services will match the plan’s cost sharing that applies to non-fertility medical services (e.g., plan’s cost share for the same type of service, lab, imaging, etc.). Fertility drugs will be covered, equal to plan’s generic/brand /specialty cost share.
For large group customers renewing between July and December 2025, the benefit will be included as part of the renewal. As a contract renews and SB 729 coverage is included, this expanded benefit will act as a benefit reset. A covered member will be eligible for SB 729 services, regardless of whether the member has accessed or exhausted any previous supplemental fertility services coverage.
Small Group Update:
All existing employers and brokers with INF plans, both ACA-metal and grandfathered, will receive a one-time email notification informing them of the benefit enhancements at time of renewal, beginning mid-June (pending DHMC approval).
How will a member be informed of SB 729 fertility coverage?
Kaiser Permanente will provide information about fertility benefit coverage and how to access care to employees who are members. Kaiser Permanente members can always reach out to the Member Services at Support Center or call 1-800-464-4000, 711 TTY available 24/7 for most services and more than 150 languages using interpreter services.
Kaiser Permanente’s Member Services representatives will be able to respond to any member questions about SB 729. If a member has any questions or wants more information about these changes, they can contact member services at kp.org/supportcenter or call 1-800-464-4000, 711 TTY available 24/7 for most services, offering more than 150 languages using interpreter services.
Where can a Kaiser Permanente member receive fertility services?
In Northern California, Kaiser Permanente provides comprehensive fertility care at our Kaiser Permanente’s Centers for Reproductive Health (CRH) - https://www.kpivf.com/ California Fertility Clinic (Bay Area) | Kaiser Permanente Centers for Reproductive Health.
In Southern California, the Southern California Permanente Medical Group (SCPMG) REI physicians provide IVF care in a variety of high-quality, conveniently located non-KP IVF centers within the Southern California region. All covered patients are seen at a Kaiser facility by an SCPMG REI physician who coordinates their care. Intrauterine Insemination (IUI) procedures are performed at a Kaiser facility and In-vitro Fertilization (IVF) services are performed by KP physicians at contracted facilities.
Where can members find more information about fertility care and local services at Kaiser Permanente fertility?
Members can ask their ob-gyn and visit the following pages to obtain clinic specific information along with fertility services:
Northern California
Southern California
Coverage
HMO:Infertility benefits can be added for an additional cost for 20+ groups AND Kaiser is the sole carrier.
Covered services include: services for diagnosis and treatment of infertility, artificial insemination and GIFT (limited to one treatment per lifetime).
EXCLUDES: All other services related to conception by artificial means and services to reverse voluntary, surgically induced infertility.
Covered at 50% coinsurance with no annual maximum. Benefits are not subject to deductible and do not accrue to the out-ofpocket maximum, except for HDHPs.
PPO:
$1,000 per year maximum for treatment of infertility, including GIFT.
EXCLUDES: IVF.
HSA:
Same benefits as HMO, except benefits are subject to any Medical deductible and accrue to out-of-pocket maximum.
Rider
Cost is built into the plan and varies by age and plan design.
Must be quoted by Kaiser.
Rider Cost
Rates will vary by rating region and age. If the employer chooses the infertility benefit, all plans offered will have the infertility benefit and the additional premium will be applied to each person on the policy.
Rider Lifetime Maximum
GIFT procedures up to 1 treatment cycle per lifetime
Rider Benefit
50% coinsurance. Benefits aren’t subject to deductible and do not accrue to the OOP max (exception for HDHPs)
Rider Exclusions
- Services to reverse voluntary, surgically induced infertility
- All other services related to conception by artificial means (except for GIFT), such as:
- In vitro fertilization (IVF)\
- Zygote intrafallopian transfer (ZIFT)
- Ovum transplants
- Procurement and storage of semen and eggs
MediExcel
SB 729 Fertility and Infertility Coverage
SB 729 coverage requirements do not apply to MediExcel Health Plan due to its licensure under the Knox Keene Act, Section 1351.2.MediExcel Health Plan has confirmed with the California Department of Managed Health Care that SB 729 does not apply to services delivered in Mexico.
Coverage
The following criteria outline the services covered under MediExcel Health Plan:- Diagnosis and treatment for infertility in both men and women include:
- Full Medical History (Medical Consultation).
- General Medical Exams.
- Diagnosis and treatment for infertility in females includes:
- Pelvic Examination (through an OBGYN).
- Laboratory investigation for hormonal disturbances through blood test (e.g., Follicular Stimulating Hormone, Luteinizing Hormone, Prolactin).
- Cultures for infectious agents.
- X-ray procedures used to see whether the fallopian tubes are patent (open) and if the inside of the uterus (uterine cavity) is normal through a hysterosalpingogram.
- Gamete Intrafallopian Transfer (GIFT) is considered as a treatment in cases where In-Vitro Fertilization and other Assisted Reproductive Technologies have failed.
- Diagnosis and Treatment for infertility in males include:
- Semen analysis 2 to 3 times following 5 days of abstinence.
- Laboratory investigation for hormonal disturbances through blood test (e.g., Follicular Stimulating Hormone, Luteinizing Hormone, Prolactin, and Serum Testosterone).
- Testicular biopsy when member has demonstrated azoospermia, with previous spermatoscopy.
- Scrotal ultrasound, when appropriated for azoospermia.
MediExcel Health Plan does NOT cover the following infertility services:
- Medication for treatment of sexual dysfunction, including erectile dysfunction, impotence, anorgasmia or hyporgasmy.
- Reversal of previous elective vasectomy or tubal ligation.
- Further Infertility treatment when either both partners refuse to participate or lack full participation in treatment.
- Treatment for female sterility in which donor ovum would be necessary (e.g., post-menopausal syndrome).
- Microdissection of the zona or sperm microinjection.
- Experimental and/or investigational diagnostic studies or procedures.
- Frozen embryo transfer.
- Freezing or storing of sperm, ovum, and/or pre-embryos.
- Ovum, ovum donor or ovum bank charges.
- Sperm, sperm donor or sperm bank charges.
- Inoculation of female with male’s partner’s white cells (experimental).
- Infertility services for post-menopausal women.
- Infertility from a previous elective vasectomy or tubal ligation.
- In-Vitro Fertilization due to its poor rates of success.
- Zygote Intrafallopian Transfer (ZYFT).
- Infertility services for non-members (e.g., surrogate mothers who are not MediExcel members).
- Infertility treatment with Immunoglobulin (IVIG).
- Infertility/Fertility requirements under SB 729, effective July 1, 2025, as they do not apply to MediExcel Health Plan given its licensure under the Knox-Keene Act Section 1351.2. Furthermore, the California Department of Managed Health Care confirmed that SB 729 does not extend to services delivered in Mexico.
NOTE: Although GIFT is a covered benefit, In-Vitro Fertilization is not covered. In order for GIFT to be considered as a covered treatment, the member must first have gone through an In-Vitro Fertilization procedure. As part of the authorization request, the following need to be provided:
- Medical documentation and findings from a qualified practitioner documenting that adequate attempt of In-Vitro Fertilization treatments were not successful in last 6 months.
- Member is a viable candidate for GIFT (unexplained infertility, at least one healthy fallopian tube).
- No other infertility treatments can be used.
Sharp Health Plan
SB 729 Fertility and Infertility Coverage
Sharp will offer standard plans as well as plans that include infertility benefits. SHP will no longer offer infertility rider options. For those plans that include infertility benefits, the coverage will be as follows:
Treatment of diagnosed Infertility. Including but not limited to Assisted Hatching, In Vitro Fertilization (IVF), Gamete Intrafallopian Transfer (GIFT), Intracytoplasmic Sperm Injections (ICSI), and Zygote Intrafallopian Transfer (ZIFT). Up to a maximum of three completed oocyte retrievals (egg 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.
SIMNSA
SB 729 Fertility and Infertility Coverage
Implementation is pending DMHC’s final approval of the EOC language.
The Plan confirms that for large group health care service plan contracts issued, amended, or renewed on or after January 2026, coverage will include the diagnosis and treatment of infertility and fertility services. This will include up to three completed oocyte retrievals and unlimited embryo transfers, following ASRM guidelines, with single embryo transfer used when recommended and medically appropriate.
Additionally, infertility will be defined as a condition or status characterized by any of the following:
A licensed physician’s findings, based on the patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors. NOTE: This definition shall not prevent testing and diagnosis of infertility before the 12-month or 6-month period to establish infertility.
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. “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.
Sutter Health Plan
SB 729 Fertility and Infertility Coverage
Sutter Health Plan has implemented coverage for large group plans and small group Plus plans in accordance with the requirements of SB 729 and the guidelines of the American Society for Reproductive Medicine (ASRM). Effective July 1, 2025, California Senate Bill (SB) 729 expands coverage requirements for the diagnosis and treatment of infertility and fertility services.
- Large group health plans must include coverage for the diagnosis and treatment of infertility, and fertility services.
- Small group health plans must offer coverage for the diagnosis and treatment of infertility, and fertility services.
These changes do not apply to small group Standard plans or individual and family plans (IFPs).
This coverage will include a maximum of three completed oocyte retrievals and unlimited embryo transfers.
Coverage
Covered services include, but are not limited to:- Consultations, exams, diagnostic tests, procedures and drug therapy to diagnose and treat infertility.
- A maximum of three completed oocyte retrievals.
- Unlimited embryo transfers, using single embryo transfer when recommended and medically appropriate.
- Cryopreservation and storage of sperm, oocytes, gonadal tissue and embryos for a period of three years.
- The new infertility benefit covers infertility treatment as medically necessary. There is no limit on the number of IVF cycles. There are only limits on the oocyte retrievals and cryopreservation/storage as listed above.
Limitations and Exclusions:
- Services for any individual who is not a covered Member, including any costs associated with the retrieval, cryopreservation, and storage of genetic material from anyone other than a covered Member.
- Services and supplies to reverse voluntary infertility including, but not limited to, reversals of vasectomy, tubal ligation or other surgically induced infertility, or to treat infertility following reversal procedures.
- Experimental and investigational diagnostic studies, procedures and drugs used to determine the cause of infertility or to treat infertility.
Click here for more information from Sutter Health Plan.
Total Benefit Solutions
TBS is filed as a large group in Deleware. Therefore, the California small group requirements would not apply.
UnitedHealthcare
SB 729 Fertility and Infertility Coverage
Note: UHC small business product team is in the process of updating the optional benefit language for SB729.
Coverage
HMO , PPO & HSA:Infertility is not a standard benefit. Groups need to elect infertility coverage. Pending complete details.
State Navigate Plans:
Infertility coverage limited to $2,000 per covered person per lifetime at the plan’s coinsurance.
Rider
Available on all HMO and PPO plans. This applies to all California UnitedHealthcare Small Business groups (1–100 employees).
HMO:
- Insemination procedures (artificial insemination (AI) and intrauterine insemination (IUI))
- Gamete Intrafallopian Transfer (GIFT)
- Clomid and other approved Injectable medications and syringes
The attached 2026 GAF form lists the Infertility Rider options on PDF page 4 of 4 (the broker may sign if the group chooses to add this benefit).
PPO:
Covered Services (when provided by or under the direction of a physician):- Ovulation induction
- Insemination procedures (Artificial Insemination [AI] and Intrauterine Insemination [IUI])
- Assisted Reproductive Technologies (ART)
- Outpatient pharmaceutical products for infertility treatment
- In vitro fertilization (IVF)
- Gamete intrafallopian transfer (GIFT)
- Pronuclear stage tubal transfer (PROST)
- Tubal embryo transfer (TET)
- Zygote intrafallopian transfer (ZIFT)
Infertility must be due to a recognized medical condition or the inability to conceive or carry a pregnancy to live birth after one year of unprotected intercourse.
Infertility related to voluntary sterilization or failed reversal is not covered.
Rider Cost
The infertility rider for the HMO plan adds 3.4% to the total premium for the HMO population.
Click here for: HMO Infertility Rider
Adding the infertility rider to the PPO plan will increase the total group premium by 4.9%, in addition to any renewal rate changes. The rider includes a $2,000 lifetime maximum benefit.
Rider Lifetime Maximum
HMO
- Insemination Procedures limited to 6 procedures per lifetime (benefit renews if member conceives)
- GIFT limited to 3 cycles or 1 live birth per lifetime
Rider Benefit
50% coinsurance
Rider Exclusions
- Services after a previous elective vasectomy or tubal ligation or sterilization (including reversal)
- IVF, ZIFT and procedures performed in conjunction with advanced infertility procedures
- Intravenous Gamma Globulin (IVIG)
- Treatment of sterility in which a donor ovum would be necessary (e.g., post-menopausal syndrome)
- Any costs associated with the collection, preparation, storage of or donor fees for the use of donor sperm that may be used during a course of artificial insemination
Refer to EOC for additional exclusions.
Western Health Advantage
SB 729 Fertility and Infertility Coverage
Beginning July 1, 2025, fertility and family-building benefits will be included in all large group plans and offered as a plan option for small groups. Current group contracts will continue with current Infertility (INF) and Family & Diversity Support (FAMDIV) riders until their renewal on or after July 1, 2025.Who is Eligible?
Eligibility is based on definitions set forth by California law. A member may qualify for fertility treatment coverage based on:
- A physician’s findings from medical history, diagnostic testing, and evaluation.
- Inability to conceive or carry a pregnancy without medical assistance.
- Failure to conceive after 12 months (or 6 months if age 35+) of unprotected intercourse. Miscarriage does not reset this time.
What’s Covered?
Medically appropriate, authorized care and medications, such as:
- Fertility-related consultations with a WHA provider
- Basic lab work and imaging tests
- Genetic testing for prenatal diagnosis of a rare/serious condition
- Prescribed oral or self-injectable medications (as per WHA’s Preferred Drug List)
- Office-administered medications (hormonal therapies, ovarian simulation)
- Oocyte retrieval, sperm collection and storage
- Artificial Insemination (IVI, ICI, IUI)
- Assisted Reproductive Technology (IVF, ICSI, ZIFT, GIFT, FET)
- Pre- and post-natal care and delivery for WHA member acting as a surrogate
Cost Sharing:
Copayments, deductibles, and out-of-pocket maximums align with medical and prescription drug benefits. Refer to the Copayment Summary and Evidence of Coverage & Disclosure Form (EOC/DF) for cost, details, exclusions, and limitations. An eligible member must be referred by their doctor for these services; prior authorization is required.