NEWSROOM

Effective January 1, 2026, under SB 729, California requires health plans to offer product options that cover infertility diagnosis and treatment services.

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 required to provide them.

See the overview below for additional information on the benefits and riders available with our Small Group carriers.

• Standard plans include basic infertility and fertility preservation.
• Plans with “wINF’ in the plan name will include comprehensive infertility benefits, including those based on SB 729.
• Coverage:
  • Cost sharing is based on type of service and where it is received.
  • Comprehensive Infertility Services: IVF, ZIFT, GIFT, cryopreserved embryo transfers, ICSI, ovum microsurgery, ovulation induction, and artificial insemination. Coverage is limited to 3 completed egg retrievals per lifetime and unlimited embryo transfers.
• Cost: Cost will be applied per enrollee per month and varies by plan and age. Rates can be quoted in WBQuote.
• Plan Offering: If infertility is elected, benefits will be added to all medical plans for the entire group at an additional premium.
• Link to PDD and SBCs: https://www.aetna.com/sbcsearch/home

• Diagnosis and treatment of underlying infertility causes are covered in all plans. Additional coverage is available with optional rider.
• Rider Details
  • Coverage:
    • Includes IVF, GIFT, ZIFT, artificial insemination, reconstruction surgery (except sterilization reversal), supplies & appliances, and medications given in a doctor’s office.
    • 50% coinsurance.
    • $2,000 lifetime max for services.
    • Separate $1,500 lifetime max applies to drugs prescribed for infertility treatment.
  • Exclusions: See Evidence of Coverage (EOC).
• Cost: $90/month per subscriber.
• Plan Offering: Rider will be added to all medical plans for the entire group at an additional premium.
• Link to EOCs: https://eoc.anthem.com/eocdps/.
• Additional Information:
  • Anthem Infertility Rider
  • New legislation SB 729

Current as of 10/30/2025

• HMO, PPO, HSA, and HDHP plans are available with or without infertility benefits.
• Coverage:
  • See summary of benefits for full details on HMO, PPO, and PSP benefits
  • Lifetime Maximum:
    • Natural AI (without ovum stimulation): 6/lifetime
    • Stimulated AI (with ovum stimulation): 3/lifetime
    • Oocyte retrieval: 1/lifetime
    • GIFT: 1/lifetime
    • Cryopreservation of embryos, oocytes, sperm, reproductive tissues: 1/lifetime
• 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.
• Cost: Cost will be applied per enrollee per month and varies by plan and age. Rates can be quoted in WBQuote.
• Plan Offering: If infertility is elected, benefits will be added to all medical plans for the entire group at an additional premium.
• Link to EOCs: https://www.blueshieldca.com/memberwebapp/welcome?page=sbp.
• Additional Information:
  • SB 729 FAQs

• 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.
• Additional information on plans with infertility benefits can be found here.
• Link to EOCs: https://www.calchoice.com/Public/Forms.

Current as of 10/1/2025

• Health Net offers an infertility option with all Small Business Group plans. The same plans are available without infertility benefits at a lower cost.
• Coverage:
  • Artificial Insemination; Office Visits (professional services); GIFT; Follicle ultrasounds; sperm washing; prescription drugs (oral); Inpatient and outpatient care; IVF, ZIFT, or any process that involves harvesting, transplanting, or manipulating a human ovum; services or supplies (including injections and injectable medication) which prepare the member to receive the service; treatment by injections (only when provided in connection with services that are covered by the plan); medically necessary services and supplies for established fertility preservation treatments in connection with iatrogenic infertility are covered. Iatrogenic infertility is infertility that is caused by a medical intervention, including reactions from prescribed drugs or from medical or surgical procedures for conditions such as cancer or gender dysphoria.
  • There is a lifetime maximum of 3 oocyte retrievals.
  • Applicable deductibles or copays apply to all required services and supplies.
  • Exclusions: Oocyte retrievals after the lifetime maximum of 3 oocyte retrieval cycles have been met; the collection, storage, or purchase of sperm; pre-implantation genetic diagnosis; purchase of donor eggs, sperm, or embryos; gestational carriers (surrogates).
• Cost: Cost will be applied per enrollee per month and varies by plan and age. Rates can be quoted in WBQuote.
• Plan Offering: If selected, the infertility rider will be applied to all plans within the package.
• EOCs: To request a copy of the EOC, please contact the Customer Contact Center at 1-800-522-0088.
• Additional Information:
  • Health Net Infertility 2026

• All Kaiser Permanente plans will have an INF option plan. The Department of Managed Health Care has not yet confirmed the specifics of the benefit requirements; however, pricing on these plans anticipates the expected benefit requirements.
  •  If fertility is offered, then all plans must have fertility and a plan without infertility cannot be offered. This includes PPO and KP Plus.
  • INF plans may be sliced with another carrier, so long as all plans offered by each carrier have SB 729 benefits included.
  • Adding SB 729 compliant INF benefits to Grandfather plans is an option. This will not affect Grandfather status. Taking them away at a later date may affect status.  Any requests to add the SB 729 benefit need be directed to a Kaiser Permanente Account Manager.
• Coverage:
  • SB 729 includes coverage for the diagnosis and treatment of infertility and fertility services, including artificial insemination, IVF, and fertility drugs as medically indicated.
  • Cost sharing for fertility services will match the plan's cost sharing for non-fertility medical services.
  • Once final guidance from the California regulator on what SB 729 coverage entails, Kaiser Permanente will share more details.
• Cost: Cost will be applied per enrollee per month and varies by plan and age. Rates can be quoted in WBQuote.
• Plan Offering: If fertility is offered, then all plans must have fertility and a plan without infertility cannot be offered.
• Link to EOCs: https://business.kaiserpermanente.org/business/california/small-business/evidence-of-coverage.
• Additional Information:
  • Changes to fertility benefits: California SB 729

• Infertility/Fertility requirements under SB 729 do not apply to MediExcel Health Plan (MEHP) due to its licensure under the Knox-Keene Act Section 1351.2.  The California Department of Managed Health Care confirmed that MEHP does not need to offer services delivered in Mexico.
• Coverage:
  • Coverage available includes diagnosis and treatment for men and women.
  • Exclusions: 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).
• Link to EOCs: https://www.mediexcel.com/members.
• Additional Information:
  • Infertility Benefit Coverage

• Sharp Health Plan will offer standard plans as well as plans that include infertility benefits.
• Coverage:
  • For treatment of diagnosed infertility coverage 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.
  • Cost sharing for services with copayments is the lesser of the copayment amount or allowed amount (the maximum amount on which payment is based for covered health care services).
• Cost: Cost will be applied per enrollee per month and varies by plan and age. Rates can be quoted in WBQuote.
• Plan Offering: If an employer selects INF plan design, it is required that the group elect the INF plan design for all plans.
• Link to EOCs: https://www.sharphealthplan.com/members/your-coverage-documents/member-handbooks.
•  Additional Information:
  • SB729 Health care coverage: treatment for infertility and fertility services

• Standard fertility preservation services apply to all plans as of 7/1/2025.
• Infertility and fertility services will be embedded benefits for Small Group employers with Plus plans as of July 1,2025, regardless of plan effective date. These changes do not apply to Small Group Standard plans.
• Coverage:
  • Consultation and exams with fertility specialist; diagnostic testing and lab work to assess fertility; drug therapy and prescribed medications to support fertility treatment; lifetime limit of up to 3 completed cycles of oocyte (egg) retrieval; unlimited embryo transfers, when medically appropriate; Cryopreservation and storage of sperm, oocytes (eggs), gonadal (ovarian or testicular) tissue, and embryos for up to three years; Artificial insemination and assisted reproductive technology, including IVF, ICSI, ZIFT, GIFT and FET; prenatal and postnatal care and delivery for a Sutter Health Plan member acting as a surrogate.
  • The same cost sharing (copays, coinsurance, deductibles, and out-of-pocket maximums) for the infertility and fertility services and standard fertility preservation services as you do for other covered services.
• Cost: Cost will be applied per enrollee per month and varies by plan and age. Rates can be quoted in WBQuote.
• Plan Offering: Infertility benefits are covered by all Sutter Plus Plans and may be added alongside a Standard Small Group plan.
• Link to EOCs: https://www.sutterhealthplan.org/about-us/products-plans/small-group-plans.
• Additional Information:
  • Sutter Infertility and Fertility Benefits Flyer

• Infertility is not a standard benefit; it must be elected by the group as a rider.
• Rider Details:
  • Coverage:
    • 50% coinsurance
    • HMO: Covers insemination procedures (artificial insemination (AI) and intrauterine insemination (IUI)); Gamete Intrafallopian Transfer (GIFT); clomid and other approved Injectable medications and syringes.
    • PPO: Covers Ovulation induction; insemination procedures (Artificial Insemination [AI] and Intrauterine Insemination [IUI]); Assisted Reproductive Technologies (ART); outpatient pharmaceutical products for infertility treatment. ART Definition: procedures involving manipulation of reproductive materials (e.g., sperm, eggs, embryos) to achieve pregnancy, including IVF, GIFT, PROST, TET, and ZIFT.
  • Lifetime Maximum:
    • HMO: 6 insemination procedures (benefit renews if member conceives); GIFT limited to 3 cycles or 1 live birth.
    • PPO: $2,000 lifetime maximum benefit.
  • Cost:
    • HMO Plans: Adds 3.4% to total premium.
    • Select Plus and Core Plans: Adds 4.9% to total premium.
  • Plan Offering: If offered on HMO, must be offered for all HMO plans. If offered on Select Plus/Core, must be offered for all PPO/Core plans.
• Link to EOCs: https://www.uhceservices.com/en/prelogin.
• Additional Information:
  • UnitedHealthcare to expand infertility coverage for California fully insured plans

• Offered as a plan option for Small Groups.
• Coverage:
  • 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 Western Health Advantage member acting as a surrogate.
• Copayments, deductibles, and out-of-pocket maximums align with medical and prescription drug benefits. An eligible member must be referred by their doctor for these services; prior authorization is required.
• Cost: Cost will be applied per enrollee per month and varies by plan and age. Rates can be quoted in WBQuote.
• Plan Offering: When elected by group, Fertility and Family Building Services will be added to all medical plans elected.
• EOC:  WHA Small Group EOC with Fertility
• Additional Information:
  • Fertility & Family Building Benefits