Oct 22, 2024
California To Require Insurers to Cover IVF
Updated October 22, 2024
Sacramento, California – Governor Gavin Newsom announced on September 29th that he has signed SB 729 by Senator Caroline Menjivar (D-Van Nuys) which requires large group health care service plan contracts and disability insurance policies to provide coverage for the diagnosis and treatment of infertility and fertility service, including in vitro fertilization (IVF). SB 729 Signing Message
Senate Bill 729 will require that large group health plans (employers that cover at least 100 people) provide coverage for the diagnosis and treatment of infertility. This includes a maximum of three egg retrievals and unlimited embryo transfers.
SB 729 will apply to insurance contracts and policies issued, amended, or renewed on or after July 1, 2025. This applies to fully insured plans written out of California. The mandate does not apply to level funded or self-funded plans.
It is important to highlight that the law does not mandate or require small group plans to provide this coverage. Rather, carriers of small group plans are required to offer employers the option to add coverage for the diagnosis and treatment of infertility and fertility services, including IVF. The small group rules are clear and provides no requirement the policy actually include coverage for such services.
Employers with fully insured small group health plans written out of California must have the option to choose plans with IVF coverage and will need to determine whether they will want to offer these additional benefits to their employees and/or how the additional benefits will affect their healthcare premiums.
In addition, all group plans (large and small) are prohibited from imposing different coverage limitations or cost sharing on infertility diagnosis or treatment, as compared to other treatment unrelated to infertility.
A few things to know!
- The legislation applies to large group plans, which cover around 9 million people in California, according to CalMatters. The legislation does not apply to Medicaid beneficiaries or people who receive coverage from religious employers.
- The law will go into effect July 2025 for private-sector employees, and in 2027 for California state employees.
- The law passed after four similar bills failed in the California legislature over the past five years, according to CalMatters. At least 15 states require some insurers to cover IVF, according to Resolve, the National Infertility Association.
- The move comes as some employers and payers expand access to IVF. In 2025, the Federal Employee Health Benefit Plan, the largest employer-based insurance program in the country, will require plans to pay for drug costs associated with up to three cycles of IVF per year, according to GovExec.
- In August, former president Donald Trump proposed requiring the government and private insurers to cover all costs associated with IVF. "Under the Trump administration, your government will pay for, or your insurance company will be mandated to pay for, all costs associated with IVF treatment," Mr. Trump said at a campaign rally. He did not specify how the policy would be paid for. Source - Becker's Hospital Review
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