Postponement
On June 30th, Governor Newsom signed AB 116, the state budget bill for 2025-2026. The bill includes a provision to delay the implementation of the California infertility mandate until January 1, 2026.
The mandate was initially slated to become effective July 1, 2025. While the postponement was generally expected given the many implementation challenges, it came in just under the wire on June 30th.
Background
California SB 729 was signed into law by Governor Newsom in 2024. The law mandates fully insured, large group health insurance plans (100+ employees) to provide coverage for the diagnosis and treatment of infertility and fertility services, including in vitro fertilization (IVF). Required coverage includes:
- Infertility diagnosis and treatment, including IVF
- Up to 3 completed egg retrievals
- Unlimited embryo transfers, based on clinical guidelines
The law also aims to make fertility treatment more accessible, particularly for those who face financial barriers, are part of the LGBTQ+ community, or are single parents and others who were traditionally excluded under prior infertility coverage definitions. As an example, the law removes the requirement that patients must attempt natural conception for 12 months prior to becoming eligible for fertility treatments, benefiting same-sex couples and others who face unique challenges in family-building.
Excluded Employers
Small Group Policies. The bill does not mandate small group policies to provide infertility coverage. However, it does require small group contracts to offer infertility coverage. This means that carriers must offer infertility coverage as an option on small group health insurance policies. Employers must be able to elect coverage for infertility services but are not required to provide it under their policies.
Self-Insured Employers. As with all self-funded plans, ERISA preempts state laws that relate to employee benefit plans. Therefore, self-funded plans are excluded from this mandate.
Religious Employers. The bill exempts religious employers from these requirements.
Discrimination Prohibited
The law is very clear that discrimination of any sort is prohibited. Specifically, coverage for the treatment of infertility and fertility services must be provided without discrimination based on:
- Age
- Ancestry
- Color
- Disability
- Domestic partner status
- Gender
- Gender expression
- Gender identity
- Genetic information
- Marital status
- National origin
- Race
- Religion
- Sex
- Sexual orientation
Effective Date
Initial Effective Date. Contracts issued, amended, or renewed on or after July 1, 2025, must comply with the new mandate.
Revised Effective Date. Contracts issued, amended, or renewal on or after January 1, 2026.
What the Future Holds
Carriers have recently released cost impact projections that range from 1%-2% of premiums. As such, employers can expect plans subject to the law to see an additional premium increase to reflect this coverage expansion.
Note that some carriers of fully insured large group policies are choosing to implement the required coverage changes as of July 1, 2025, ahead of the delayed effective date. To confirm how your specific policies are handled, please reach out to your Vita Account Management team.
References
