Does California require IVF coverage?

Coverage Details

California's regime splits by market. For large-group plans, Health & Safety Code § 1374.55 as amended by SB 729 (Ch. 930/2024) is a mandate-to-cover: fully insured large-group plans issued or renewed on or after January 1, 2026 must cover infertility diagnosis and treatment, including IVF, with up to three completed oocyte retrievals and unlimited embryo transfers (AB 116 delayed the original July 1, 2025 date to January 1, 2026). Small-group coverage is offer-only under § 1374.55(a)(2). Standard fertility preservation for iatrogenic infertility is a covered basic health care service. CalPERS state-employee plans follow on July 1, 2027, religious-employer and plan-type exceptions may apply, and ERISA self-funded employer plans generally are not controlled by the state mandate.

Coverage Summary

How to Verify Your Coverage

1. Ask your employer or plan administrator whether the plan is fully insured or self-funded.
2. Request the plan document for infertility diagnosis, treatment, fertility preservation, medication, and laboratory benefits.
3. Confirm prior authorization, network, age, diagnosis, cycle, and lifetime-limit requirements with the insurer.
4. Ask the clinic billing team to verify both the clinic and laboratory providers for the services you expect to use.

Pending or Future Changes

Clinics publishing insurance or employer-benefit information

These California clinic profiles name at least one insurer or employer fertility-benefit program in a reviewed source. Inclusion does not guarantee that your plan, treatment, physician, or laboratory is covered.