California’s New Infertility Mandate: What Employers Need to Know
- Ali Farr McCarty
- Oct 1
- 2 min read
Starting January 1, 2026, California will require many health insurance plans to cover infertility treatment and in vitro fertilization (IVF). This mandate, established by Senate Bill 729 (SB 729), significantly expands access to fertility care for Californians but also raises important questions for employers about compliance, benefits, and costs.
Who Is Subject to this Mandate?
Fully insured large groups (generally 101+ employees) must provide coverage for the diagnosis and treatment of infertility and fertility services within their health plans.
Fully insured small group plans (generally 100 or fewer employees) can offer infertility coverage but are not required to.
Not subject / exceptions:
Self-funded or level-funded plans are not bound by this state mandate.
Medi-Cal managed care is excluded.
Religious employers may request certain exemptions.
Requirements for CalPERS are delayed until July 1, 2027.
What Infertility Benefits Are Required?
Coverage for the diagnosis and treatment of infertility and fertility services including up to three completed egg retrievals with unlimited embryo transfers in line with American Society for Reproductive Medicine guidelines. The law also adopts a more inclusive definition of an individual’s inability to reproduce with or without a partner which will allow coverage for same-sex couples and single individuals.
Parity and access protections
Plans/policies may not:
Impose stricter limits on fertility drugs than on other prescriptions.
Deny coverage because a third party (donor, surrogate, gestational carrier) is involved.
Apply different cost-sharing or benefit maximums to infertility services than to other medical benefits (aside from specific egg-retrieval limits).
How Much Does This Increase Prices?
The cost impact depends on group size, carrier, and claims history. Early actuarial estimates suggest:
Small premium increase: Most carriers project an increase of between 1% – 3% on fully insured premiums, but this may change in the future as carriers have a better understanding of mandate’s impact on utilization of infertility services.
High-cost services: While IVF procedures can run $15,000 – $25,000 each, spreading the cost across the insured pool keeps the rate increase modest.
What CA Large-Group Employers Should Do
Budget for modest increases starting with 2026 renewals. If you used to budget for a 10% increase, perhaps increase that to 12%.
Communicate clearly with employees - this mandate is a major expansion of benefits, especially for those considering fertility treatments.
Review plan documents to ensure compliance and understand how your carrier is implementing the change.
Summary
California’s infertility mandate brings life-changing benefits to many families and new considerations for employers. While costs will rise, the expanded coverage is expected to improve access, employee satisfaction, and equity in reproductive care.
At Farr Johnen & Associates, we help employers navigate changes like this, prepare for renewals, and communicate benefits effectively. Reach out to learn how this new mandate may impact your business in now or in the future.