Carrier Infertility Overview
The Department of Managed Health Care (DMHC) has updated the All Plan Letter (APL) 25-021 to clarify the requirements of Senate Bill 729 (2024). The law requires large group health plans to cover infertility diagnosis and treatment services and requires small group health plans to offer this coverage to employers. Click here to view the letter.
In the Small Group market, SB 729 does not require every plan to include infertility by default. Instead, it requires carriers to offer at least one plan that includes comprehensive infertility coverage – meaning the benefit must be available in the market, even though employers are not required to select or offer that plan to their employees.
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. Coverage is limited to the diagnosis and treatment of an underlying medical condition. Please refer to the PDDs found in the SBC search tool for an outline of each plan.
- For Small Group plans, expanded infertility benefits are included in all plans ending with “wINF,” in accordance with SB 729.
- For Large Group plans, the benefits are included in all plan offerings.
- 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
Coverage:
Covered infertility diagnosis and treatment including:
- In vitro fertilization (IVF), including up to three completed oocyte (egg) retrievals and unlimited embryo retrievals.
- Gamete intrafallopian transfer (GIFT).
- Zygote intrafallopian transfer (ZIFT)
- Artificial insemination.
- Reconstructive surgery, except for sterilization reversal.
- Supplies and appliances required for infertility and assisted reproductive technology services.
- Fertility medications, including oral, injectable, and office-administered medications.
- Diagnosis and treatment of infertility, including evaluation, testing, and related medical services.
- Physician services, including consultation and referral.
- Physical examination.
- Genetic evaluation, testing, and screening.
- Screening and diagnostic laboratory and imaging services.
- Semen analysis and sperm DNA fragmentation analysis.
- Tubal and uterine evaluation.
- Hormone, ovulation, thyroid function, and ovarian reserve testing.
- Diagnostic surgery and biopsy.
- Infectious disease screening and testing.
- Any other services to diagnose infertility consistent with established medical practices and the ASRM guidelines.
Coverage:
Donors, donor material, and surrogate services (Surrogate and donor medical care are not covered unless the surrogate or donor is a member).
Medically necessary infertility and fertility services are covered to enable parenthood using donor gametes, donor embryos, or surrogate services, including:
- Procurement and retrieval of donor sperm, oocytes, and embryos.
- Laboratory and imaging services.
- Genetic testing and screening.
- Infectious disease screening and testing.
- Medications to induce ovulation.
- Gamete and embryo transfer.
- Any other medically necessary services consistent with Section II above.
Cryopreservation of sperm, oocytes, embryos, and gonadal tissue is covered for three years (aligned with ASRM).
Storage of cryopreserved genetic material for up to five years from the date of initial cryopreservation.
- Cost: $90 a month per subscriber
- ex. $90 per monthly premium x 5 employees = $450/month
- Plan Offering: Large group plans are required to cover infertility diagnosis, treatment, and fertility services, while small group plans must offer infertility and fertility coverage.
- For small groups, this coverage is optional as our infertility rider (applies to all areas and ages).
- Link to EOCs: https://eoc.anthem.com/eocdps/.
- Additional Information:
Fully insured Blue Shield of California (BSC) 2026 group products with infertility coverage were reviewed and approved by the Department of Managed Health Care (DMHC) in 2025, consistent with the requirements of SB 729. Benefit updates that have already been approved by the DMHC have been implemented.
BSC recognizes that the DMHC has issued guidance interpreting SB 729 in a revised All Plan Letter (APL) 25-021, and has since updated that guidance, most recently in the revised version of the APL issued on October 5, 2026. The revised guidance includes further clarification regarding implementation of SB 729 and specifies that the revisions apply to plans issued or renewed on or after July 1, 2027.
BSC clinical, regulatory, and operational teams are actively assessing the revised requirements and potential impacts. Any benefit changes that may be required must be approved by the DMHC. If further changes are approved, plan documents, including Evidence of Coverage (EOCs) and Summary of Benefits (SOBs), will be updated accordingly.
BSC will continue to monitor regulatory developments and provide updates as additional information becomes available.
Please review the SB 729 FAQs for further details and contact your Account Management team with any questions.
Current as of 10/23/2026
- 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.
- 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:
- All Kaiser Permanente plans will have an INF option plan.
- 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:
- SB 729: The infertility and fertility treatment requirements under California SB 729 do not apply to MediExcel Health Plan due to our licensure under Health & Safety Code Section 1351.2.
- Coverage: MediExcel Health Plan provides coverage for medically necessary diagnosis and treatment of infertility for both men and women, including the evaluation and treatment of underlying medical conditions that may cause infertility, subject to prior authorization, the member's Evidence of Coverage (EOC), and applicable medical necessity criteria.
- Exclusions: The following services are not covered:
- Medication for the treatment of sexual dysfunction, including erectile dysfunction, impotence, anorgasmia, or hypoorgasmia.
- Reversal of a previous elective vasectomy or tubal ligation.
- Further infertility treatment when either partner refuses or fails to participate in medically appropriate treatment.
- Treatment requiring donor ova (eggs), including treatment for post-menopausal infertility.
- Microdissection of the zona or sperm microinjection.
- Experimental and/or investigational diagnostic studies or procedures.
- Frozen embryo transfers.
- Freezing or storing of sperm, ovum, and/or pre-embryos.
- Ovum, ovum donor, ovum bank, sperm donor, or sperm bank charges.
- Immunization of a female with her male partner's white blood cells (experimental).
- Infertility services for post-menopausal women.
- Infertility resulting from a previous elective vasectomy or tubal ligation.
- In-Vitro Fertilization (IVF).
- Zygote Intrafallopian Transfer (ZIFT).
- 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
- 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 group selects an INF plan design (i.e., a plan including coverage for the diagnosis and treatment of infertility and fertility services), it is required that the group elect INF plan designs for all plans, including plans offered through wrapping with another carrier.
- Link to EOCs: https://www.sharphealthplan.com/members/your-coverage-documents/member-handbooks.
- Additional Information:
2027 Offer of Add-On Policy for Infertility Treatment Coverage – SB 729 Compliance:
In accordance with California Senate Bill 729 (SB 729), SIMNSA is pleased to present an optional add-on infertility treatment coverage policy for inclusion in your medical insurance plan.
This benefit aligns with the new requirements under SB 729 and provides comprehensive infertility coverage to eligible members. Below is the exact language outlining what is included in the proposed rates:
Included Infertility Coverage (SB 729)
“Infertility” is defined as any of the following:
- A licensed physician’s findings, based on the patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors. This definition shall not prevent testing and diagnosis of infertility before the 12-month or 6-month period to establish infertility.
- A person’s inability to reproduce, either as an individual or with their partner, without medical intervention.
- The failure to establish a pregnancy or to carry a pregnancy to live birth after regular, unprotected sexual intercourse. “Regular, unprotected sexual intercourse” means no more than 12 months of unprotected intercourse for a person under 35 years of age or no more than 6 months for a person 35 years of age or older. A pregnancy resulting in miscarriage does not restart the 12-month or 6-month time period to qualify as having infertility.
Coverage is limited to a maximum of three (3) completed oocyte retrievals with unlimited embryo transfers in accordance with the guidelines of the American Society of Reproductive Medicine (ASRM), using single-embryo transfer when recommended and medically appropriate.
Please note: All enrolled members in the group policy will incur the additional cost associated with this infertility coverage add-on, regardless of how many individuals are eligible for or utilize these services.
Coverage Type:
- Infertility Treatment Add-On (SB 729)
- $271.53 PMPM
- 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:
- Coinsurance: Infertility and IVF services must be covered at the same cost-sharing as other medical services. Coinsurance cannot be higher than what applies to comparable medical services and is determined by the members’ plan and place of service.
- HMO Benefits: HMO members follow the Medical Policy. Under SB 729, UHC will include a notice of coverage in the HMO large group fully insured California EOC. HMO provider medical groups should refer members to an in-network fertility specialist when appropriate.
- PPO Benefits: PPO members follow the Retail Pharmacy Policy. Under SB 729, UHC will include a notice of coverage in the PPO large-group fully insured California EOC/COC.
- Lifetime Maximum:
- Large Group Plans: Infertility coverage may include lifetime limits on sperm and oocyte collection/retrieval. Under the revised guidance, those limits cannot be less than three completed sperm retrievals/collections and three completed oocyte retrievals.
- Small Group Plans: When infertility coverage is purchased, the coverage must include cryopreservation and storage for at least one year.
- If a member changes health plans during the covered storage period, additional requirements may apply regarding continued storage and transportation of the genetic material.
- Donor and Surrogate Services:
- Coverage may include medically necessary fertility services involving donor sperm, donor oocytes, donor embryos, or a surrogate when required to treat the covered member's infertility. Under the revised guidance, covered medical services provided to a donor or surrogate must be covered through the member's health plan, subject to the applicable requirements and benefit limitations.
- The revised guidance also provides additional requirements for the procurement and retrieval of donor gametes, including minimum coverage standards.
- Cost:
- HMO Plans: Adds 3.4% to total premium (remains for 2027).
- Select Plus and Core Plans: Adds 4.9% to total premium (remains for 2027).
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.
Additional Resources:
Current as of 10/23/2026
- 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:
| Glossary of Terms | |
| AI | Artificial Insemination |
| ART | Assisted Reproductive Technologies |
| ASRM | American Society for Reproductive Medicine |
| FET | Frozen Embryo Transfer |
| GIFT | Gamete Intrafallopian Transfer |
| ICI | Intracervical Insemination |
| ICSI | Intracytoplasmic Sperm Injections |
| INF | Infertility |
| IUI | Intrauterine Insemination |
| IVF | In Vitro Fertilization |
| IVI | Intravaginal insemination |
| IVIG | Intravenous Immunoglobulin |
| PROST | Pronuclear Stage Tubal Transfer |
| TET | Tetralogy of Fallot |
| ZIFT/ZYFT | Zygote Intrafallopian Transfer |
| ZYFT | Zygote Intrafallopian Transfer |
Carrier Commission Disclaimer
The information herein was collected from sources deemed reliable including information from various carriers. We have not verified nor can we guarantee the accuracy, timeliness or completeness of such information, which is provided on an “AS-IS” basis. It is solely your responsibility to verify this information before making decisions or incurring costs based on such information. Further, you should contact the carrier for full details regarding the products and programs contained herein.
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