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California Senate Bill (SB) 729 requires fully insured Large Group health plans in California to include comprehensive infertility coverage, including in vitro fertilization (IVF). For fully insured Small Group plans, carriers must make at least one plan available with comprehensive infertility coverage – but the employer is not required to sponsor it. An employer can choose to offer it to employees, or not.

That's the short version. Below is the fuller picture – what "comprehensive infertility coverage" actually means now that regulators have spelled it out in more detail than the law originally did, plus answers to a couple of questions we hear most often from brokers working through this with clients.

Who This Actually Applies To

SB 729's requirements attach to the fully insured contract itself – specifically, to plans regulated by California's Department of Managed Health Care (DMHC) or Department of Insurance (CDI). It does not attach to individual employees based on where they happen to live.

For example, if an employer is based outside California, with a fully insured plan issued and regulated in another state with one or more employees living in California, SB 729 generally doesn't apply. That’s because the plan itself isn't a California-regulated fully insured contract – even though some of the people covered under it live in California. The same goes for self-funded and most level-funded plans regardless of where the employer or its employees are located. Those arrangements are governed by federal ERISA law, not DMHC or CDI rules, so SB 729 doesn't reach them at all.

Large Group vs. Small Group

For fully insured Large Group plans issued, amended, or renewed on or after January 1, 2026, comprehensive infertility coverage is part of the plan – there's nothing for the employer to elect. 

For fully insured Small Group plans issued, amended, or renewed on or after that same date, the carrier is required to make at least one plan available with this coverage, but sponsoring it is the employer's choice.

One thing worth clarifying for clients: SB 729 doesn't set its own headcount cutoff for Large Group versus Small Group. That classification comes from how carriers already sort fully insured plans into those two markets. SB 729 applies on a market segment basis, not a headcount basis – so an employer with 101 or more employees whose plan is still classified as Small Group generally is not suddenly subject to Large Group's requirements just because of its size. What matters is which market segment the plan is in, not the employer's headcount on any given day.

What "Comprehensive Infertility Coverage" Actually Includes

This is where things got murky for a while. SB 729, as written, requires coverage for "the diagnosis and treatment of infertility and fertility services," but the statute never lists specific procedures, and it never uses the words "in vitro fertilization." That left it up to each carrier to interpret, and not every carrier landed in the same place early on.

The DMHC has since settled that question for the plans it regulates. In All Plan Letter (APL) 25-021, most recently revised February 23, 2026, the DMHC lays out exactly which services are included – and IVF is named explicitly, along with intracytoplasmic sperm injection (ICSI), in vitro maturation, embryo biopsy, assisted hatching, preimplantation genetic testing, intrauterine and intracervical insemination, and donor egg, sperm, and embryo services. On the diagnostic side, it covers the standard workup too, including physician consultation, genetic evaluation, lab testing, imaging, semen analysis, and related testing.

The APL also sets specific minimums:

• Large Group plans must cover at least three sperm retrieval attempts, three completed egg retrievals, and unlimited embryo transfers. 
• Small Group plans, when the infertility plan option is elected, are subject to different minimum coverage requirements than Large Group plans.

A few other things the APL clarifies:

• Donor and surrogacy services are covered. That includes donor eggs, sperm, and embryos, the enrollee's medically necessary infertility services, and medically necessary testing of the surrogate before embryo transfer when a surrogate is involved. (The surrogate's own pregnancy and maternity care remain covered under the surrogate's own health plan, not the enrollee's plan.)
• Coverage can't be denied solely because someone was previously diagnosed with infertility or previously had voluntary sterilization – though the reversal surgery itself isn't a required covered benefit.
• Coverage has to be delivered without discrimination based on marital status, sexual orientation, gender identity, and similar protected characteristics.

Plans were required to certify their compliance with DMHC by March 19, 2026.

One Distinction Worth Knowing: DMHC vs. CDI

Everything above regarding IVF and the rest of that list comes from DMHC's APL 25-021, which only applies to Knox-Keene health care service plans regulated by the DMHC. As a general rule, the DMHC regulates HMO-style plans, while the CDI regulates PPO and other indemnity-style insurance policies. The CDI, which covers that smaller slice of the fully insured market, hasn't issued equivalent guidance confirming IVF and the rest of this list in the same detail. If your client's plan is CDI-regulated, the underlying statute still requires comprehensive infertility coverage – the broader "diagnosis and treatment of infertility and fertility services" language – but the same explicit list hasn't been confirmed for CDI plans the way it has for DMHC plans.

Why Carriers Didn't All Say the Same Thing at First

If you asked more than one carrier about this earlier in the year, you may have gotten more than one answer about what was actually covered. That wasn't carriers being careless – the statute simply didn't spell out specific procedures, so each carrier had to make its own call before DMHC's guidance existed. Now that APL 25-021 names IVF and the rest of the treatment list explicitly, carriers have been updating their plan documents and member materials to match it, and we expect that to keep happening as the DMHC issues further clarification.

For the most current, carrier-specific detail – coverage, cost, and plan design – check our Carrier Infertility Overview in the W&B Newsroom. We keep it updated when we hear directly from our carrier partners regarding their specific approaches to SB 729.

What's Still to Come

This likely isn't the DMHC's last word on the subject. Additional guidance from the Department is expected, though not guaranteed, later this year, so some of the finer points here may continue to develop. We'll keep the Carrier Infertility Overview current as that happens, and we will update this piece if anything material changes.

Bottom Line

For fully insured Large Group employer clients on a DMHC-regulated plan, comprehensive infertility coverage – including IVF – is confirmed and already part of the plan. 

For CDI-regulated Large Group plans, the same broad coverage requirement applies under the statute, though the CDI has not issued the same explicit confirmation on IVF specifically as of this column’s posting. 

For fully insured Small Group employer clients, the carrier must make comprehensive infertility coverage available; whether to sponsor it is the employer's call. And for self-funded, level-funded, or out-of-state plans not regulated by the DMHC or CDI, none of this is required – regardless of whether some employees happen to live in California.

_{This article is intended as an educational summary of a California regulatory development and does not constitute legal advice. Coverage details can vary by carrier and by plan; brokers with client-specific compliance questions should confirm plan language directly with the carrier or consult qualified legal counsel.}