The Exciting News: California’s Fertility Coverage Law is Here!

When Does Coverage Start?

The law is in effect NOW, but your personal coverage depends on when your employer’s health plan renews.

Understanding Your Coverage Start Date

IMPORTANT: Coverage doesn’t automatically start on January 1, 2026 for everyone. It begins when your employer’s insurance contract renews or is newly issued on or after January 1, 2026.

What This Means:

• If your plan renewed on January 1, 2026: Your coverage started this week! 🎉
• If your plan renews in March 2026: Your coverage starts in March
• If your plan renews in August 2026: Your coverage starts in August
• CalPERS state employees: Your coverage begins January 1, 2027

How to Find Out Your Coverage Date:

Action Step #1: Contact your HR department TODAY and ask:

1. “When does our company’s health insurance plan renew in 2026?”
2. “Is our plan fully insured or self-funded?”
3. “Do we have a large group plan (100+ employees)?”
4. “Has our plan incorporated SB 729 fertility coverage yet?”

Action Step #2: Call your insurance company’s member services (number on your insurance card) and ask:

• “Does my plan now include SB 729 fertility coverage?”
• When will fertility coverage take effect on my plan?” “
• Can you send me written confirmation of my fertility benefits?”

Important Timing Consideration

Don’t delay care if your situation is time-sensitive! While it’s exciting that coverage is here, fertility can be time-sensitive, especially as we age. If you’re ready to start treatment now, don’t feel you need to wait months for your plan to renew. We’ll help you make the decision that’s best for YOUR unique situation.

Who has Coverage?

✅ YOU are covered if you:

Large Employers (100+ employees)

• You work for a company with 100 or more employees
• Your health plan is fully insured (not self-funded)
• Your plan is state-regulated
• Your plan has renewed on or after January 1, 2026

Small Employers (with fertility coverage option)

• Your employer chose a small group plan that includes fertility benefits
• Your plan has renewed on or after January 1, 2026

❌ NOT automatically covered:

Self-Funded Plans

• Your employer has a self-funded (ERISA) plan
• These plans are not required to provide SB 729 coverage
• Ask your HR department if your plan is “fully insured” or “self-funded”

Small Employers (without opt-in)

• Your employer has fewer than 100 employees AND
• They chose not to select the fertility coverage option

Certain Other Plans

• Religious employer plans (may be exempt)
• Medi-Cal managed care plans

A More Inclusive Definition of Infertility 🌈

ALL Paths to Parenthood Are Recognized

This is truly groundbreaking: SB 729 explicitly recognizes that families come in all forms.

You’re included regardless of:

✓ Your age (no upper age limit specified in the law)

✓ Sexual orientation (LGBTQ+ individuals and couples)

✓ Marital status (single parents by choice)

✓ Gender identity (transgender individuals)

✓ Whether you need donors or surrogates

No More “12 Months of Trying” Requirement

Important: You do NOT need to prove you’ve been trying to conceive for 12 months through unprotected heterosexual intercourse (a requirement that excluded many people).

Instead: Your doctor determines medical necessity based on:

• Your complete medical history
• Your reproductive health assessment
• Physical findings and diagnostic testing
• Your individual circumstances
• Your age and fertility factors

This means same-sex couples, single individuals, and anyone requiring medical assistance to conceive can access coverage based on their doctor’s medical determination – not outdated requirements.

Understanding What May NOT Be Fully Covered

We believe in complete transparency, so here’s what you need to know about potential out-of-pocket costs:

Preimplantation Genetic Testing (PGT)

The Situation:

PGT-A (Aneuploidy Screening) – Likely NOT Covered:

• Routine genetic screening of embryos to check for chromosome abnormalities
• This is typically considered “elective” or not medically necessary for all patients
• Expected cost: $3,000-$5,000+ per cycle if you choose to use it

PGT-M (Monogenic Disorders) / PGT-SR (Structural Rearrangements) – May Be Covered:

• If you’re a known carrier of a specific genetic disease (like cystic fibrosis, sickle cell disease, Tay-Sachs, etc.)
• If you have a chromosomal translocation or structural issue
• Testing to prevent passing a known genetic condition to your child may be covered as “medically necessary”

What You Should Do:

• Discuss with us whether PGT would benefit YOUR specific situation
• Get pre-authorization if you have a genetic condition that qualifies
• Plan for out-of-pocket costs if choosing elective PGT-A

Donor Eggs – Some Uncertainty Remains

What We Know:

Definitely Covered (Your medical care):

• Your embryo transfer procedure
• Your medications to prepare for transfer
• Your monitoring appointments
• Embryo creation and fertilization

Definitely NOT Covered (Donor-related fees):

• Egg donor compensation ($8,000-$15,000+)
• Egg donor agency fees ($6,000-$10,000+)
• Egg donor legal fees
• Egg donor insurance policies

Still Unclear (Awaiting Guidance):

• The egg donor’s medical cycle (retrieval, medications, monitoring)
• Coverage is being determined by regulators and insurers

What You Should Know: Even with SB 729, if you need donor eggs, plan for $15,000-$30,000+ in out-of-pocket expenses for donor compensation, agency fees, and potentially the donor’s medical cycle.

We’ll help you: Understand all costs upfront, work with your insurance for maximum coverage, and create a clear financial plan.

Gestational Surrogacy – Significant Out-of-Pocket Costs

What We Know:

Likely Covered (Your IVF portion):

• Your egg retrieval
• Embryo creation
• Your fertility medications
• Embryo storage

Definitely NOT Covered (Surrogacy-related costs):

• Gestational surrogate compensation ($40,000-$60,000+)
• Surrogacy agency fees ($20,000-$35,000+)
• Legal fees for surrogacy contract ($8,000-$15,000+)
• Surrogate’s pregnancy and delivery care (handled separately)
• Surrogate’s insurance, life insurance, disability insurance

Still Unclear (Awaiting Guidance):

• Embryo transfer to the surrogate
• Surrogate’s medications for transfer preparation
• Surrogate’s monitoring related to embryo transfer

What You Should Know: Total surrogacy costs typically range from $120,000-$200,000+. Even with SB 729 covering your IVF cycle, expect $100,000-$180,000+ in out-of-pocket expenses for all surrogacy-related costs.

We’ll help you: Connect with reputable surrogacy agencies, understand the complete process and costs, and maximize any available coverage.

How to Verify Your Benefits – Action Checklistuick Answers

Step 1: Contact Your HR Department (Do This First!)

Questions to Ask:

• What is our health insurance plan renewal date in 2026?
• Is our plan fully insured or self-funded (ASO)?
• How many employees does our company have?
• Has fertility coverage under SB 729 been added to our plan yet?
• Can you provide written confirmation of our fertility benefits?

Step 2: Contact Your Insurance Company

Call the Member Services number on your insurance card and ask:

• Does my plan include SB 729 fertility coverage?
• When did/will this coverage take effect?
• Do I need a referral from my primary care doctor?
• Do I need prior authorization for fertility services?
• Which fertility clinics are in-network?
• What are my copays/coinsurance for fertility services?
• Can you send me written confirmation of my benefits?

Step 3: Contact Our Office

We’ll help you:

• Verify your insurance benefits
• Understand prior authorization requirements
• Navigate any insurance questions or issues
• Plan for any out-of-pocket costs
• Create your personalized treatment plan

Important Things to Know Right Now

Implementation is Ongoing

The law just took effect, which means:

✓ Insurance companies are actively implementing coverage now ✓ Some details are still being finalized by regulators ✓ Specific requirements may evolve over the coming months ✓ The California Department of Managed Health Care (DMHC) has until January 1, 2027 to issue final compliance guidance

What this means for you: Some specifics (like exact prior authorization requirements or coverage details for donor eggs) may not be completely clear yet. We’re monitoring all updates and will keep you informed.

Different Plans, Different Timelines

Remember:

• Every employer’s plan renews at different times
• Your coworker might have coverage this month while you wait until June
• This is normal! Coverage rolls out throughout 2026 as plans renew
• Coverage dates depend on each employer’s individual contract

Prior Authorization May Be Required

Some insurance companies (like UnitedHealthcare) require prior authorization for IVF services. This means:

• We submit documentation to your insurance before starting treatment
• Insurance reviews and approves the treatment
• This process typically takes 7-14 days
• We handle this for you, but plan for this timing

Your Plan Renewal Creates a “Benefit Reset”

Good news: When SB 729 coverage is added to your plan at renewal, you get a fresh start!

Even if you previously had limited fertility coverage and used it up, when your plan renews with SB 729 coverage, you’re eligible for the new benefits:

Unlimited embryo transfers (new count)

Up to 3 egg retrievals (new count)

Ready to Get Started? Your Next Steps

If Your Coverage Has Already Started:

1. Schedule a consultation with us to discuss your fertility goals
2. Complete any recommended testing to assess your fertility
3. Verify your benefits with our financial counselors
4. Obtain prior authorization (we’ll help with this)
5. Begin your treatment plan when you’re ready!

If You’re Waiting for Your Plan to Renew:

1. Schedule a consultation anyway – there’s no reason to wait!
2. Complete testing and evaluation now so you’re ready when coverage begins
3. Confirm your exact renewal date with HR
4. Consider starting sooner if time-sensitive – we’ll discuss whether waiting makes sense for YOUR situation
5. Stay connected with us – we’ll help you prepare and be ready when coverage starts

If You’re Not Sure About Your Coverage:

1. Call us first! We can help you understand your situation
2. We’ll guide you through checking with HR and your insurance
3. We’ll verify your benefits at no cost to you
4. We’ll explain all your options clearly and transparently

Why This Matters: The Bigger Picture

A Historic Moment for California Families

10 million Californians now have access to fertility care, including IVF.

This law represents:

• Recognition that fertility care IS healthcare
• Acknowledgment that all families deserve support
• Understanding that paths to parenthood are diverse and valid
• Commitment to removing financial barriers to family building

California now has one of the most inclusive fertility coverage laws in the nation, joining 15 other states that mandate IVF coverage.

What Makes SB 729 Special

Inclusivity: Explicitly recognizes and supports LGBTQ+ individuals, same-sex couples, single parents, and anyone needing medical assistance to build their family.

Comprehensiveness: Covers not just IVF but the complete spectrum of fertility diagnosis and treatment.

Fairness: Requires the same cost-sharing as other medical care – no separate, higher deductibles or copays.

Generosity: Three egg retrievals with unlimited transfers is among the most generous coverage in the country.

FAQ

Q: Should I wait for coverage or start treatment now? A: This depends on your individual situation, especially your age and fertility factors. Time can be critical in fertility treatment. We’ll help you weigh the financial and medical considerations to make the best decision for YOU.

Q: What if my insurance denies something I think should be covered? A: You have the right to appeal! We’ll help you with documentation and will advocate for you throughout the appeals process.

Q: Will my premiums go up because of this? A: Some premium increases are expected industry-wide as insurers add this benefit, but the exact impact depends on your employer and plan. Ask your HR department about any premium changes.

Q: What if I’ve already started IVF before coverage began? A: Costs incurred before your coverage took effect typically aren’t reimbursed, but you may be able to use your new coverage for future cycles. Discuss your specific situation with us.

Q: Can I choose any fertility clinic? A: You’ll need to use in-network providers to receive full coverage. We can help you understand network requirements and check if we’re in your network.

Q: What if I need more than 3 egg retrievals? A: After three egg retrievals, additional cycles would be out-of-pocket unless your plan offers additional benefits. Many patients achieve success within three cycles, and we optimize each cycle for the best possible results.

We’re Here for You

This is an exciting time, and we know navigating new insurance benefits can feel overwhelming. You don’t have to figure this out alone.

Our Commitment to You:

We’ll help you verify your benefits and understand your coverage

We’ll handle prior authorizations and insurance communications

We’ll be transparent about all costs – covered and out-of-pocket

We’ll advocate for you if coverage is denied

We’ll keep you updated as new information becomes available

We’ll support you every step of your fertility journey

Your Path Forward:

Whether you’re starting treatment today, waiting for coverage to begin, or still exploring your options, we’re here to provide compassionate, expert care.

Your dreams of building a family deserve support, and we’re honored to be part of your journey.

Contact Us Today

Ready to take the next step?

Call our office to:

• Schedule your consultation
• Verify your insurance benefits
• Ask questions about coverage
• Discuss your treatment options
• Get started on your path to parenthood

Remember: The law is now in effect, and coverage is rolling out. Don’t wait to start the conversation about your fertility journey!

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Information current as of January 2026. SB 729 took effect January 1, 2026. Coverage details may vary by insurance carrier and plan. We recommend verifying benefits directly with your insurance provider and employer. Some implementation details are still being finalized by regulators and will be updated throughout 2026.This is an exciting new chapter for fertility care in California – and we can’t wait to help you write your family’s story!

Your dreams of building a family deserve support. We’re honored to be part of your journey!

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