CALIFORNIA SB 729: WHAT YOUR PLAN ACTUALLY HAS TO COVER
California’s fertility coverage law took effect January 1, 2026. In December 2025, the state issued detailed guidance to health plans spelling out exactly what they must cover.
That guidance requires more than most people expected. Preimplantation genetic testing, ICSI, donor procurement, and medical testing of a gestational surrogate are all explicitly covered — services that early commentary assumed patients would pay for out of pocket.
If you were told these weren’t covered, you were told wrong. This page reflects the actual state guidance.
Be sure to CONTACT US if you have any questions.
Do you have coverage?
Three things must be true:
1. Your employer has 100 or more employees.
2. Your plan is fully insured — not self-funded. This is the one that surprises people. Many large employers are self-funded, meaning they pay claims themselves under federal law. SB 729 does not reach them. Working for a big company does not mean you’re covered. Plan type is what matters.
3. Your employer’s contract was issued, amended, or renewed on or after January 1, 2026. Coverage begins at renewal. If your plan renews in October, your benefits begin in October.
Not covered by this law
- Self-funded (ERISA) employer plans
- Religious employers
- Medi-Cal managed care
- Medicare Advantage
- CalPERS — state employee plans are not required to comply until July 1, 2027
Fewer than 100 employees?
Small-group plans must offer your employer the option to buy fertility coverage. Some employers purchase it; some don’t. Ask HR — and if they didn’t, ask why not.
The two questions to ask your HR department:
“Are we fully insured or self-funded?” “When does our health plan contract renew?”
What must be covered?
Diagnosis
Physician consultation and referral · physical examination · genetic evaluation · diagnostic laboratory and imaging services · semen analysis · sperm DNA fragmentation analysis · tubal and uterine evaluation · hormone testing · ovulation testing · thyroid function testing · ovarian reserve testing · diagnostic surgery and biopsy
Plus any other diagnostic service consistent with current ASRM guidelines.
IVF
- At least three completed egg retrievals (large group)
- At least three attempts to collect or retrieve sperm (large group)
- Unlimited embryo transfers, using single embryo transfer where recommended and medically appropriate
Three is a floor, not a ceiling. A plan may impose a lifetime limit, but that limit cannot be fewer than three retrievals.
Laboratory procedures — including the ones you were told to expect to pay for
The state explicitly lists these as covered fertility services:
- Preimplantation genetic testing (PGT)
- Intracytoplasmic sperm injection (ICSI)
- Embryo biopsy
- Assisted hatching
- In vitro maturation
- Thawing of previously cryopreserved gametes, embryos, and tissues
This is the biggest correction to the early conventional wisdom. Most commentary in late 2025 and early 2026 assumed PGT and ICSI would be excluded as elective add-ons. The state’s guidance says otherwise.
If your plan denies PGT or ICSI outright as non-covered services, that denial is worth challenging. Tell us.
Other covered treatment
Intrauterine insemination (IUI) · intracervical insemination · medication to treat infertility · medication to induce ovulation · surgery to treat infertility · reproductive counseling · genetic counseling · genetic testing and screening · infectious disease screening and testing · ovarian tissue reimplantation · laboratory and imaging services
Donor Eggs, Donor Sperm, Donor Embryos
Covered by your plan:
- Procurement of donor semen, oocytes, and embryos
- The donor’s laboratory and imaging services
- The donor’s genetic testing and screening
- The donor’s infectious disease screening and testing
- Medication to induce ovulation for the donor
- Retrieval of donor gametes
- Gamete and embryo transfer
- Any other medically necessary fertility service required for you to become a parent using donor material
Not covered — plan to pay out of pocket:
- Donor compensation
- Donor agency fees
- Legal fees for the donor agreement
The law covers medical services. It does not reach what you pay a donor or an agency.
What this means in practice: the medical cost of a donor cycle — historically a large share of the total — now runs through your insurance. The compensation and agency components do not. We will give you an itemized estimate rather than a headline number.
Gestational Surrogacy
Covered by your plan:
Your plan must cover medically necessary health testing of the surrogate — for each attempt to collect eggs or sperm, for each attempt to create embryos, and for each attempt to achieve a pregnancy with that material.
Where your plan’s responsibility ends:
At the embryo transfer. Your health plan is not responsible for the surrogate’s health care costs after the transfer procedure, including maternity services. Those run through the surrogate’s own coverage or the arrangements set out in your surrogacy agreement.
Not covered — plan to pay out of pocket:
- Surrogate compensation
- Agency fees
- Legal fees
- The surrogate’s insurance policies
Honest summary: SB 729 meaningfully reduces the medical portion of a surrogacy journey. It does not change compensation, agency, or legal costs — which remain the largest share of the total. Anyone telling you surrogacy is now “covered” is overselling it. Anyone telling you nothing is covered is out of date.
Freezing and Storage
Large group plans: cryopreservation and storage covered for at least five years from the date material is first frozen.
Small group plans (if purchased): at least one year.
Two notices your plan owes you
- Within 30 business days of receiving a storage claim — written notice of your covered storage period, your options if coverage ends early, and any out-of-pocket costs.
- At least 90 calendar days before your storage period expires — notice again, with your options and costs.
If you haven’t received these, ask for them.
Changing jobs or health plans?
Your new plan is responsible for storage for the remainder of the applicable period, and pays transportation costs if it requires the material moved. Your old and new plans must coordinate the transfer.
A plan has no obligation to keep paying for storage once you’re no longer enrolled. Don’t let a job change go unmanaged.
Limits — and the floors beneath them
Plans may impose lifetime limits, but not below:
- Three retrieval attempts
- Five years of cryopreservation (large group)
Small group enrollees may not be subject to lifetime limits at all.
Services from a prior employer may not count against you
If you used fertility benefits under a self-insured plan or a plan regulated by another state, those services cannot be counted toward your California large-group lifetime limits.
If a plan tells you you’ve “used up” your retrievals based on treatment at a previous job, ask what kind of plan that was.
You cannot be denied for these reasons:
A prior infertility diagnosis. A plan may not deny medically necessary infertility treatment based solely on the fact that you’ve already been diagnosed.
A prior elective sterilization. Tubal ligation or vasectomy cannot be used as grounds to refuse fertility treatment. (The plan is not required to cover surgical reversal of the sterilization itself.)
Who you are. Plans may not discriminate on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation.
The 12-month rule is gone
You no longer have to demonstrate a year of trying to conceive. Infertility is determined by a licensed physician’s findings based on your medical, sexual, and reproductive history, your age, physical findings, and diagnostic testing.
This is what opens access for same-sex couples, single parents by choice, and transgender and nonbinary patients. You do not have to fail at something first in order to qualify for care.
If your plan says no
The most useful thing to know about SB 729
Any medical necessity determination — and any utilization review criteria a plan applies to infertility services — must be consistent with established medical practice and current ASRM guidelines.
A denial grounded in an internal plan policy that contradicts ASRM is a compliance problem, not a final answer.
This is where a physician-led practice matters. We know the standard your plan is held to, and we hold them to it.
You may also contact the California DMHC Help Center at 1-888-466-2219 or www.DMHC.ca.gov for assistance obtaining infertility treatment services.
What you’ll still pay
Your plan may not impose different conditions or limitations on fertility services than it imposes on other covered medical services. Your fertility care runs through your regular deductible, copays, coinsurance, and out-of-pocket maximum.
What that adds up to depends entirely on your plan design. We verify your benefits and give you a written estimate before you begin treatment. No surprises.
Budget separately for:
- Donor compensation and donor agency fees
- Surrogate compensation, surrogacy agency fees, legal fees
- Anything your plan deems not medically necessary, experimental, or investigational
- Elective fertility preservation with no medical indication
FREQUENTLY ASKED QUESTIONS
Yes. Preimplantation genetic testing is explicitly listed by the California Department of Managed Health Care as a covered fertility service for the treatment of infertility. Early commentary widely assumed PGT would be excluded; the state’s guidance says otherwise. If your plan denies PGT outright as non-covered, that denial is appealable.
Yes. ICSI is explicitly listed as a covered service, along with embryo biopsy, assisted hatching, and in vitro maturation.
Substantially. Procurement of donor oocytes, the donor’s labs, genetic and infectious disease screening, ovulation induction medication, retrieval of donor gametes, and embryo transfer are all covered. Donor compensation and agency fees are not.
Partially. Your plan must cover medically necessary health testing of the surrogate for each attempt to collect gametes, create embryos, and achieve pregnancy. Your plan’s responsibility ends at the embryo transfer — it does not cover the surrogate’s maternity care. Surrogate compensation, agency fees, and legal fees are not covered.
Large-group plans must cover at least three completed egg retrievals and at least three sperm collection attempts, with unlimited embryo transfers. Three is a minimum, not a maximum.
No. Self-funded (ERISA) plans are governed by federal law and are not required to comply with SB 729. Many large employers are self-funded — ask your HR department directly whether your plan is fully insured or self-funded.
Coverage begins when your employer’s health plan contract is issued, amended, or renewed on or after January 1, 2026. If your plan renews mid-year, your coverage begins mid-year. CalPERS plans are not required to comply until July 1, 2027.
No. That requirement was eliminated. Infertility is determined by a licensed physician’s findings based on your medical, sexual, and reproductive history, age, physical findings, and diagnostic testing.
No. A plan may not deny medically necessary infertility treatment based solely on a prior elective sterilization. The plan is not required to cover reversal of the sterilization itself.
Large-group plans must cover cryopreservation and storage for at least five years from the date material is first frozen. Your plan must notify you within 30 business days of a storage claim, and again at least 90 days before your storage period expires.
DON’T WAIT FOR YOUR RENEWAL DATE TO GET EVALUATED
Ready to take the next step?
Diagnostic workup takes weeks. Ovarian reserve does not pause for an insurance renewal date.
Get evaluated now. Be ready to treat the day your coverage begins.
For some patients — particularly those over 35 or with diminished ovarian reserve — the right decision is to begin treatment now rather than wait. That is a conversation to have with a physician, with your actual numbers in front of you.
Schedule your consultation TODAY
Sources: California Department of Managed Health Care, All Plan Letter 25-021, “Implementation of Senate Bill 729 (2024),” issued December 30, 2025, revised February 23, 2026. Health & Safety Code §1374.55; Insurance Code §10119.6.
This page is educational and is not a guarantee of coverage. Benefits vary by plan. Always verify your specific benefits directly with your health plan. Gen 5 Fertility will verify benefits on your behalf at no charge.