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State Mandates
In the U.S., 22 states and the District of Columbia have laws mandating some form of fertility treatment coverage, but the specifics vary greatly. While some states mandate coverage for IVF and fertility preservation, others may only mandate coverage for certain treatments or only for specific populations. Many states have exemptions, such as those for small employers, religious employers, or self-funded plans.
State mandates do NOT extend to ERISA plans, Medicaid, Federal Plans, or military plans (Tricare).
California Specific
Senate Bill 600 was passed in 2019 and mandates that fully insured plans written in CA cover fertility preservation for iatrogenic treatment (chemotherapy, radiation, and pelvic surgery). It is a great starting point and is currently undergoing a lot of revision to ensure the best treatment coverage for this pool of patients.
Current California law requires insurers to offer fertility benefits as an optional rider to employers when they purchase their annual insurance plans. Beginning January 1, 2026, Senate Bill 729 will require that all large group, fully insured health plans — that is, employers that cover at least 100 people and are written in the state of CA — provide coverage for the diagnosis and treatment of infertility as well as a maximum of three egg retrievals and unlimited embryo transfers plus medications.
- Any CA residents under Disability Plans, written in or out of the state of CA, are included in the mandate.
- This does not apply to all CA residents. All other commercial plans must have the infertility rider written in the state of CA.
- Small Group plans (less than 100 people covered) as well as Individual plans are exempt from the SB 729 mandate.