Introduction

On September 29, 2024, California Governor Gavin Newsom signed Senate Bill (SB) 729 into law, creating a significant shift in reproductive health policy for employers statewide by expanding fertility insurance coverage in California. Effective January 1, 2026, SB 729 mandates that fully insured, large group health plans (those with 101 or more covered employees) must provide coverage for the diagnosis and treatment of infertility, including in vitro fertilization (“IVF”). These changes reflect California’s efforts to expand access to fertility care and mirror policies in select other states—which we have previously discussed here.

Background

Previously, California’s Knox-Keene Health Care Service Plan Act did not mandate coverage for infertility or IVF. Insurers typically provided optional riders that employers could purchase, and IVF was frequently excluded from these options. Additionally, coverage was limited by the prior definition of infertility—which did not include LGBTQIA+ couples, single parents, and those with non-traditional paths to parenthood (e.g., surrogacy). Self-funded plans remained outside the scope of these requirements, governed only by federal ERISA law.

SB 729, authored by Senator Caroline Menjivar, was intended to fill these coverage gaps and expand access to fertility benefits for California workers. Advocates for SB 729 emphasized the need for inclusivity and for updating the definition of infertility. Opposition to SB 729 focused...

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