California’s New Fertility Coverage Mandate: What Employers Need to Know

Legislative Background

The fertility coverage mandate requires large and small group health care service plan contracts and disability plan contracts to provide diagnosis and treatment of infertility, as well as fertility services. More specifically, the law applies to certain fully insured medical plans in California that are issued or renewed on or after January 1, 2026.¹ The law’s original July 1, 2025, effective date was delayed by six months as part of a trailer bill enacted on June 30.

This mandate does not apply to self-insured plans, including level-funded medical plans. It does not apply to Medi-Cal, dental or vision policies, or accident-only or specified disease policies. In addition, certain religious employers are exempt from this mandate. 

What’s Covered? 

The law imposes different requirements on plans depending on whether they are large group (cover more than 100 employees) or small group (100 or fewer employees). 

Large group plans will be required to provide coverage for the diagnosis and treatment of infertility, including three egg retrievals and an unlimited number of embryo transfers. 

For small group plans, the mandate looks different. Carriers are required to offer employers the opportunity to procure coverage for these fertility-related services, but the plan is not required to provide this coverage (unless elected/purchased by the employer, likely as a rider to the policy). 

The specifics of this mandate (such as whether the coverage of three egg retrievals is per employee per lifetime, how such limits apply as an employee changes his/her employment or coverage, etc.), are not clear, but further guidance is expected to be forthcoming for California’s Department of Managed Health Care. 

Who Is Covered?

The mandate defines “infertility” broadly, and includes individuals who have a medical diagnosis, a single individual or same sex couple who cannot reproduce without medical intervention, as well as those unable to establish and carry a pregnancy to a live birth after 12 months of unprotected sexual intercourse (or six months for those over age 35). 

Next Steps for California Plans

Plans subject to this mandate should expect to see some increase to their medical premiums upon their next renewal. California employers that already offer a separate fertility benefit should review those existing fertility benefits for any gaps or redundancies with the new mandate. Employers that offer a fully insured plan option alongside a self-insured option may want to consider mirroring the benefits (if those benefits aren’t already covered in the self-funded plan).