UnitedHealthcare to expand infertility coverage for California fully insured plans

Prior to recent guidance SB 729, California law required group health care plans to offer coverage for the treatment of infertility, including in vitro fertilization (IVF).

• Fully insured large group health plans including disability policies must provide coverage for diagnosis and treatment of infertility and fertility services including coverage for IVF.
• Fully insured small group health plans and disability policies may choose to offer coverage for diagnosis and treatment of infertility and fertility services including coverage for IVF.
• This does not apply to ASO plans, specialized plans, or religious employer’s groups.

Legislation formally indicates that benefits are required on or after renewal, January 1, 2026, for Large Group (LG), but UnitedHealthcare has designated this as a Benefit Standard effective 7/1/2025 for large fully insured groups sitused in CA. For Small Group (SG) it will be available only if purchased. The extraterritorial coverage requirement is delayed until January 1, 2026.

• Legislation ends the prior exclusion of IVF and includes coverage for:
  • The diagnosis and treatment of infertility and fertility services and coverage for certain assisted reproductive technology services to “create” a pregnancy such as artificial insemination (AI), in vitro fertilization (IVF), and related services.
  • An annual maximum of three completed oocyte retrievals with unlimited embryo transfers using single embryo transfer.
  • Fertility services involving sperm donors, egg donors or surrogates.
• Requires large group fully insured plans to cover the expenses of up to three completed oocyte (egg) retrievals and unlimited embryo transfers per plan year.
• Prohibits discrimination in coverage for medical and disability plans.
  • Ends exclusion of LGBTQ+ people in fertility coverage.
  • Insurance contracts may not put extra restrictions (e.g., exclusions, limitations, deductibles, copays, benefit maximums, waiting periods) on fertility services, treatment, diagnosis, or medications that are not imposed on other services or prescriptions.
• Dollar or annual limits are permitted.
• Coverage aligns with the group’s plan year and for large fully insured groups will apply to new business and renewals on and after 7/1/25.  Small fully insured groups may add IVF if purchased.
• A UnitedHealthcare notice of coverage rider/amendment will be applied to the evidence of coverage (EOC) or Certificate of Coverage (COC).

For questions, contact your UnitedHealthcare representative or broker.