25-641 Expanded Coverage for Infertility Diagnosis and Treatment, Including In Vitro Fertilization

Date: 07/18/25

SB 729 is mandated for large group insurance plans with coverage offered for small groups

Health Net implemented Senate Bill (SB) 729 for large group plans to cover infertility services, effective July 1, 2025. Coverage is required for infertility diagnosis and treatment, including a maximum of three completed oocyte retrievals with unlimited embryo transfers.

• The SIMNSA tier of Salud HMO (both small and large groups) is effective January 1, 2026.
• The CalPERS plan will adopt the expanded infertility benefits, effective
   July 1, 2027.
• SB 729 will not apply to plans for groups designated as religious employers.

New or renewing groups: The new infertility benefits will be available upon the effective date of their evidence of coverage.

What does SB 729 cover?

• Diagnosis and treatment of infertility.
• Artificial insemination, gamete intrafallopian transfer (GIFT), in vitro fertilization (IVF), and (zygote intrafallopian transfer (ZIFT), with up to three completed oocyte retrieval cycles per lifetime with unlimited embryo transfers, following American Society for Reproductive Medicine guidelines for single embryo transfer when medically appropriate.
• Covered services that prepare the member to receive the procedure, including:
  • Prescription drugs.
  • Professional services.
  • Inpatient and outpatient care.
  • Treatment by injections.
• Infertility prescription drugs are subject to the applicable Tier 1, 2 or 3 drug copayments as listed in the member’s Schedule of Benefits. Large groups can be in the Specialty Tier. Small groups can also be in Tier 4.
• There are no additional lifetime maximum limitation or deductibles on covered infertility services.
• The covered infertility cost share must apply to the out-of-pocket maximum.

What you need to know

• Cost-sharing for infertility services aligns with the applicable service type listed in the member’s Schedule of Benefits. For example, if an infertility service requires an office visit, the office visit copayment will apply.
• Prior authorization – the covered infertility services prior authorization requirements are not impacted.

Additional information

For additional information, refer to SB-729 Health care coverage: treatment for infertility and fertility services.

Relevant sections of Health Net’s provider operations manual has been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal.

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone at 800-641-7761 or through the Health Net provider portal.

 

This information applies to Physicians, Participating Physician Groups (PPGs), and Ancillary Providers.