An extremely significant piece of legislation, SB729, is currently being considered by the California Assembly’s Committee on Appropriations. If enacted, SB729 would repeal and add Health & Safety Code §1374.55 and repeal and add Insurance Code § 10119.6.
It would also (and most importantly) require all health care contracts or health insurance policies issued, amended, or renewed on or after January 1, 2024, to include coverage for both fertility and infertility services.
So, What Would Be Changed?
First, with respect to large group coverage plans, available fertility treatments include “a maximum of three oocyte retrievals with unlimited embryo transfers in accordance with the guidelines of the American Society for Reproductive Medicine (ASRM), using single embryo transfer when recommended and medically appropriate” (emphasis and hyperlink added).
That’s right. As just one of the many changes to health and insurance law in California in this bill, insureds could expect to have up to three oocyte (egg) retrieval surgeries and potentially unlimited embryo transfer procedures covered by their health insurance provider.
But that’s not all.
The bill would also define “infertility” to mean any one of three things:
- A licensed physician makes a determination of infertility based on the patient’s “medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors”; OR
- “A person’s inability to reproduce either as an individual or with their partner without medical intervention”; OR
- Depending on the patient, the inability to become pregnant or to carry a pregnancy to term after having unprotected sex for six months if the patient is 35 or one year if the patient is younger than 35. Importantly, miscarriage does not restart the relevant time-period.
Subpart (2) is particularly significant in that it ostensibly would provide infertility coverage to LGBT families who biologically cannot reproduce with each other. Moreover, regardless, of the above subpart the insured falls into, SB729 has prohibitions against insurance providers imposing any of a host of exclusions, limitations, or restrictions on those seeking this treatment.
SB729 was sent to the Assembly Appropriations Committee on August 15, 2023. Until the bill is signed into law, it remains just a piece of proposed legislation, with no impact on existing law. The bill itself is also far more complex than this article, which is just for informational purposes, could do justice. If you have any questions about SB729, we urge you to call your respective legislator or a licensed attorney.