IVF and related services coverage updates

For certain commercial plans in California

In accordance with California’s Senate Bill 729 mandate (SB 729), which will be effective Jan. 1, 2026, we’ll cover the diagnosis and treatment of infertility and fertility services. However, for California fully insured group plans with policy effective dates between July 1 and Dec. 31, 2025, in vitro fertilization (IVF) and related services will be part of the standard benefit.

Why the change?

The IVF, infertility treatment and fertility services mandate has been postponed by the governor and legislature from July 1, 2025, to Jan. 1, 2026. However, we’re covering these fertility services as part of our standard coverage until SB 729 goes into effect.

Coverage details

California large employer groups with policies that are new or renewing between July 1, 2025, and Dec. 31, 2025, will have fertility services under a standard benefit. 

California employer groups’ policies that are new or renewed on or after Jan. 1, 2026, will have the mandated coverage. California residents who are insured under a large group policy issued outside of California will have the mandated coverage when their policy is new or renewed on or after Jan. 1, 2026.

How you can help your patients

Members interested in these services can be referred to call Optum® Fertility Solutions at 866-774-4626 for clinical support and medical management.

We’ll also pay claims when Optum Fertility Solutions is not used.

Prior authorization requirements are not changing

We’ll continue to require prior authorization for IVF and related services. To request prior authorization, please submit a request by signing in to the UnitedHealthcare Provider Portal. For more information, see our infertility Prior Authorization Requirements. 

Plans the law applies to

• Large group health plans include disability policies, which must provide coverage for diagnosis and treatment of infertility and fertility services including IVF
• Small group health plans and disability policies that choose to offer coverage for diagnosis and treatment of infertility and fertility services including IVF
• All plans issued, amended or renewed on or after Jan. 1, 2026. Legislation formally indicates that benefits are required on or after renewal, Jan. 1, 2026, for large groups, but UnitedHealthcare has designated this as a benefit standard effective July 1, 2025. For small groups, it will be available only if purchased.
• Large-group HMO and large-group PPO regulated by the California Department of Managed Health Care. It also applies to large-group PPO regulated by the California Department of Insurance. For small groups, it will be available only if purchased.

Coverage information

• This 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, IVF and related services
  • Large-group, fully insured plans are required to cover the expenses of up to 3 completed oocyte (egg) retrievals and unlimited embryo transfers per plan year for an annual maximum
  • Allows for sperm donors, egg donors or surrogates
• Ends the prior exclusion of IVF
• Prohibits discrimination in coverage for medical and disability plans, ending the exclusion of LGBTQ+ people in fertility coverage

Contractual information

The division of financial responsibility will not change. If a health care professional is on a standard professional (RL3) or a global (RL5) agreement, the risk will remain with UnitedHealthcare.