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California Infertility Insurance Mandate

California is one of the few states that currently has an fertility treatment insurance mandate in place. Only 15 states have an infertility insurance mandate in place to offer coverage or provide coverage for fertility treatment and IVF costs.

California law on fertility treatment insurance was enacted in 1989. The California law can be found in Section 1374.55 of the California Health and Safety Code . According to this infertility insurance law, every health care service plan contract that covers hospital, medical, or surgical expenses, must offer coverage for fertility treatments.

However, this California fertility treatment insurance law does not require insurers to provide the fertility treatment coverage. It also does not require employers to include it in the insurance plans for their employees.

Most notably, the California fertility treatment insurance law excludes in vitro fertilization (IVF) coverage from the requirement, so IVF costs would not be covered.

Coverage under California Fertility Treatment Insurance Law

The California law on infertility insurance for fertility treatment costs defines infertility as one of the following conditions:

  • The presence of a condition diagnosed by a medical professional, such as a fertility doctor, as the cause of the infertility
  • The inability for the couple to conceive or carry a child to term after a year or more of unprotected sexual intercourse

Fertility treatments covered under the California infertility insurance mandate include infertility diagnostics, infertility tests , fertility medication, surgery, and gamete intrafallopian transfer (GIFT). In vitro fertilization, which is excluded from the requirement, is defined as a laboratory medical procedure that involves the actual in vitro fertilization process.

The California infertility insurance mandate does not require employers from religious organizations to offer coverage for fertility treatments that may be “inconsistent with the religious organization's religious and ethical principles.

Comments (2)

Had only two pregnancies in my life. One with 8 year-old son and second with deceased 5th month-of-pregnancy daughter. My mom had 8 children. I had/have no health problem (e.g. blood results 100% great) and was 36 while I was pregnant with daughter. They said I just had an incompetent cervix. I believe it was caused by (at the time) intern/resident/student Doctor who gave me a C-section. They said there's no proof or medical fact that can cause it but I saw an article online in OBY/GYN from Japan 5 yeas later that states C-sections performed by doctors may cause an incompetent cervix...causing ladies to lose their next child unexpectedly. That same doctor has 3 children now. Ever since daughter's death, I became heartbroken and sad and find it difficult to conceive. Now at 40, I contacted the doctor about it and he tells me to try a infertility doctor. Why isn't infertility insurance included in health insurance? It was not a health problem before, but after the C-section...it is.

Hi Hard to Conceive,

You might be able to have your doctor or insurance company push through the claim for coverage depending on whether or not you need IVF. Call your insurance company and also speak with your fertility doctor.

Best,
Kim

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