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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 (7)

We are so bummed, my wife and I call her Insurance UnitedHealthway HMO. They do not cover any infertility stuff, just PCP and Ob Gyn for papsmear and women health stuff. I thought they would cover some infertility stuff if it is madated in California. We are so sad. We have been TTC for about 5 years, now that we devided to call the insurance we get the bad news. We are so sad :(

Hello Jose,

I am so sorry to hear that you and your wife have been struggling. When you called your insurance provider did you inquire further about the state mandate in California? Fertility clinics in California typically do not accept HMO plans. I'm very sorry as I know that is a major road block. Has your wife discussed these concerns with her Gynecologist? Gynecologists can assist with fertility related concerns / questions / diagnostic testing. If she hasn't already I highly recommend that she do so. Have you undergone a semen analysis test with a Urologist? If you haven't already, I recommend that you do so as well as these specialists can also assist.

If finances are a concern you can apply for grants / financial aid programs:

https://www.fertilityauthority.com/costs/grants-and-aid-infertility-trea...

I hope this helps.

Best,
Julie

hello, at 16 years old before my miscarriage i was regular in my menstrual cycle, after the miscarriage i became very irregular (having periods 3/4 times a year). since im trying to conceive, i made an appointment with my obgyn to see if she could help me check why im not getting regular cycles. She reffered me to a fertility specialist, but they said they couldnt help me without fertility insurance. i was bummed out specially because i went back to my obgyn told her what the specialist had said and she told me there was nothing she could of help me with that i was going to have to look for another clinic outside my insurance. Clinics are expensive outside my insurance, i went with my family doctor and all he was able to help with was giving me birth control. Before bc i went 150 days without a period and being irregular is hard to track ovulation. I dont know what to do anymore i get so depress from this.

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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