CommercialCoverageMedium impact
25-641 Expanded Coverage for Infertility Diagnosis and Treatment, Including In Vitro Fertilization
Health Net·CA · OB-GYN, Endocrinology·Prior Authorization
Effective date
Jul 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net is implementing expanded coverage for infertility diagnosis and treatment under California Senate Bill 729, including IVF with up to three completed oocyte retrievals and unlimited embryo transfers. Coverage begins July 1, 2025 for large groups, with different effective dates for various plan types, and maintains existing prior authorization requirements.
Action Required
By July 1, 2025: Billing team must verify member eligibility for new infertility benefits based on group size and plan type. Update billing procedures to apply standard cost-sharing (office visit copayments, drug tier copayments) for infertility services. Ensure infertility services are counted toward out-of-pocket maximums. Continue following existing prior authorization requirements for covered infertility services. Note: SIMNSA tier of Salud HMO effective January 1, 2026, and CalPERS plans effective July 1, 2027.