5/15/2025
California
In 2025, California has made changes to coverage for Emergency Room Service, IVF and Preventive Care. These changes apply to fully insured plans but do not apply to self-funded plans, including level-funded plans.
Emergency Room Service Changes in California (2025)
In 2025, California introduced important changes to emergency room (ER) services under state law, particularly aimed at improving access, safety and follow-up care.
Expanded Coverage for Survivors of Sexual Assault
This law is effective for plans issued, amended, renewed, or delivered on or after July 1, 2025. It applies to individual, small, and large group fully insured plans in California.
Key IVF Coverage Changes in California (Effective 2025)
Mandatory IVF Coverage for Large Group Plans
In 2025, California passed legislation to ensure access to preventive health services, regardless of changes at the federal level. Here’s a summary of the most important updates.
SB 406 codifies the requirement for California-regulated health plans to follow U.S. Preventive Services Task Force (USPSTF) recommendations for preventive services, independent of federal mandates.
These protections apply to individual and small group fully insured plans, including those purchased through Covered California.
Emergency Room Service Changes in California (2025)
In 2025, California introduced important changes to emergency room (ER) services under state law, particularly aimed at improving access, safety and follow-up care.
Expanded Coverage for Survivors of Sexual Assault
- AB 2843 requires full-service health plans to:
- Cover emergency room medical care for survivors of rape or sexual assault.
- Provide nine months of follow-up services at no cost to the patient.
- This includes no cost-sharing, meaning no copays, deductibles or coinsurance.
- Insurer cannot require enrollee to have filed a police report or have brought charges against an assailant, or for the assailant to have been convicted of rape or sexual assault.
This law is effective for plans issued, amended, renewed, or delivered on or after July 1, 2025. It applies to individual, small, and large group fully insured plans in California.
Key IVF Coverage Changes in California (Effective 2025)
Mandatory IVF Coverage for Large Group Plans
- SB 729, signed into law by Governor Gavin Newsom in September 2024, requires large group health insurance plans to cover:
- Diagnosis and treatment of infertility
- Fertility preservation services
- In vitro fertilization (IVF) (maximum of 3 completed oocyte retrievals and unlimited embryo transfers)
- Limits cost-sharing to the same structure as for other benefits.
- Revises the definition of infertility and removes the exclusion of in vitro fertilization from coverage.
- The law applies to large group fully insured health plans issued or renewed on or after July 1, 2025 (typically employers with 101+ employees).
- Fully insured small group plans can provide the new level of benefits but are not required to do so.
In 2025, California passed legislation to ensure access to preventive health services, regardless of changes at the federal level. Here’s a summary of the most important updates.
SB 406 codifies the requirement for California-regulated health plans to follow U.S. Preventive Services Task Force (USPSTF) recommendations for preventive services, independent of federal mandates.
- Requires health plans to cover preventive services recommended by the USPSTF without cost-sharing, even if federal protections under the Affordable Care Act (ACA) are weakened. This includes:
- Cancer screenings (e.g., mammograms, colonoscopies)
- Immunizations
- Well-woman visits
- Contraceptive care
- HIV prevention medications (e.g., PrEP and PEP)
These protections apply to individual and small group fully insured plans, including those purchased through Covered California.