Sutter Health Plan Discusses Coverage For Infertility and Fertility Services In Light of SB 729

California Senate Bill (SB) 729 expands coverage requirements for the diagnosis and treatment of infertility and fertility services to:

• Large group health plans — these plans must include coverage for the diagnosis and treatment of infertility and fertility services.
• Small group health plans — these plans must offer coverage for the diagnosis and treatment of infertility and fertility services.

Coverage for Infertility and Fertility Services

Sutter Health Plan will embed coverage for medically necessary services, supplies and drugs for the diagnosis and treatment of infertility and fertility services as follows:

• All large group employers with new or renewing plans effective on or after July 1, 2025 
• All small group employers with Plus plans as of July 1, 2025, regardless of plan effective date 

Note: These changes do not apply to small group Standard plans or Individual and Family plans. 

Covered services include, but are not limited to: 

• Consultations, exams, diagnostic tests, procedures, and drug therapy to diagnose and treat infertility 
• A maximum of three completed oocyte retrievals 
• Unlimited embryo transfers, using single embryo transfer when recommended and medically appropriate 
• Cryopreservation and storage of sperm, oocytes, gonadal tissue, and embryos for a period of three years
• Cost sharing for covered services to diagnose and treat infertility and fertility services are the standard cost sharing applicable to the type of service (e.g., office visit, outpatient lab, etc.)

For more specific information about a group’s coverage, please refer to their Sutter Health Plan Evidence of Coverage (EOC) available on Sutter’s Broker Portal as applicable, based on plan type and renewal date. 

Important Definitions

For purposes of this benefit, infertility means a condition or status characterized by any of the following:

• A licensed physician’s findings, based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors  
• A person’s inability to reproduce either as an individual or with their partner without medical intervention  
• The failure to establish a pregnancy or to carry a pregnancy to live birth after regular, unprotected sexual intercourse. 

Additionally, there is a lifetime limitation for infertility and fertility services. For this benefit, lifetime includes all infertility and fertility services provided to a member while they are covered by Sutter Health Plan. 

Here for You

If you have questions about the information in this update, call Sutter Health’s Customer Service at (855) 315-5800, available 8 a.m. to 7 p.m., Monday through Friday.