The California Infertility Insurance Mandate: Another Step Toward Reproductive Justice?

American Journal of Obstetrics & Gynecology

DOI: 10.1016/j.ajog.2025.10.014

First author: Alexander M. Quaas
Journal: American Journal of Obstetrics & Gynecology
Month, Year: February 2026

Synopsis

This AJOG Perspective examines California Senate Bill 729, signed in September 2024, which mandates infertility insurance coverage for large group health plans starting January 1, 2026. The law requires coverage for infertility diagnosis and treatment, including up to three completed oocyte retrievals and unlimited embryo transfers, while prohibiting discrimination based on sexual orientation, gender identity, or marital status. The authors frame the statute within reproductive justice, emphasizing infertility as a disease rather than an elective service. They review the evolution of infertility insurance mandates across the United States and summarize evidence that mandates increase access to assisted reproductive technology while encouraging safer practices such as single embryo transfer. The article also addresses criticisms regarding cost and mixed effects on disparities. Unresolved issues include exclusions for Medi-Cal beneficiaries, small group plans, and uncertainties surrounding coverage for third-party reproduction.