California Senate Bill 729 (SB 729), which addresses fertility and infertility healthcare coverage, takes effect for employee benefit plans on January 1, 2026. 

What? Large-group fully insured health plans (covering 100+ employees) must cover infertility diagnosis and treatment, including in vitro fertilization (IVF), intrauterine insemination (IUI), egg retrieval cycles, and embryo transfers. Small-group plans (covering 1-100 employees) must offer employers the option to purchase this coverage.

Who? The law expands the definition of infertility, bringing long-excluded groups such as LGBTQ+ families and single parents by choice under the umbrella of covered care. 

California isn’t the first state to move in this direction. Illinois, New York, Colorado, Connecticut, and others have required fertility benefits for years. However, SB 729 stands out as one of the more comprehensive in the country so far. 

As employers prepare for 2026 renewals, many are already feeling the strain of rising healthcare costs, and the addition of SB 729 may bring understandable concerns about premium impact. However, early data from states with similar mandates suggests that premium impact is modest, typically between 0.5-1.1% range, depending on existing coverage and workplace demographics.  The impact on California businesses will vary, but the mandate also introduces a benefit with meaningful value for employees and strategic potential for employers who lean in. 

Key provisions of SB 729

Here’s a high-level overview of SB 729 requirements for fully insured large-group plans: 

• Required fertility coverage for large group plans: Large-group plans must provide coverage for the diagnosis and treatment of infertility and fertility services, including up to three completed egg retrievals, unlimited embryo transfers, and medically necessary fertility preservations (e.g., egg or sperm freezing prior to cancer treatment). 
• Applies only to fully insured health plans: Self-funded ERISA plans are not required to comply, though many employers may choose to align voluntarily to reduce inequities and remain competitive in talent markets. 
  Fertility coverage option for small-group plans: Small-group plans must offer infertility and fertility coverage as an option to employers. 
• No special limits, exclusions, or higher costs: Plans cannot impose restrictions on fertility services that differ from other medical services, including higher copays or coinsurance, different deductibles, separate waiting periods, or lower benefit maximums.
• Coverage cannot be denied when third parties are involved: Plans cannot deny or exclude treatment based on the involvement of third parties such as egg donors, sperm donors, embryo donors, gestational carriers, or surrogates. This is significant for same-sex couples, single parents by choice, and many others pursuing assisted reproduction. 
• Extraterritorial applicability: The law appears to apply to out-of-state policies that cover California employees, though the scope is not entirely clear. Employers with multistate workforces should monitor guidance from regulators and carriers as the interpretation is clarified. 

As with any statewide mandate, the details of SB 729 will vary by employer depending on plan type, renewal timing, and workforce needs. Employers should review the full legislation and work closely with their benefits advisors to understand how these requirements intersect with their current plan structure. 

How SB 729 can be a talent advantage

Family-building benefits carry outsized meaning for today’s workforce. Over 30% of employees say support for preparing to have a family is their most important benefit, and 73% of Millennials and 69% of Gen Z say they’re more likely to stay with an employer that offers these benefits. Fertility benefits can be a meaningful driver of retention in a labor market where turnover costs often range from half to more than twice the annual salary of the lost employee.

While SB 729 levels the playing field regarding required coverage, it does not codify how employers communicate, support, and deliver this benefit. Companies that educate employees early, offer empathetic guidance, and connect the mandate to their culture and values will stand out — particularly among women in leadership, LGBTQ+ individuals, and early career talent — even when offering the same required coverage.

Best practices for employers navigating SB 729:

1. Help your employees understand this new benefit.
While SB 729 may be a major focus for leadership and HR teams, most employees won’t immediately recognize its implications for them. Like every change during open enrollment season, clear, proactive communication ensures your teams understand the value and feel supported. 

Use open enrollment as an opportunity to: 

• Explain your renewal date and when SB 729 coverage begins
• Outline what’s changing in plain language
• Prepare HR teams with scripts and FAQs for sensitive questions
• Reinforce that the company supports diverse family structures and journeys

How you communicate this benefit — transparently and early — is where differentiation happens

2. Position SB 729 as a meaningful enhancement to your benefit offerings.
Employees across the country are bracing for higher contributions and rising medical costs. Highlighting the impact of SB 729 helps balance the benefits narrative. Employers should take the opportunity to explain what’s changing, why it matters, and how it meaningfully supports employees’ family-building needs. 

3. Reevaluate existing fertility benefits and look for opportunities to optimize. 
Employers that currently offer benefits to help employees offset the cost of IVF and related services should reassess their offerings and determine what may be redundant. It’s also an ideal time to decide where additional investments could make a meaningful difference. For example, employers could reinvest any savings from redundant benefits into mental health or leave benefits for employees undergoing fertility treatment. 

4. Prepare for operational changes.
SB 729 introduces several operational considerations for HR and benefits teams. Employers should anticipate:

• Carrier guidance on authorization and medical-necessity criteria
• Increased coordination between OB/GYN, reproductive endocrinology, and behavioral health providers
• Eligibility questions from LGBTQ+ employees, single parents by choice, and nontraditional families. 

HR teams should also be prepared to navigate sensitive conversations, timelines, and documentation requirements as employees begin exploring fertility services. 

Getting the full value out of SB 729
If you’re responsible for funding this benefit, the best way to get value from it is to help your employees understand it, access it, and feel supported using it. When employees know how to navigate the changes, this emotionally meaningful benefit can become a signal of care, inclusion, and long-term investment in your workforce.