California Law Mandating Insurance Coverage

The California Infertility Health Insurance law requires insurers to offer coverage for infertility diagnosis and treatment.  Insurers must let employers know infertility health insurance coverage is available as an option to offer to employees.

The California mandate does not require that insurers actually provide infertility health insurance coverage - just offer the option.  It also does not force employers to include infertility coverage in their employee insurance plans.  The law is intended to make sure the option is available for those employers who choose to make it available.

Consider using supplemental infertility insurance coverage to fund your maternity leave, and protect your income in case of complications, and/or premature birth.

The California Infertility Insurance law defines infertility as:

• The presence of a demonstrated condition recognized by a licensed physician and surgeon as a cause of infertility; or
• The inability to conceive a pregnancy or carry a pregnancy to a live birth after a year or more of sexual relations without contraception.

Employers decide if they will provide the following benefits to their employees:

• Diagnosis and diagnostic tests for infertility
• Fertility drugs
• Surgery
• Gamete Intrafallopian Transfer (GIFT).

Cut your infertility treatment costs by 1/3 or more by using your flexible spending account to pay for un-reimbursed infertility treatment expenses.

The California law specifically exempts insurers from having to offer in vitro fertilization coverage (IVF). Also, the law does not require employers that are religious organizations to offer coverage for treatment that conflicts with the organization's religious values.

What This Means for You

Infertility health insurance mandates raise the costs of insurance for all plan participants.  Insurers competing for business are unlikely to include the coverage unless specifically requested by an employer.  Employers looking to cut cost are unlikely to make the option available unless the employee population demands the option. 

You may find that your employer does offer health insurance with infertility coverage.  And even if they do, you may find that many procedures are not covered.

Get interest free fertility treatment financing through your flexible spending account.  Your annual election is availabe on the first day of your plan year for eligible expenses such as your IVF procedure, and other infertility treatments.