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Resource update · October 26, 2026

DMHC revised fertility coverage guidance (APL 25-021, SB 729/AB 116)

Revised regulatory guidance — not a carrier rate announcement. For payroll and HR administrators planning renewals, employee communication, and enrollment setup.

Published . DMHC revision dated .

Official source: DMHC revised All Plan Letter 25-021 (PDF) →

Scope. The APL applies to DMHC-regulated full-service commercial health plans. It does not apply to Medi-Cal managed care plans, Medicare Advantage plans, or religious employers. This summary does not extend to self-funded plans or CDI-regulated insurance policies, which are outside this guidance.

This is general administrative information from the DMHC letter only — not a premium forecast, plan recommendation, or legal advice. Nothing here indicates a change to January 2027 premiums.

Two effective dates

Underlying requirements —

SB 729, as delayed by AB 116, applies to contracts issued, amended or renewed on or after January 1, 2026.

October 2026 revisions —

DMHC says the revisions take effect for contracts issued, amended or renewed on or after July 1, 2027.

Small group vs. large group

Small group: plan must offer coverage
  • At least 1 completed sperm retrieval or sperm collection
  • At least 1 completed oocyte retrieval
  • At least 1 year of cryopreservation and storage

An offer is not automatic coverage. Employers decide whether to elect it; it does not mean every employer pays for it.

Large group: plan must cover
  • At least 3 completed sperm retrievals or collections, and at least 3 completed oocyte retrievals
  • At least 5 years of cryopreservation and storage

Other revised details

  • Donor procurement: at least 3 oocyte cohorts with a minimum of 8 oocytes each, and at least 6 vials of semen.
  • Small-group lifetime limits: the October 5 redline deletes the prior blanket statement prohibiting lifetime limits for small-group coverage. Because the remaining redline text is grammatically unclear, review the actual carrier offer or rider for any lifetime retrieval, storage, or benefit limits. This is separate from the minimum small-group offer terms above.
  • Donor and surrogate services are covered through the enrollee's plan, regardless of the donor's or surrogate's own coverage.
  • When an enrollee changes plans during the storage period, the prior and new plans coordinate the transfer of stored genetic material.
  • Prior elective sterilization: plans may not deny treatment based solely on sterilization performed for medical safety, health or disease prevention, or gender-affirming care. Surgical reversal is not required.

Payroll and HR checklist — July 1, 2027 and later renewals

  1. Renewal review: verify whether fertility coverage is included (large group) or offered (small group) in the renewal.
  2. Compare the benefit: the exact rider or benefit, member cost sharing, exclusions, retrieval and storage limits, and any premium impact.
  3. Employee communication: explain what is included only after the benefit is confirmed in plan documents.
  4. Enrollment configuration: update plan and rider codes in your enrollment system once the elected plan is final.
  5. Payroll deductions: change deductions or employer contributions only after the employer elects the offered benefit and rates are confirmed.

More renewal sources: California group renewal research →