1. (a) A health care service plan subject to this section shall cover medically necessary standard fertility preservation services pursuant to Health and Safety Code section 1374.551 if either paragraph (1) or (2) is true:

   1. (B) The provider recommends the enrollee receive such treatment within the next 12 months and the enrollee attests that the enrollee plans to undergo such treatment in the next 12 months. A health care service plan shall accept an attestation from the enrollee or provider contained in a request for services.

      (2)(A) The enrollee received a covered medical treatment that may cause infertility; and

   2. (B) The enrollee's medical condition was such that the enrollee was unable to either undergo fertility preservation or complete their fertility preservation cycle(s); and
   3. (C) The enrollee faces an ongoing risk for infertility due to reproductive damage caused by those treatments.

   (1)(A) The enrollee's provider has recommended the enrollee receive a covered medical treatment that may cause infertility; and

2. (b) As used in this section, “standard fertility preservation services” means any of the following services consistent with the current established medical practices and professional guidelines published by the American Society of Clinical Oncology or the American Society for Reproductive Medicine:

   1. (1) Retrieval of gametes as follows:

      1. (A) A lifetime limit of up to two cycles for oocyte retrieval for enrollees with ovaries.
      2. (B) A lifetime limit of up to two attempts to collect sperm for enrollees with testicles.
   2. (2) A lifetime limit of up to two attempts of embryo creation. However, a health care service plan shall not be required to cover any costs associated with the retrieval of gametes from anyone other than the enrollee undergoing the medical treatment that may cause iatrogenic infertility.
   3. (3) A lifetime limit of up to two attempts to retrieve gonadal tissue.
   4. (4) The lifetime limits specified in subdivision (b)(1)-(3) of this section apply to an enrollee regardless of the number of health care service plans the enrollee enrolls in during the enrollee's lifetime.

   5. (5) Cryopreservation and storage of sperm, oocytes, gonadal tissue, and embryos as follows:

      1. (A) Until the enrollee reaches age 26 for an enrollee who is under the age 18 on the date the enrollee's genetic material is first cryopreserved.
      2. (B) Until the enrollee reaches age 26 or for three years, whichever period is longer, for an enrollee who is 18 years or older but not yet 26 years old on the date the enrollee's genetic material is first cryopreserved.
      3. (C) For a period of three years for an enrollee who is 26 years or older at the time the enrollee's genetic material is first cryopreserved.
   6. (6) With respect to cryopreservation of genetic material, a health care service plan shall have the right to select a storage vendor of its choosing.
   7. (7) Gonadal shielding or transposition during a procedure or treatment, if not already included in the usual coverage for that procedure or treatment.
   8. (8) Any other standard fertility preservation services consistent with the established medical practices and professional guidelines published by the American Society of Clinical Oncology or the American Society for Reproductive Medicine.

3. (c) A health care service plan shall not deny a coverage request for medically necessary standard fertility preservation services based solely upon:

   1. (1) A prior diagnosis of infertility, where medical evaluation indicates that the enrollee would have a reasonable chance of responding to such services.
   2. (2) The enrollee's age, where medical evaluation indicates the enrollee would have a reasonable chance of responding to such services.
   3. (3) The enrollee's gender.
   4. (4) The enrollee's gender identity.
   5. (5) The enrollee's sexual orientation.
   6. (6) The enrollee's gender expression.
   7. (7) The enrollee's marital status.
   8. (8) The enrollee's disability.

4. (d) A health care service plan shall have no obligation to continue to cover storage for an individual who is no longer enrolled with the health care service plan.

   1. (1) If an enrollee changes health care service plans during the covered storage period and the new health care service plan deems it necessary to transport the genetic material to a different storage facility, the enrollee's new health care service plan shall be responsible for transportation costs of genetic material to a storage facility selected by the new health care service plan and is required to cover storage for the remainder of the applicable storage time frame to the extent required by this section.

      1. (A) With respect to embryo cryopreservation, the transportation and storage costs shall be paid by the new health care service plan providing coverage to the enrollee that received or is receiving medical treatment pursuant to this section.
      2. (B) The current health care service plan shall coordinate with the new health care service plan to ensure the transfer and transportation of genetic material is achieved in the most cost-effective manner. The current health care service plan shall provide the new health care service plan with information showing the beginning date of any cryopreservation of the genetic material.
      3. (C) The new health care service plan shall provide notice to the enrollee that the transportation and storage costs will be covered by the new health care service plan for the remainder of the applicable storage time.
5. (e) A health care service plan shall not deny a request for coverage of standard fertility preservation services based upon an exclusion of treatment of infertility contained in the health care service plan's Evidence of Coverage or related documents.
6. (f) Nothing in this section shall be construed to deny, restrict, or limit any existing right or benefit to coverage and treatment of infertility services or fertility services under any existing law, plan, or policy.
7. (g) Nothing in this section shall be construed to abrogate or diminish a health care service plan's obligations to provide basic health care services and to the extent applicable, prescription drugs as required by Section 1342.7(h), Section 1342.71(c), Section 1345(b), and Section 1367(i) of the Health and Safety Code and Section 1300.67, Section 1300.67.005, and Section 1300.67.24 of Title 28 of the California Code of Regulations.
8. (h) Nothing in this section shall require a health care service plan to cover services that are not medically necessary.
9. (i) Nothing in this section shall be interpreted to require a health care service plan to cover services that are considered experimental or investigational. If a health care service plan denies coverage on the basis that a requested service is experimental or investigational, that decision is subject to review under Section 1370.4 of the Health and Safety Code.
10. (j) A health care service plan contract shall not impose higher deductibles, copayments, coinsurance, longer waiting periods, or any other limitations on coverage for medically necessary standard fertility preservation services than those imposed on other basic health care services.
11. (k) Any medical necessity determination or the utilization review criteria the health care service plan, and any entity acting on the health care service plan's behalf, applies to determine the medical necessity of standard fertility preservation services shall be consistent with current guidelines or recommendations for standard fertility preservation therapies established by the American Society of Clinical Oncology or the American Society for Reproductive Medicine.

12. (l) This section shall not apply to a contract for any of the following:

    1. (1) Specialized health care services.
    2. (2) Medicare supplement pursuant to Article 3.5 of the Act (commencing with Section 1358.1).
    3. (3) Medicare pursuant to Title XVIII of the Social Security Act.
    4. (4) Medi-Cal managed care, including contracts with the State Department of Health Care Services for the delivery of health care services pursuant to Chapter 7 (commencing with Section 14000), Chapter 8 (commencing with Section 14200), Chapter 8.75 (commencing with Section 14591), or Chapter 8.9 (commencing with Section 14700) of Part 3 of Division 9 of the Welfare and Institutions Code.
13. (m) “Iatrogenic infertility” as defined by Health and Safety Code section 1374.551 subdivision (b)(1) does not include infertility caused by a medical treatment performed for the purpose of preventing pregnancy, including vasectomy or tubal ligation.

14. (n) 90 days before the expiration of the storage periods described in subdivision (b)(5) of this section, the health care service plan shall provide the enrollee with written notice explaining the termination of the storage period. At a minimum, the notice shall inform the enrollee of the following:

    1. (1) Options for continued storage of genetic material; and
    2. (2) Any potential out-of-pocket costs to the enrollee associated with the continued storage of genetic material after coverage has ended.

15. (o) 30 working days after receipt of a claim for cryopreservation services, as described in subdivision (b)(5) of this section, the health care service plan shall provide the enrollee with written notice explaining the covered storage period. At a minimum, the notice shall inform the enrollee of the following:

    1. (1) An explanation of how the timeframes in subdivision (b)(5) of this section apply to the enrollee based on the enrollee's age at the time cryopreservation services are received;
    2. (2) Options for continued storage of genetic material if coverage ends prior to the expiration of the storage period; and
    3. (3) Any potential out-of-pocket costs to the enrollee associated with the continued storage of genetic material if coverage ends prior to the expiration of the storage period.

16. (p) A health care service plan's Evidence of Coverage, Disclosure Forms, and any combined Evidence of Coverage and Disclosure Form shall include the following statements separately in bold and in no less than 12-point font:

    You have a right to receive standard fertility preservation services for iatrogenic infertility when you meet the requirements in Section 1300.74.551 of Title 28 of the California Code of Regulations. “Iatrogenic infertility” means infertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment. If [health plan name] fails to arrange those services for you with an appropriate provider who is in the health plan's network, the health plan must cover and arrange needed services for you from an out-of-network provider. If that happens, you will pay no more than in-network cost-sharing for the same services.

    If you do not need the services urgently, your health plan must offer an appointment for you that is no more than 10 business days for primary care and 15 business days for specialist care from when you requested the services from the health plan. If you urgently need the services, your health plan must offer you an appointment within 48 hours of your request (if the health plan does not require prior authorization for the appointment) or within 96 hours (if the health plan does require prior authorization).

    If your health plan does not arrange for you to receive services within these timeframes and within geographic access standards, you can arrange to receive services from any licensed provider, even if the provider is not in your health plan's network. If you are enrolled in preferred provider organization (PPO) coverage, and your health plan can arrange care for you within the timeframes and within geographic standards, your voluntary use of out-of-network benefits may subject you to incur out-of-network charges.

    If you have questions about how to obtain standard fertility preservation services for iatrogenic infertility or are having difficulty obtaining services you can: 1) call your health plan at the telephone number on your health plan identification card; 2) call the California Department of Managed Care's Help Center at 1-888-466-2219; or 3) contact the California Department of Managed Health Care through its website at www.DMHC.ca.gov to request assistance in obtaining standard fertility preservation services for iatrogenic infertility.

Note: Authority cited: Sections 1344 and 1374.551, Health and Safety Code. Reference: Sections 1342.7, 1342.71, 1345, 1367, 1367.03 and 1370.4, Health and Safety Code.

History

1. New section filed 4-18-2025; operative 7-1-2025 (Register 2025, No. 16).