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Beyond SB 729: What New Federal IVF Proposals Could Mean for Self-Funded Employers

When California enacted SB 729, many employers focused on understanding how the law would affect their health plans. While the new mandate expanded infertility coverage requirements for certain fully insured health plans, self-funded employers were largely left outside its scope.

Now, federal policymakers are exploring ways to expand access to fertility benefits nationwide, including for employers that sponsor self-funded health plans. Recent federal proposals could create new opportunities for employers to offer fertility and in vitro fertilization (IVF) benefits in a more flexible and potentially more accessible way.

A quick review of SB 729

Effective for plan years beginning on or after January 1, 2026, California's SB 729 requires fully insured large group health plans to cover infertility diagnosis and treatment services, including certain IVF services. However, the law does not apply to self-funded plans.

Because self-funded plans are generally regulated under federal law rather than state insurance mandates, many employers sponsoring these plans have continued to evaluate fertility benefits based on their own workforce needs, benefit strategies, and budget considerations.

Federal focus on IVF access

In February 2025, the White House issued an Executive Order directing federal agencies to develop recommendations aimed at protecting access to IVF and reducing the cost of fertility treatment. The order highlighted the significant financial barriers many individuals face when pursuing IVF, with treatment costs often reaching tens of thousands of dollars.

In response, the U.S. Departments of Labor, Health and Human Services, and Treasury issued proposed regulations in May 2026 designed to expand access to fertility benefits through employer-sponsored plans.

A new category of fertility benefits?

The proposed regulations would create a new category of "excepted benefits" for fertility services. Excepted benefits are a type of coverage that can be offered separately from an employer's primary medical plan, similar to stand-alone dental or vision benefits.

Under the proposal, employers could offer fertility benefits focused on the diagnosis, mitigation, or treatment of infertility through a separate benefit arrangement. The proposed coverage could include services such as fertility evaluations, medications, counseling, and assisted reproductive technologies, including IVF.

Importantly, the proposal would allow these benefits to be offered by both self-funded and fully insured employers.

What could this mean for self-funded employers?

If finalized, the proposed rules could provide self-funded employers with additional flexibility when designing fertility benefits.

For employers that have been interested in supporting employees pursuing fertility treatment, a standalone fertility benefit may offer an alternative to incorporating those services directly into the major medical plan. The proposal may also create opportunities to expand access for employees who are not enrolled in the employer's primary health plan.

At the same time, employers would still need to evaluate several factors, including:

• Program costs and funding considerations

• Administrative requirements

• Vendor and third-party administrator capabilities

• Coordination with existing health plan benefits

• Employee communication and education needs

As with any emerging benefit strategy, employers should carefully monitor regulatory developments before making plan design decisions.

What's next?

The federal fertility benefits proposal is not yet final. A public comment period closed in July 2026, and regulators are currently reviewing feedback. If finalized, the new fertility benefit option is expected to become available for plan years beginning on or after January 1, 2027.

For employers sponsoring self-funded plans, the proposal is worth watching. While SB 729 focused on expanding access to infertility coverage in California's insured market, the federal initiative could broaden the conversation by creating new opportunities for self-funded employers to offer fertility and IVF benefits to their workforce.