IVF coverage in California for single and LGBTQ+ patients
California's law uses an inclusive definition of infertility: you qualify based on a physician's finding or on being unable to conceive without medical intervention, with no requirement for a period of unprotected heterosexual intercourse. Plans in scope of the law cannot make single or same-sex-partnered patients pay out of pocket for the diagnostic phase that heterosexual couples get covered.
What to ask
- "How does the plan define infertility, and does it apply to me?"
- "Is donor sperm or donor egg purchase covered?" (Most state laws exclude the purchase; some carve-outs cover it.)
- "Are IUI cycles required before IVF, and do self-paid IUIs count?"
Where people get surprised
- Self-funded employer plans (the majority at large employers) are exempt under federal ERISA law — the card usually says 'administered by'.
- Coverage starts at renewal, not on Jan 1 — ask HR for your plan year start date.
- Religious employers may claim an exemption.
- Medi-Cal does not cover IVF.
- PGT-A, embryo storage beyond the cycle, and donor gametes may be handled differently by each plan — ask specifically.