Key points to using fertility insurance
- Fertility insurance is an element of a health insurance plan that provides coverage for certain aspects of fertility treatments.
- The type of plan and the particulars of premiums, deductibles and out-of-pocket payments vary with different plans.
- A new California law (SB 729) will soon greatly expand fertility treatment coverage – including in vitro fertilization (IVF) and LGBTQ+ services – in large company employer-based plans.
- Ember Fertility Clinic is an in-network provider for many health insurance plans, listed below.
- Our skilled insurance experts can help patients get the most out of their fertility insurance benefits.
At Ember, everyone is a VIP – very important patient
And we have a thing for the small things: Each Ember patient gets a dedicated fertility coordinator, a patient’s personal care guide through every clinic detail, from the very first phone call to meeting your little miracle.
Fertility insurance and how coverage varies
Any health insurance can be difficult to understand and insurance for fertility treatments often can be even more complicated. Some plans offer generous benefits, some offer partial coverage and others may provide no coverage for fertility services.
It’s crucial that Ember patients check their specific policy for coverage details before treatment begins. Once patients have a basic understanding of their coverage, we can help them with specifics on utilizing their fertility insurance coverage for services and treatments at our practice.
Knowing what to expect ahead of time helps prevent surprises on unforeseen costs, delays in care, and frustration with insurance limitations and requirements. This is very important because health insurance for fertility treatment in California is about to experience a major change with the implementation of California Senate Bill 792 that mandates that large group health insurance plans that cover more than 100 employees provide coverage for infertility treatment, including IVF. See the section below for more details on SB 792.
Fertility insurance FAQ
- What are the different types of fertility insurance plans?
- Employer health insurance, private health insurance and government health plans.
- What fertility care is covered by my insurance?
Your health insurance plan will include an explanation of benefits section that lists covered services as well as copay amounts and limits on coverage. You can also call a representative of your plan. - What insurance items should I bring to my appointment?
Have your insurance card, member ID number and contact information for your insurer. This helps us verify coverage and benefits more easily. - Is Ember Fertility an in-network provider for my insurance?
The list of insurance networks Ember works with that are considered in-network for your plan is below. You can also contact us. - What costs should I be aware of with my insurance plan?
Understand your premiums, deductible, copays or coinsurance, coverage limits and the out-of-pocket responsibility. - Do I need a referral in order for my visit to your clinic to be covered?
Check if your plan requires a referral for fertility care and learn how to obtain a referral if needed.
Types of fertility insurance & what they cover
Fertility coverage can depend on your employer, your insurance provider and the type of plan you have. Following is general information on insurance plans and coverage. Patients’ plans can provide a wide variety of coverages and exclusions, so checking with the insurance provider is necessary for specific information.
Types of health insurance plans
Employer health insurance is insurance provided through a person’s employer and is what most people have in the United States. Coverage options, premiums, deductibles and copay amounts vary.
Private health insurance is purchased by the individual or family directly from an insurance provider. Patients can access these on their own, through an insurance broker or through the California Health Insurance Exchange.
Government health insurance is provided through the state or federal government and include Medi-Cal (California’s Medicaid) for limited incomes and California Covered marketplace.
Fertility treatments and services that are often covered
Patients should always check if a treatment is covered by insurance before proceeding. Those with insurance policies that do not cover fertility care, or patients with no insurance coverage, will self-pay for fertility services. We offer several financial discounts and financing services that can help with this.
These fertility treatments are often covered by insurance
- Diagnostic testing: evaluations to determine causes of infertility and effective treatment.
- Medications: fertility drugs to stimulate ovulation and for other purposes.
- Surgical procedures: surgical treatments addressing reproductive health issues.
- Assisted reproductive treatments: such as IVF and intrauterine insemination (IUI).
- LGBTQ+ reproductive services: for individuals and couples unable to conceive without medical intervention, which includes LGBTQ+ and single patients.
Covered health insurance plans Ember accepts
Future Family, see below.
Check back soon for additional health plans.
California SB 729 expands fertility insurance coverage
Starting July 1, 2025, California law SB 729, called “Health care coverage: treatment for infertility and fertility services,” will require large group health plans (100+ employees) to cover infertility diagnosis and treatment including IVF. With IVF, the law allows up to three completed egg retrievals and unlimited embryo transfers.
Note: The law’s implementation is likely to be postponed until January 1, 2026. This is to allow the state time to update its benchmark plan, which will be used as a model for commercial insurers.
While small group plans are not required to include this coverage, insurers must offer it as an option. It remains unclear whether the law mandates coverage for donor materials, gestational carriers or surrogate-related medical costs.
LGBTQ+ patients benefit from expanded definition of infertility
SB 729 also broadens the definition of infertility to be more inclusive, benefiting LGBTQ+ individuals and couples as well as single parents. Coverage must be provided without discrimination based on factors like age, gender identity, disability, marital status or sexual orientation.
IVF refund programs
Ember Fertility Center offers its patients a financially protected plan for IVF treatment. This plan, backed by our partner Future Family, which is the first organization to offer IVF insurance, ensures that patients either have a baby or receive their money back.
This unique insurance policy reduces patient stress by eliminating the possibility of “total loss.” If IVF treatment at Ember Fertility Center is unsuccessful, patients are reimbursed for the treatment cost, providing a financially protected path to parenthood.
How Future Family works
- Fill out an application online.
- Once your eligibility is confirmed, you will get an initial premium quote.
- Choose between plans for a single cycle, two cycles, or two cycles with meds included.
- Our doctor will give you an IVF form to submit.
- Pay your premium, which can be financed, and start IVF treatment.
- If your IVF cycle(s) with frozen embryo transfers are not successful, submit a claim for money back.
Future Family IVF insurance can be a great fit for patients with poor ovarian reserve, who have failed with IVF before, or those with no apparent problems to IVF success who are looking for assurance and peace of mind.
Common health insurance terms
Health insurance premium
The amount you pay for a health plan, usually monthly. Employers often cover some or all of this for job-based plans.
Cost sharing
This is the split between what you pay and what your insurer pays for fertility care. These include:
- Deductible: The amount you pay out-of-pocket before insurance kicks in.
- Copayment: A fixed fee you pay for a service. In some plans, this only applies after meeting your deductible.
- Coinsurance: A percentage of the fertility service cost you pay (such as 15%) after meeting your deductible.
- Out-of-Pocket maximum: The cap on what you pay in a year. Once reached, insurance covers 100% of covered care.
Explanation of benefits (EOB)
A document from your insurer that details what is covered, what you will owe for the service and what part the insurer paid for the service.
