Amanda Wilde (Host): Welcome to Fertile Edge, a podcast presented by the Reproductive Science Center of the San Francisco Bay Area. I'm your host, Amanda Wilde. Today, everything you need to know about the new California Insurance Mandate with Dr. Deborah Wachs. Dr. Wachs is IVF Practice Director and Managing Partner at Reproductive Science Center. Thank you so much for being here today, Dr. Wachs.

Dr. Deborah Wachs: Thank you so much for having me.

Host: What is SB 729?

Dr. Deborah Wachs: So, SB 729 is a new Senate Bill that has passed in California. It's a law that expands insurance coverage for infertility and fertility treatment.

Host: And in what ways does it do that?

Dr. Deborah Wachs: So prior to this law going into effect, large group insurance health plans did not necessarily have to cover fertility. And the biggest change that we are excited to see for our patients is that an infertility diagnosis that comes from a physician now leads to insurance coverage for the fertility treatment that will follow.

Host: When does the new law take effect?

Dr. Deborah Wachs: That's a little tricky to answer. So officially, the mandate starts January 1st of this year. But what will really happen is that, as plans are renewed or as open enrollment is completed, that's when the plan will need to go into effect. So for employers, any renewal or open enrollment that occurs in 2026 then has to go into effect for the new plan. And many of the employers do open enrollment towards the end of the year. So for many of our patients, it may be that the open enrollment that they have in October or November of 2026 is what's going to allow the mandate to go into effect for them for the following year.

Host: You just mentioned employers. What about clients or patients? What should we do to prepare for the new mandate coverage?

Dr. Deborah Wachs: So, we're encouraging all of our patients to talk to their employers to understand how their employers are going to be rolling out this mandate. It is also important to understand that there are some employers who are putting it into effect earlier. So, it's a combination of patients speaking directly to their human resources department plus our office and our financial counselors helping patients navigate.

Host: Can you expand on what services are covered under this new law?

Dr. Deborah Wachs: Yes. So, what SB 729 covers is the diagnostic procedures and tests that are being ordered to arrive at the diagnosis of infertility, then the treatment recommendations that follow. That can include IVF services and specifically up to three egg retrievals. Then, following egg retrievals, the next step is commonly embryo transfer. And the plan does cover unlimited embryo transfers following clinical guidelines. And we also expect that there will be the tests that patients often had to pay out of pocket. Thus far, tests for their fallopian tubes, semen analysis, hormone levels, so that will all fall under the diagnostic portion.

Host: So, this will make a big difference for your patients who is eligible under the new California mandate.

Dr. Deborah Wachs: This is potentially going to make a huge difference for a lot of our patients. Up until now, we had approximately 50 to 60 of our patients who already had fertility as a covered benefit, and that's been great for them. But it was always really challenging for the large subset of patients who didn't fall under an insurance plan that was covering it.

The definition is broad, and that's another aspect that is really exciting for patients and far more inclusive for patients. So when the law is defining who falls under this, it is no longer excluding patients based on their marital status or their sexual orientation or gender identity. We now have clear guidelines that LGBTQ+ individuals will have coverage, same sex couples will have coverage, single people will have coverage. So, it's far more inclusive and expansive.

Host: So, many more folks are covered. Who is not covered?

Dr. Deborah Wachs: So, there's a couple areas that seem to be carved out. One is fertility preservation that is falling under an elective diagnosis. So, we have a lot of patients who come to us who aren't quite ready to start their families, or they're single and they want to freeze their eggs, that is excluded from this plan.

So, what they're calling elective egg freezing or elective embryo freezing for a non-medical reason is generally going to be excluded. Just to follow-up on that, if fertility preservation is deemed medically necessary, so for example, if somebody is going to start chemotherapy treatment for a new cancer diagnosis, that's considered a medical indication for fertility preservation, and that will likely fall under the bill. But not all plans are going to have to follow this mandate. Small employers, less than a hundred employees are not being held accountable to the same mandate.

Host: So, what should clients or patients look at in terms of if they are not covered under this new law, can you address what happens for those folks?

Dr. Deborah Wachs: Yes, they fall under a category that we're very used to helping because, up until this point, we really have had a lot of patients who came to us already having the diagnosis of infertility and already knowing they needed treatment, but not necessarily having coverage for that. What we try to offer at RSC is every patient has their own financial counselor. We have programs that can help patients apply for financial aid. We have payment programs, we have multi-cycle discounted programs. So, we are well set up for helping the subset of patients where this bill is not necessarily going to change their coverage.

Host: So, that's a real benefit that you have, those resources to provide.

Dr. Deborah Wachs: Absolutely. Another thing that we're excited about is even without this bill, RSC has already had longstanding relationships with all of the major insurance carriers. Since 2008, we have had strong referrals and relationships with the insurance companies and have been able to provide patients who came in with that coverage. We've had contracts that were already in place. So, we're hoping for this whole new subset of patients who now have benefits, it'll be a very smooth transition because we're already contracted with their carriers most likely.

Host: That is excellent. Well, thank you, Dr. Wachs, for this important information about the California Insurance Mandate and how we go forward in the future.

Dr. Deborah Wachs: Thank you so much. One thing I'd also just love to add for patients is it's never too early to schedule the appointment and start the workup and get that diagnosis of infertility. And ideally, the patients will already have been seen by us. We'll know what plan we want to put into effect, and then we're just waiting for the insurance to kick in. And that will be really beneficial for patients to be ahead of the game rather than waiting for the coverage to kick in and then scheduling the appointment. So, we are really excited to open doors to patients for initial consultations to help them find out what their issues are, do they have this diagnosis, what treatment is going to be recommended, so that once the plan goes into effect, they're ready to go and they can just smoothly transition into treatment.

Host: That's great. Thank you so much for being a resource and, as I said earlier, getting us pointed in the right direction for those who will be exploring the new possibilities under this new mandate.

Dr. Deborah Wachs: Thank you so much.

Host: Dr. Deborah Wachs is IVF practice director and managing partner at Reproductive Science Center. To learn more about SB 729 or to schedule an appointment with an RSC fertility specialist, please visit rscbayarea.com. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Amanda Wilde. Thanks for listening to Fertile Edge, a podcast from the Reproductive Science Center of the San Francisco Bay Area.