The law amends the state’s Insurance Code to prohibit insurers from withholding coverage for most fertility treatments based on “age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, sex or sexual orientation.” (See AB460.pdf)
Most fertility treatments, including some that cost tens of thousands of dollars, are included, such as “diagnosis, diagnostic tests, medication, surgery, and gamete intrafallopian transfer.” Although the law covers artificial insemination, it specifically excludes in vitro fertilization.
The bill also contains a conscience clause that “shall not be construed to require any plan, which is a subsidiary of an entity whose owner or corporate member is a religious organization, to offer coverage for treatment of infertility in a manner inconsistent with that religious organization’s religious and ethical principles.”
A.B.460 was introduced by Assemblyman Tom Ammiano, a San Franciso Democrat and LGBT rights activist who portrayed himself in a film starring Sean Penn about the murder of openly gay San Francisco Supervisor Harvey Milk by a disgruntled former supervisor.
"To restrict fertility coverage solely to heterosexual married couples violates California's non-discrimination laws. I wrote this bill to correct that," Ammiano said in a statement praising Brown for signing the legislation.
“We applaud the Governor and the Legislature for recognizing that same-sex couples, transgender people, and single women should have equal access to fertility services,” echoed Cathy Sakimura, Family Protection Project director at the National Center for Lesbian Rights.
Couples in California currently have to try to conceive naturally for 12 months before coverage for fertility treatments kicks in.
"The National Institute for Health and Clinical Excellence (NICE) recently released updated clinical guidelines on assessment and treatment for people with fertility problems. Included in the guidelines are definitions for when men and women in same-sex relationships not having vaginal intercourse should be eligible for assessment and possible treatment for infertility. Specifically, the clinical guidelines state that “for same-sex couples, failure to conceive after 6 cycles of [artificial insemination] within the 12 past months should be the indication for further assessment,” according to an analysis of the bill by the California Health Benefits Review Program.
The report noted that AB460’s “impact on costs is unknown,” including whether the additional costs of providing fertility treatment to gays and unmarried individuals will shift to other public or private premium payers.
The California Association of Health Plans took no position on the final version of the bill. “I think that the plans will move forward and implement the law,” spokeswoman Nicole Evans told reporters.