Your Right to Fertility and IVF Benefits: What California Employees Should Know
Family-building isn’t one-size-fits-all. For many Californians, fertility treatment—including IVF, IUI, egg freezing, or fertility medications—is an essential part of starting a family. Here’s what employees should know about coverage, reimbursements, leave, and protections under California law and typical employer plans.
Do Employers Have to Cover Fertility or IVF?
California requires large-group health plans to offer infertility diagnosis and treatment, but IVF coverage depends on the specific plan. Many employers voluntarily provide enhanced fertility benefits (including IVF, medications, and genetic testing) or partner with fertility vendors. Self-funded employers set their own coverage rules. Always request the Summary Plan Description (SPD) and evidence of coverage to confirm:
- Which treatments are covered (IUI, IVF, medications, egg/sperm storage)
- Any lifetime or annual maximums, cycle caps, or waiting periods
- Network requirements, prior authorizations, and lab/pharmacy limitations
- Exclusions (e.g., elective egg freezing vs. medically indicated)
Accessing Benefits: Practical Steps
- Get it in writing. Ask HR/benefits for the SPD and any fertility rider.
- Pre-authorize. Confirm medical necessity criteria, coding, and network clinics.
- Track expenses. Use FSA/HSA and maintain receipts for claim submissions.
- Appeal denials. Plans must explain denials; you can appeal internally and, where applicable, externally.
Job Protections and Time Off
- CFRA Bonding Leave: After a child is born via IVF or surrogacy, eligible employees may take up to 12 weeks of job-protected bonding leave.
- Pregnancy Disability Leave (PDL): Birth mothers may receive up to 4 months of job-protected leave for pregnancy-related disability (including medically necessary pre- or post-birth care), separate from CFRA.
- Paid Family Leave (PFL): Up to 8 weeks of partial wage replacement for bonding.
- Sick/Protected Leave: Some municipal and company policies allow sick leave or PTO for treatment days, retrievals, and monitoring.
Tip: Coordinate PDL → CFRA → PFL to maximize time and wage replacement where eligible.
Reasonable Accommodations
Even if your plan doesn’t cover IVF, you may be entitled to reasonable schedule adjustments or time for medically necessary appointments. If fertility treatment overlaps with a qualifying medical condition (e.g., complications or treatment side effects), accommodation obligations may be triggered.
Anti-Retaliation and Privacy
Employers cannot retaliate against you for using lawful benefits or protected leave. Keep medical details confidential—share only what’s necessary with HR/benefits (not your manager), and store approvals, emails, and EOBs.
If You’re Facing a Denial or Pushback
- Document everything: plan docs, calls, approvals, and denials.
- Escalate through the plan’s formal appeal process and HR.
- Seek advice if you suspect discrimination, interference with leave, or retaliation for taking time off for treatment.
Bottom line: Many California employees have real paths to fertility support—through plan coverage, tax-advantaged accounts, and protected time off. If you’re hitting roadblocks, experienced counsel can help you enforce your rights.
