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CalPERS to add state‑required fertility coverage, selects Progyny to run family‑building benefit
Summary
CalPERS approved implementing California’s SB 729 infertility coverage for basic HMO plans and recommended extending comparable benefits to basic PPOs; staff recommended Progyny as administrator. Estimated cost: $2.91 per member per month (about a 0.3% basic plan premium impact).
The California Public Employees' Retirement System committee approved a plan to implement the family‑building benefits required by state law (SB 729) for HMO basic plans effective July 1, 2027, and voted to extend the comparable benefit to basic PPO (PO) plans to ensure parity across CalPERS' basic program.
Julia Logan (CalPERS staff) told the committee the benefit will cover a comprehensive suite of infertility services consistent with Department of Managed Health Care guidance, including diagnostic testing, in‑vitro fertilization (IVF) with up to three retrieval attempts and unlimited embryo transfers, prescription medications, counseling, five years of cryopreservation and storage, medically necessary services related to surrogacy (excluding surrogate compensation and nonmedical/legal costs), and basic adoption support and referrals. Logan said the design aims to provide equitable access for heterosexual couples, LGBTQ+ couples and single parents.
Staff recommended contracting with Progyny as the benefit administrator, pointing to Progyny's statewide network, performance guarantees, provider‑quality standards, patient navigation services and competitive pricing. "Progyny will expedite setting appointments and begin taking calls before July 1st, 2027 so that members can access care as soon as the benefit is effective," Logan told the committee.
CalPERS staff estimated the benefit cost at approximately $2.91 per member per month, equal to an average premium increase of roughly 0.3% for basic members; because the benefit begins midyear, the full annual cost will appear in 2028 premiums. Staff said implementing the benefit across HMOs and POs simultaneously also produced better pricing from vendors (Progyny estimated about a 10% lower cost than an HMO‑only rollout).
The committee voted to approve adding the family‑building benefit to CalPERS PO basic plans (the HMO requirement stems from SB 729 and was already accepted for HMO basic plans), directing staff to finalize vendor agreements and member communications for open enrollment.
