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AB 428

Requires certain health plans to include coverage for fertility preservation services. (BDR 57-915)

2025 Regular Session Introduced by Natha Anderson and 17 co-sponsors

AB 428 requires broad health plans to cover medically necessary fertility preservation for individuals with breast or ovarian cancer, with limited religious exemptions and state en

Chapter 473.
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Bill Summary · AB 428

AB 428 — Summary (Fertility Preservation Coverage)

Status: Enacted — chaptered into law (Chapter 473). Introduced February 5, 2025. Effective for policies delivered/issued/renewed on or after January 1, 2026.

Purpose

Require a broad set of health plans to cover medically necessary procedures and services to preserve fertility for individuals diagnosed with breast or ovarian cancer when the disease or its treatment may directly or indirectly cause infertility.

Key provisions

  • Coverage required: Public and private health plans (including Medicaid and plans covering state and local government employees) must include coverage for procedures and services for fertility preservation that are:
    • Consistent with established medical practice or guidelines of the American Society for Reproductive Medicine (ASRM) or the American Society of Clinical Oncology (ASCO); and
    • Medically necessary because the insured has breast or ovarian cancer and either the cancer or anticipated treatment may directly or indirectly cause infertility.
  • Definition guidance: A treatment “directly or indirectly cause infertility” when it has a potential side effect of impaired fertility as established by ASCO or ASRM guidance.
  • Network access: Insurers must ensure required benefits are made available through providers who participate in the insurer’s network (amendment language clarifies network availability).
  • Religious exemption: Insurers affiliated with a religious organization may decline to provide the mandated coverage if they (1) object on religious grounds and (2) give written notice to current and prospective insureds specifying the coverage they refuse to provide.
  • Enforcement: The Commissioner of Insurance may suspend or revoke an HMO’s certificate (and take analogous action against other insurers) for failure to provide required coverage.
  • Out‑of‑state policies: The Commissioner may require individual policies issued by domestic insurers for out‑of‑state residents to meet these standards in specified circumstances.
  • Medicaid implementation and fiscal measures: Amendments include an appropriation to the state division that administers Medicaid to cover costs associated with implementing the benefit for Medicaid enrollees.

Who is affected

  • Primary beneficiaries: Insured individuals diagnosed with breast or ovarian cancer who may face treatment‑related infertility.
  • Payers: Private insurers, HMOs, Medicaid (state program), employer-sponsored plans for state/local employees.
  • Regulators and administrators: Commissioner of Insurance; state Medicaid agency (Division of Health Care Financing and Policy / Department of Health and Human Services).
  • Insurers affiliated with religious organizations (given the statutory exemption).

Fiscal and procedural notes

  • The bill was identified as containing an unfunded mandate (may affect local governments) and has potential state fiscal impacts; an appropriation was added for Medicaid costs.
  • The State Division of Insurance noted the mandated benefit may not be included in the federal Essential Health Benefits benchmark and could trigger federal defrayal obligations.
  • Effective implementation: policies delivered, issued for delivery, or renewed on or after January 1, 2026 must comply.

Practical effect

AB 428 creates a targeted insurance mandate expanding access to fertility preservation for patients with breast or ovarian cancer, while providing a narrow religious exemption and giving state regulators enforcement authority. It also recognizes potential budgetary impacts and includes state appropriations to support Medicaid implementation.

Compiled from official sources — confirm details with the bill’s official record.

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