SB 62 revises California’s essential health benefits rules for individual and small group health care service plan contracts under the Knox-Keene Act. The bill states legislative intent to review and update the state’s benchmark plan for the 2027 plan year, and it directs that, if federal approval is obtained for a new benchmark plan, the plan must add specified benefits beginning January 1, 2027. Those added benefits include a broad package of infertility evaluation and treatment services, including artificial insemination, multiple gamete and embryo retrieval and creation attempts, pretransfer testing, cryopreservation and storage, donor sperm and eggs, surrogacy-related coverage, and surrogate testing.
The bill also expands coverage for certain durable medical equipment and related services, including mobility devices, communication devices, CPAP machines, portable oxygen, hospital beds, annual hearing exams, and one hearing aid per ear every three years. It preserves existing requirements for habilitative services, pediatric vision care, and pediatric oral care, and it limits substitutions by health plans except in narrow circumstances involving prescription drug formularies. The measure applies to plans inside and outside Covered California, excludes specialized plans, Medicare supplement plans, and grandfathered plans, and authorizes the Department of Managed Health Care to issue guidance and regulations to implement the changes.
In terms of state law, SB 62 amends Health and Safety Code Section 1367.005, which defines the essential health benefits that individual and small group health plans must cover. Because violations of the Knox-Keene Act can be criminally enforceable, the bill also states that it creates a state-mandated local program, while simultaneously declaring that no reimbursement is required. The practical effect is to raise the minimum benefit standard for affected health plans if the federal benchmark-plan approval condition is met, thereby broadening mandated coverage in California’s regulated health insurance market.
The overall sentiment reflected in the vote history was strongly favorable and largely noncontroversial. The bill advanced through committees and floor votes with unanimous or near-unanimous support, including multiple 11-0, 7-0, 6-0, 39-0, 16-0, 15-0, 76-0, and 39-0 votes. No committee transcript objections were provided, and the voting record suggests broad bipartisan agreement on expanding health coverage, especially for fertility care, hearing services, and durable medical equipment.
The main points of potential contention are not reflected in recorded opposition votes, but they are inherent in the policy choices the bill makes. The most notable issues are the expansion of infertility and surrogacy-related coverage, the added cost implications for health plans, and the bill’s dependence on federal approval of a new benchmark plan. There is also a technical/legal issue around the interaction with federal PPACA requirements and whether the state would be required to defray any benefit costs, which the bill tries to address through limiting language.
SB 62 amends Health and Safety Code Section 1367.005, the statute governing essential health benefits for individual and small group health care service plan contracts under the Knox-Keene Health Care Service Plan Act. If the federal benchmark-plan approval condition is satisfied, the bill requires health plans to cover additional infertility services, durable medical equipment, hearing exams, and hearing aids starting in 2027, while preserving existing pediatric vision, pediatric oral, habilitative, and mental health parity-related requirements. It also authorizes DMHC to issue guidance and regulations and restricts plan substitutions for mandated benefits, thereby increasing the minimum coverage obligations for affected health plans and potentially affecting premiums and plan design.
The bill appears to have enjoyed strong support throughout the legislative process. Vote totals were unanimous or nearly unanimous at each recorded stage, and the bill ultimately became Chapter 739 of the Statutes of 2025. The absence of recorded dissent in the available votes suggests broad agreement with the policy goal of expanding health coverage, particularly for fertility treatment and assistive devices.
No formal opposition is reflected in the available vote record, but the bill’s policy choices raise several likely points of debate. The most significant is the expansion of infertility treatment and surrogacy coverage, which can be costly and may be viewed differently by insurers, employers, and advocates. Another issue is the bill’s dependence on federal approval of a new benchmark plan, which makes implementation contingent and could create uncertainty. Finally, the bill’s interaction with PPACA cost-defrayal rules and its effect on plan pricing and benefit design are the main legal and fiscal pressure points.