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Infertility Insurance Coverage in Houston, Texas

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The road to family-building can take a financial toll on couples, as many infertility treatments require multiple cycles at high costs. In order to help defray the cost, many couples look to their insurance companies to offer health insurance for their infertility treatments.

Currently, 15 states have enacted mandates that require health insurance companies to cover infertility treatments or to offer coverage for infertility treatments. Fortunately for Houston residents, Texas is one of the states that require offering insurance coverage for infertility treatments.

Insurance Coverage for IVF Treatment

As part of the Texas Insurance Code, Article 3.51-6, the law requires insurance plans that cover pregnancy services to offer coverage for IVF treatments. Insurers must let employers know this coverage is available, but employers are not forced to include it in their plans.

In order for the treatment to be covered, the patients must meet certain criteria. The patient’s eggs must be fertilized by her husband’s sperm, she must have been unable to carry a successful pregnancy through other infertility treatments, and she and her spouse must have a five-year history of unexplained fertility. However, the five-year clause can be waived if the infertility is associated with endometriosis, fetal exposure to diethylstilbestrol, blocked or removed fallopian tubes, or oligospermia.

However, organizations that are affiliated with religious groups are not required to cover infertility treatments that contradict with their religious or ethical beliefs.

Before beginning infertility treatments, it is a good idea to talk directly with your health insurance plan’s provider for information on specific costs and areas of coverage.