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Texas Insurance Coverage for Infertility

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One of the biggest challenges that people experiencing infertility face is how to pay for treatment. IVF treatment can cost upwards of ten thousand dollars and repeated cycles may be necessary. Texas is among 15 states that have passed laws requiring insurance companies to offer coverage for infertility diagnosis and treatment. This became effective in 1987 with Texas Insurance Code Ann. Section 3.51-6, Sec. 3A. Texas is also a state that has a law mandating employers with more than 50 employees to offer infertility insurance as part of regular health care coverage.

Eligibility Requirements for Texas Mandated Insurance Coverage

To receive this infertility insurance benefit the patient for the procedure must be the employee or spouse of the employee. There are other requirements including the IVF procedure must be done at an American Society for Reproductive Medicine (ASRM) approved facility, the patient’s eggs must be fertilized with a spouse’s sperm, and the patient must have a history of five years of infertility.

Exceptions to Texas Mandated Insurance Coverage

This legislation states insurers are only required to offer IVF if the above requirements are met. Religious employers are not mandated to offer insurance coverage for infertility treatment. Employers who self insure are exempt from this requirement. Mandated insurance coverage in Texas only includes only coverage for in vitro fertilization (IVF).

Additional Considerations

Even though Texas is a state that offers some insurance coverage it is important to fully understand your total insurance coverage. Know how much and what is covered before you begin your infertility treatments. Find out what specific treatments are covered, what the limits of coverage are, and if you must meet any deductibles or make co-payments. If you are working with donors learn about what aspects of the donor’s treatment and medication you are responsible for. Medications are costly and are frequently needed with infertility treatment so ask about that coverage. Request your insurance carrier or employer put this information in writing so you have proper documentation in case insurance problems emerge.

Insurance Assistance

If your company has a human resources department speak with them about specific questions regarding your infertility insurance coverage. If you are working with a fertility clinic their business office is a good resource to help you get information on specific aspects of your insurance coverage.