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Texas Infertility Insurance Mandate

Currently, there are only 15 states that have laws in place that require insurance companies to offer coverage or to provide coverage for fertility treatment or IVF costs. The state of Texas has an infertility insurance mandate in place that requires insurance companies to offer coverage for IVF costs.

Texas state law on fertility treatment insurance is found in Chapter 1366 in Title 8 of the Texas Insurance Code. The Texas infertility insurance law states that insurance plans that cover pregnancy-related services must also offer coverage for in vitro fertilization (IVF). The benefits for IVF procedures must be provided at the same extent as benefits provided for pregnancy-related services on the plan.

Texas law on insurance coverage for IVF costs was enacted in 1987, but was amended in 2003. The changes became effective in 2005.

Texas Infertility Insurance Mandate Limitations

There are certain criteria that must be met in order for a Texas insurance plan to be required to offer coverage for IVF costs. According to Texas fertility treatment insurance law, the following conditions must be met in order for IVF costs coverage to be offered:

  • The IVF patient must be an individual covered under the group health benefit plan
  • The eggs for the IVF procedure must be fertilized only by sperm from the patient’s spouse
  • The IVF patient and her spouse must have a history of infertility of at least five continuous years of duration, unless the infertility is associated with any of the following conditions: endometriosis, in utero exposure to Diethylstilbestrol (DES), blockage or surgical removal of one or both of the fallopian tubes, or oligospermia (low sperm count)
  • The IVF patient has been unable to achieve a successful pregnancy through other less costly fertility treatments offered under the health plan
  • The IVF procedures are performed at a fertility clinic or medical center that conform to the IVF guidelines set in place by the American Society for Reproductive Medicine (ASRM)

Religious organizations who believe that IVF goes against their beliefs and practices are not required to provide coverage for IVF costs.

Comments (6)

Also, if your company is a self paid insurer the procedure will not be covered. As well as, the company being head quartered of of Texas. You must be a Texas residents.

This is a bunch of crap. I had insurance that covered pregnancy, but it specifically excluded all assisted reproduction and meds associated.

I have health insurance. It does not cover ivf I meet criteria for it to be covered but my insurance says they don't cover it. Not sure where to go now?

I would like to know: I am a 47 y/o female who has been Ivf and not been able to get pregnant.i am healthy, no apparent anatomical problem. I want to know if the insurance ( blue cross blue shield will help to pay if I decide to forgo another Ivf.

Hi Monica, Although Texas does have a mandate for infertility coverage, your policy may vary depending on the state in which it was written, the size of your company, and any religious affiliation your place of employment may have. It is best for you to consult a representative of the insurance company. They will be able to provide the most accurate information regarding fertility treatment coverage. Best of luck! Kim

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