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Infertility Insurance Coverage in El Paso, Texas
Currently, 15 states have infertility insurance mandates that require health insurance companies to cover infertility treatments or to offer coverage for infertility treatments. Fortunately for residents of El Paso, Texas is one of the states that require offering insurance coverage for infertility treatments.
Insurance Coverage for IVF Treatment
Texas law (Texas Insurance Code, Article 3.51-6) requires insurance plans that cover pregnancy services to offer insurance coverage for IVF treatment. Insurers are required to let employers know this coverage is available, but employers are not required to include it in their plans. However, Organizations that are affiliated with religious groups are not required to cover infertility treatments that contradict with their religious or ethical beliefs.
In order for IVF treatment to be covered by insurance in Texas, the patients must meet certain criteria:
- The patient’s eggs must be fertilized by her husband’s sperm.
- The patient must have been unable to carry a successful pregnancy through other infertility treatments
- The patient and her spouse must have a 5-year history of unexplained fertility. However, the 5-year clause can be waived if the infertility is associated with endometriosis, fetal exposure to diethylstilbestrol, blocked or removed fallopian tubes, or oligospermia (semen with a low sperm count).
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.