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Saturday, April 3, 2010


I was searching online and found this article on Fertility Lifelines regarding mandated infertility coverage by state.  WTH kind of sense does this make?


Tex. Insurance Code Ann. Section 3.51-6, Sec. 3A

Definition of Infertility/Patient Requirements

Requires group insurers to offer coverage of IVF. Employers may choose whether or not to include infertility coverage as part of their employee health benefit package

If an employer chooses to offer the benefit, patients must meet the following: the patient for the IVF procedure is the policyholder or spouse of the policyholder; the patient’s eggs must be fertilized with her spouse’s sperm; the patient and the patient’s spouse have a history of infertility of at least five continuous years or associated with endometriosis, DES, blockage of or surgical removal of one or both fallopian tubes or oligospermia; the patient has been unable to attain a pregnancy through less costly treatment covered under their policy; the IVF procedures must be performed at medical facilities that conform to ACOG and ASRM guidelines

Coverage - No coverage is required. Insurers are only required to offer IVF

Exceptions - Does not require religious employers to cover infertility treatment, Employers who self-insure are exempt from the requirements of the law

So, as I understand it . . . the state of Texas is required to offer coverage for IVF, but the employers can choose whether or not they want to offer it.  Basically, the law is telling them they are required to do the right thing, but it's their choice if they want to or not.  It's like giving a kid some candy but telling them they can't eat it.  Ridiculous.


Baby bump bound said...

I'm in the same boat. NY has a similar mandate, but out of 5 insurance plans I have had, only 1 covered "advanced" treatments - IVF. It's frustrating and I wish we could buy into plans that are offered in other states, like MA or CT - they have AWESOME coverage!!

Maria (MKC101103) said...

I swear all of these policies are written by men. They're just plain old stupid.

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