| I am very confused by the laws regarding infertility coverage. I live in Texas and the company I work for does not offer infertility coverage on any of their plans...however, I was on the ASRM (American Society for Reproductive Medicine) web site and copied the following information:
Texas
This state's law requires certain insurers (my question - which insurers??) that cover pregnancy services to offer coverage for infertility diagnosis and treatment - including in vitro fertilization. That means insurers must let employers know this coverage is available. However, the law does not require those insurers to provide the coverage; (how can they be required to let them know that this coverage exists, but then can turn around and say that they won't offer it as part of the plan to that employer?? This makes no sense to me.) nor does it force employers to include it in their health plans (I understand this - it may be expensive for the company. But, because the Company does not have to include infertility coverage and the insurance company does not have to offer it - what exactly does this law do?? It seems pointless.).
Patients need to meet the following conditions in order to get their IVF covered:
The patient must be the policyholder or the spouse of the policyholder and be covered by the policy;
The patient's eggs must be fertilized with her spouse's sperm;
The patient has been unable to get and stay pregnant through other infertility treatments covered by insurance;
The IVF is performed at medical facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists; and
The patient and her spouse must have at least a continuous five-year history of unexplained infertility, OR the infertility must be associated with one or more of the following conditions:
Endometriosis.
Fetal exposure to diethylstilbestrol (DES);
Blocked or surgical removal of one or both fallopian tubes; or
Oligospermia
The law does not require organizations that are affiliated with religious groups to cover treatment that conflicts with the organization's religious and ethical beliefs. (Texas Insurance Code, Article 3.51-6).bbbbb
So, does this mean that because my company does not offer infertility coverage as part of any group health plans or HMOs that are offered, that I can NEVER be covered for IVF - or does it mean that after five years of trying, I can be covered by my company's policy? Of course, don't get me started on how ridiculous it is to make someone wait 5 years - when IVF will be more risky and less likely to work.
Thanks for any advice - and I do apologize if I sound slightly frustrated...but who writes these laws!!
Thanks again,
Lisa | 
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