Texas ladies please help!


#1

Ok I got some questions for the ladies in Texas regarding your insurance.

I work for local government and have excellent insurance
90/10 policy $250 deductible and $1000 max out of pocket!! Great right!

Yeah except that it has ZERO infertility…yesterday I came across that Texas is one of 13 states to mandate infertility coverage including IVF, has anybody dealt with this or know what to do. I am scared to “rock the boat” without knowing exactly what to do. I have had 6 :bfn: and would like to move to ivf but its not even a possibility for financial reasons…lookin for some help…:pray: :pray:

Am I lucky enough to find an insurance lawyer here???


#2

This is what i got from the Texas law

Tex. Insurance Code Ann. § 1366.001 et seq. (1987, 2003) requires that all health insurers offer and make available coverage for services and benefits for expenses incurred or prepaid for outpatient expenses that may arise from in vitro fertilization procedures. In order to qualify for in vitro fertilization services, the couple must have a history of infertility for at least five years or have specified medical conditions resulting in infertility. The law includes exemptions for religious employers.

Insurance Coverage for Infertility Laws

But also found

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.

Texas Infertility Insurance Mandate


#3

I live in TX as well and also work for the government, just because TX mandates IVF coverage does not mean your insurance has to cover you. A group coverage can opt out of infertility coverage, which our govt plans have. The mandate law is very odd and really doesn’t mean anything (inmo). Basically, my understanding is that the insurance company has to OFFER it however the employer can opt out of that coverage as a whole, therefore the state (who provides my insurance) has opted out of offering that coverage. It is more beneficial when you are getting private insurance, when you’re picking out your plan for whatever company, they will offer it to you & you can chose to pay for that coverage. In other states w/o this law, all insurance companies have the right to not even offer infertility coverage…


#4

Well after calling aound to our HR, I am in the same boat :frowning:
I got a little hopeful should have known better.

Go back to the dr today to see what the plan is.

Thank you for the info I really appreciate it!!!