state health plans must cover outpatient in vitro fertilization

The text as introduced · 577 words

89R1892 RDS-D

By: Walle
H.B. No. 618

A BILL TO BE ENTITLED

AN ACT

relating to health benefit plan coverage of certain in vitro

fertilization procedures for certain governmental employees and

retirees.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 1366.001, Insurance Code, is amended to

read as follows:

Sec. 1366.001. APPLICABILITY OF SUBCHAPTER. Except as

otherwise provided by this subchapter, this [ This ] subchapter

applies only to a group health benefit plan that provides benefits

for hospital, medical, or surgical expenses incurred as a result of

accident or sickness, including a group health insurance policy,

health care service contract or plan, or other provision of group

health benefits, coverage, or services in this state that is

issued, entered into, or provided by:

(1) an insurer;

(2) a group hospital service corporation operating

under Chapter 842;

(3) a health maintenance organization operating under

Chapter 843; or

(4) an employer, multiple employer, union,

association, trustee, or other self-funded or self-insured welfare

or benefit plan, program, or arrangement.

SECTION 2. Subchapter A, Chapter 1366, Insurance Code, is

amended by adding Section 1366.0045 to read as follows:

Sec. 1366.0045. COVERAGE FOR CERTAIN GOVERNMENTAL

EMPLOYEES AND RETIREES. (a) Notwithstanding any other law, this

section applies only to:

(1) a basic coverage plan under Chapter 1551;

(2) a basic plan under Chapter 1575;

(3) a primary care coverage plan under Chapter 1579;

and

(4) a plan providing basic coverage under Chapter

1601.

(b) Subject to Section 1366.005, a health benefit plan that

provides pregnancy-related benefits for individuals covered under

the plan must provide coverage for outpatient expenses that arise

from in vitro fertilization procedures.

(c) A health benefit plan must provide benefits for in vitro

fertilization procedures required under this section to the same

extent that the plan provides benefits for other pregnancy-related

procedures.

SECTION 3. Section 1366.005, Insurance Code, is amended to

read as follows:

Sec. 1366.005. CONDITIONS APPLICABLE TO COVERAGE. The

coverage offered under Section 1366.003 or provided under Section

1366.0045 is required to be offered or provided only if:

(1) the patient for the in vitro fertilization

procedure is an individual covered under the group health benefit

plan;

(2) the fertilization or attempted fertilization of

the patient's oocytes is made only with the sperm of the patient's

spouse;

(3) the patient and the patient's spouse have a history

of infertility of at least five continuous years' duration or the

infertility is associated with:

(A) endometriosis;

(B) exposure in utero to diethylstilbestrol

(DES);

(C) blockage of or surgical removal of one or

both fallopian tubes; or

(D) oligospermia;

(4) the patient has been unable to attain a successful

pregnancy through any less costly applicable infertility

treatments for which coverage is available under the group health

benefit plan; and

(5) the in vitro fertilization procedures are

performed at a medical facility that conforms to the minimal

standards for programs of in vitro fertilization adopted by the

American Society for Reproductive Medicine.

SECTION 4. Subchapter A, Chapter 1366, Insurance Code, as

amended by this Act, applies only to a health benefit plan that is

delivered, issued for delivery, or renewed on or after January 1,

2026. A health benefit plan delivered, issued for delivery, or

renewed before January 1, 2026, is governed by the law as it existed

immediately before the effective date of this Act, and that law is

continued in effect for that purpose.

SECTION 5. This Act takes effect September 1, 2025.