| |
| |
|
|
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. |