Insurance
Understanding your health insurance even for the most scholarly --- can be a daunting and complicated task. The language used in many insurance policies can be very difficult to understand, confusing and vague. Infertility insurance is one type of health coverage offered by insurance providers. The intent of infertility insurance is to help people finance their fertility treatments. In exchange for a monthly premium, insurance providers will supply you with coverage for various infertility procedures.
The best possible position for you is to advocate for yourself. To determine if your health insurance policy covers infertility treatment, obtain a copy of your insurance policy. Your most recent explanation of benefits should be available online or you can get a copy through your company’s human resources department, if it is through your employer. Look through the policy for a specific exclusion for infertility treatment. If you do not see one, then the insurance company must cover anything that they do not specifically exclude.
Depending on the state in which you live, mandated infertility insurance may be available. To see if your state is included in mandated list, contact your state’s insurance commissioner.
Texas state law requires certain insurers that cover pregnancy services to offer coverage for 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; nor does it force employers to include it in their health plans. Patients need to meet the following conditions in order to get their IVF covered:
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The patient must be the policyholder or the spouse of the policyholder and be covered by the policy;
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The patient's eggs must be fertilized with her spouse's sperm;
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The patient has been unable to get and stay pregnant through other infertility treatments covered by insurance;
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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
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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:
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).