89R1892 RDS-D
By: Walle, Plesa 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.