Insurance Code § 1366.005

Sec. 1366.005. CONDITIONS APPLICABLE TO COVERAGE. The coverage offered under Section 1366.003 is required 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. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.