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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES |
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Subtitle E. BENEFITS PAYABLE UNDER HEALTH COVERAGES |
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Chapter 1366. BENEFITS RELATED TO FERTILITY AND CHILDBIRTH |
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Subchapter A. COVERAGE FOR IN VITRO FERTILIZATION PROCEDURES |
Sec. 1366.005. CONDITIONS APPLICABLE TO COVERAGE
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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.