When a couple is faced with infertility, several therapeutic options are open to them. Many of these are costly and are rarely covered by health insurance companies. However within the past decade, insurance companies in fifteen states were mandated to cover their patients' infertility treatments. Blue Cross/Blue Shield of Texas is one of them. While each person's policy differs slightly, the infertility coverage of this company is said to be one of the best. Accordingly, it has proven to be a beacon for many couples trying so hard to conceive.
Texas Fertility Coverage Mandate History
In 1987, the Texas Insurance Code Ann. Section 3.51-6, Sec. 3A was written into law. In effect, it forced corporations located within Texas to begin covering patients for certain treatments for infertility.
Important to note is that while Blue Cross/Blue Shield of Texas is required to let employers know of this availability, "the law does not require those insurers to provide the coverage; nor does it force employers to include it in their health plans."
Blue Cross/Blue Shield's Infertility Treatment Benefit
While the extent of coverage varies from state to state, some being inclusive of outpatient procedures, for example, Texas mandates coverage of only the IUI or IVF procedure itself. Should there be a need for diagnostic procedures, such as a hysterosalpingogram or similar procedures related to infertility, the cost would likely be the responsibility of the patient.
Blue Cross/Blue Shield of Texas completely covers the medications that are required for infertility treatment. All that the patient must be concerned with is the co-payment at the time of purchase. This is a valuable part of the coverage, as the medication cost for most infertility care is the most expensive part of the treatment.
Blue Cross/Blue Shield of Texas infertility coverage requires that the couple have no less than a five-year history of unexplained infertility. If this requirement cannot be met, then the infertility must be caused by at least one of the following conditions:
DES exposure Fallopian tube blockage Removal of one or both of the fallopian tubes Low sperm count or motility
Another important requirement that Blue Cross/Blue Shield sets out is that the sperm utilized for any IUI or IVF procedures must be that of the patient's spouse. There is no fertility coverage for those outside of this type of relationship.
Exemptions of Infertility Coverage Mandate
Certain companies that insure their employees through Blue Cross/Blue Shield can claim exemption from this mandate. For instance, a religious employer is not required to offer this coverage, nor are employers who "self-insure."
Texas Corporations with Infertility Coverage
The following corporations operating within Texas are known to offer infertility treatment insurance:
Zerox, Inc. Talbot's, Inc. Dynegy, Inc. Alltell, Inc.
It is important to note that these companies may or may not offer Blue Cross/Blue Shield as a group insurance option.