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The Texas state mandate for Infertility. Is this to be

Customer Question
The Texas state mandate...

The Texas state mandate for Infertility.
Is this to be offered to the employer or employee of the plan?
What Is the definition of pregnancy related benefits in Texas?
What is the purpose of the mandate if employers are not made to follow it.
TDI said the complaint process can take 60 to 90 days. Is this true. Why do they have so long to respond for a medical need.

Lawyer's Assistant: Was this discussed with a manager or HR? Or with a lawyer?

HR manager Yes Lawyer No. Not yet. Thinking this is my next step.

Lawyer's Assistant: Is the workplace "at will" or union? Is the job hourly or salaried?

At will, Hourly based off a salary wage

Submitted: 5 months ago.Category: Employment Law
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Answered in 14 minutes by:
3/20/2018
Employment Lawyer: Law Educator, Esq., Attorney replied 5 months ago
Law Educator, Esq.
Category: Employment Law
Satisfied Customers: 126,847
Experience: 20+ Years of Employment Law Experience
Verified

Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

The Texas infertility insurance law states that insurance plans that cover pregnancy-related services must also offer coverage for in vitro fertilization (IVF).

Under Texas law, the IVF patient must be an individual covered under the group health benefit plan. The eggs for the IVF procedure must be fertilized only by sperm from the patient’s spouse The IVF patient and her spouse must have a history of infertility of at least five continuous years of duration, unless the infertility is associated with any of the following conditions: endometriosis, in utero exposure to Diethylstilbestrol (DES), blockage or surgical removal of one or both of the fallopian tubes, or oligospermia (low sperm count) The IVF patient has been unable to achieve a successful pregnancy through other less costly fertility treatments offered under the health plan The IVF procedures are performed at a fertility clinic or medical center that conform to the IVF guidelines set in place by the American Society for Reproductive Medicine (ASRM)

If you meet those guidelines, then you should have coverage. TDI is correct that their complaints can take 60 days or so to investigate, but that is because they are so busy.

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DISCLAIMER: Answers from Experts on JustAnswer are not substitutes for the advice of an attorney. JustAnswer is a public forum and questions and responses are not private or confidential or protected by the attorney-client privilege. The Expert above is not your attorney, and the response above is not legal advice. You should not read this response to propose specific action or address specific circumstances, but only to give you a sense of general principles of law that might affect the situation you describe. Application of these general principles to particular circumstances must be done by a lawyer who has spoken with you in confidence, learned all relevant information, and explored various options. Before acting on these general principles, you should hire a lawyer licensed to practice law in the jurisdiction to which your question pertains.

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