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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: 3 months ago.Category: Employment Law
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Answered in 14 minutes by:
3/20/2018
Employment Lawyer: Law Educator, Esq., Attorney replied 3 months ago
Law Educator, Esq.
Category: Employment Law
Satisfied Customers: 125,256
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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The responses above are from individual Experts, not JustAnswer. The site and services are provided “as is”. To view the verified credential of an Expert, click on the “Verified” symbol in the Expert’s profile. This site is not for emergency questions which should be directed immediately by telephone or in-person to qualified professionals. Please carefully read the Terms of Service (last updated February 8, 2012).

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