HB618 - Relating to health benefit plan coverage of certain in vitro fertilization procedures for certain governmental employees and retirees.

  89R1892 RDS-D     By: Walle, Plesa H.B. No. 618       A BILL TO BE ENTITLED   AN ACT   relating to health benefit plan coverage of certain in vitro   fertilization procedures for certain governmental employees and   retirees.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 1366.001, Insurance Code, is amended to   read as follows:          Sec. 1366.001.  APPLICABILITY OF SUBCHAPTER.   Except as   otherwise provided by this subchapter, this [ This ] subchapter   applies only to a group health benefit plan that provides benefits   for hospital, medical, or surgical expenses incurred as a result of   accident or sickness, including a group health insurance policy,   health care service contract or plan, or other provision of group   health benefits, coverage, or services in this state that is   issued, entered into, or provided by:                (1)  an insurer;                (2)  a group hospital service corporation operating   under Chapter 842;                (3)  a health maintenance organization operating under   Chapter 843; or                (4)  an employer, multiple employer, union,   association, trustee, or other self-funded or self-insured welfare   or benefit plan, program, or arrangement.          SECTION 2.  Subchapter A, Chapter 1366, Insurance Code, is   amended by adding Section 1366.0045 to read as follows:           Sec.   1366.0045.     COVERAGE FOR CERTAIN GOVERNMENTAL   EMPLOYEES AND RETIREES. (a)   Notwithstanding any other law, this   section applies only to:                 (1)  a basic coverage plan under Chapter 1551;                 (2)  a basic plan under Chapter 1575;                 (3)     a primary care coverage plan under Chapter 1579;   and                 (4)     a plan providing basic coverage under Chapter   1601.           (b)     Subject to Section 1366.005, a health benefit plan that   provides pregnancy-related benefits for individuals covered under   the plan must provide coverage for outpatient expenses that arise   from in vitro fertilization procedures.           (c)     A health benefit plan must provide benefits for in vitro   fertilization procedures required under this section to the same   extent that the plan provides benefits for other pregnancy-related   procedures.          SECTION 3.  Section 1366.005, Insurance Code, is amended to   read as follows:          Sec. 1366.005.  CONDITIONS APPLICABLE TO COVERAGE.  The   coverage offered under Section 1366.003 or provided under Section   1366.0045 is required to be offered or provided 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.          SECTION 4.  Subchapter A, Chapter 1366, Insurance Code, as   amended by this Act, applies only to a health benefit plan that is   delivered, issued for delivery, or renewed on or after January 1,   2026.  A health benefit plan delivered, issued for delivery, or   renewed before January 1, 2026, is governed by the law as it existed   immediately before the effective date of this Act, and that law is   continued in effect for that purpose.          SECTION 5.  This Act takes effect September 1, 2025.