H.B. No. 1207 amends Section 1366.005 of the Texas Insurance Code to update the conditions under which health benefit plans are required to cover in vitro fertilization (IVF) procedures. The bill specifies that coverage is mandated only if the patient is covered under a group health benefit plan and either the patient or their spouse has a history of infertility lasting at least three continuous years, or if the infertility is linked to specific medical conditions such as endometriosis or oligospermia. Additionally, the bill removes the previous requirement that fertilization must only occur with the sperm of the patient's spouse and adjusts the duration of infertility from five years to three years.

Furthermore, the bill stipulates that patients must have been unable to achieve a successful pregnancy through less costly infertility treatments covered by their health plan before qualifying for IVF coverage. It also maintains the requirement that IVF procedures be performed at facilities meeting the standards set by the American Society for Reproductive Medicine. The changes will apply to health benefit plans issued or renewed on or after January 1, 2026, with the existing law remaining in effect for plans renewed before that date. The act is set to take effect on September 1, 2025.

Statutes affected:
Introduced: Insurance Code 1366.005 (Insurance Code 1366)