Sec. 1366.005. CONDITIONS APPLICABLE TO COVERAGE. The coverage offered under Section 1366.003 is required 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.
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