Written by a parent, not a doctor. Nothing here is medical advice.

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Fertility preservation before chemo (Texas insured plans)

Some Texas plans cover fertility preservation when cancer treatment risks future fertility. Children can qualify too.

What it is

Some Texas plans cover fertility preservation when cancer treatment risks future fertility. Children can qualify too.

The oncology team says whether treatment risks future fertility and whether an option fits your child; the only window is before that treatment. Fully insured Texas plans cover the procedure; a plan where the employer pays its own claims, Medicaid, CHIP and TRICARE are outside the law.

Who this can help
  • The mandate covers applicable insured plans issued or renewed on or after January 1, 2024. Self-funded plans, Medicaid and CHIP are outside it.
  • The applicability list does not name ERS, TRS-Care, TRS-ActiveCare or UT/A&M plans. Their own fertility policies need a separate check.
  • There is no adult-only restriction, but age alone does not establish puberty or the right procedure. Ovarian tissue preservation and experimental testicular tissue freezing are different options. The specialists assess treatment timing, procedural risks and tissue safety. Before a child starts chemotherapy or radiation, the facility must provide the legally required fertility-risk notice to the parent or guardian.
What you get
  • Coverage for standard preservation procedures when the Texas requirement applies.
  • Access to an oncology and fertility-specialist discussion before intensive treatment.
What the rules cover
  • Insurance Code 1366.104 requires standard procedures consistent with ASCO or ASRM guidelines. Options can include sperm, oocyte or ovarian-tissue preservation.
  • Storage is excluded from the statutory coverage requirement. A navigator can discuss separate storage assistance.
If you decide to apply
  1. Ask the oncologist whether the next treatment phase risks fertility and whether preservation can fit safely.
  2. Ask the fertility navigator to check your plan type, renewal date and the specialist’s recommendation.
  3. Review the plan’s written procedure decision and separate storage price with the navigator.

Your oncology team or fertility-preservation navigator; TDI: 800-252-3439 · Official page ↗

What happens next
  • The oncology team documents treatment-related infertility risk, and the fertility specialist recommends a procedure. The plan reviews any required prior authorization.
  • If the plan refuses, its written reason helps the team distinguish a plan exclusion from a medical-necessity dispute. TDI can review complaints within its authority.
Good to know

The plan may charge you part of the cost. Texas does not require storage coverage, but your plan may offer it.

Other details
  • The clinical team checks whether a procedure can fit safely before the relevant treatment phase. After treatment, the team can still advise whether a fertility assessment or further preservation discussion is relevant. Neither timing nor age guarantees a suitable procedure or insurance payment.
  • TRS-ActiveCare and ERS use separate appeal procedures. Their own documents govern benefits not established by this mandate.
Official sources
Ask your social worker

“Could treatment affect my child’s future fertility, and what are the benefits, risks and costs of preservation before the next phase? Can you help us check coverage?”

Why I’m asking: I want to understand the options while the treatment schedule still allows a conversation.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask the oncologist about fertility risk and preservation before the next phase, and give HR's fully insured answer to the clinic.

Your social worker

Connects the family to the fertility-preservation navigator and keeps the request from delaying treatment.

The care team

Documents the infertility risk of the protocol and refers to a fertility specialist for the standard procedure. Discusses it before intensive therapy when clinically appropriate.

Who decides
The health plan on prior authorization
Ask the care team
“Does my child's treatment risk fertility, and is preservation possible before the next phase? Can your team check whether our plan must cover it?”

How to apply

First step: Ask the oncologist whether your child's protocol risks fertility and whether preservation is possible before the next phase. Then ask the plan for prior authorization

  1. Ask the oncologist whether your child's protocol risks fertility and whether preservation is possible before the next phase. Then ask the plan for prior authorization

Where it starts: Oncologist’s referral and prior-authorization request citing Insurance Code 1366.104

What to gather

  • HR's answer on fully insured versus self-funded and the plan renewal date
  • The oncologist's letter on infertility risk
  • The fertility specialist's procedure recommendation

How long: Days, not weeks. The procedure must fit before the next phase.

What a yes looks like

A prior authorization for the procedure. The family arranges storage separately.

What a no looks like, and the next move

Ask the plan to name the exclusion. If the plan is insured and renewed since 2024, appeal and call TDI at 800-252-3439.

Watch out

  • The deadline is before intensive therapy starts. Ask the oncology team on day one, not after.
  • The statute does not require storage coverage. Ask the plan about its benefit and any separate assistance.
  • Self-funded plans, Medicaid and CHIP are outside this law, and its list does not name the teacher and state-employee plans (TRS-ActiveCare, HealthSelect). Ask the plan for its own policy.
  • TRS-ActiveCare and ERS have separate appeal procedures. TRS’s administrator removed medical prior authorization for its administrative-services arrangement in September 2024; that does not settle every benefit or local public plan. Ask which document applies.

If they say no, quote this: Insurance Code 1366.104 (coverage of standard fertility preservation); applicability in 1366.102.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 10, 2026.

What it is worth

Standard fertility-preservation procedures before treatment that can cause infertility, on insured plans issued or renewed since January 1, 2024. Storage is not included.

Legal protection: Coverage of standard fertility preservation consistent with ASCO or ASRM guidelines (Ins. Code 1366.104)

What it costs the family: Plan cost-sharing applies. Storage is outside the mandate; ask the plan about any separate storage benefit.

The eligibility facts, as published

Plan
fully insured plans issued or renewed on or after 2024-01-01
Excluded
self-funded plans, Medicaid, CHIP
Age
no adult-only limit; HSC 161.681 addresses parent or guardian notice
Public employee plans
not named: the 1366.102 applicability list covers carriers plus small-employer (ch. 1501) and standard (ch. 1507) plans; it does not name the ERS, TRS-Care, TRS-ActiveCare or UT/A&M plans; ask the plan for its own policy

The trap: The deadline is before intensive therapy starts. Ask the oncology team on day one, not after.

Where I read this

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