HB1895.DOC

SECTION 1. The purpose of this Act is to temporarily suspend the mandatory coverage of certain benefits in health insurance policies and contracts offered in the State.

This Act is intended to temporarily reduce or moderate health insurance premium costs to policyholders, especially employers providing group health care coverage for employees. The legislature finds that the State's economic recovery from the Great Recession has not been robust.

Promoting the economic recovery is necessary to maintain and increase employment levels in the State.

Reducing or moderating health insurance premium costs for employers would enable employers to use the savings productively by retaining existing workers, employing new workers, paying higher wages, or investing in their businesses, all to the benefit of the local economy. This Act also would benefit individual health plan policyholders by reducing or moderating premium costs for individuals.

SECTION 2. Section 431:10A-116.5, Hawaii Revised Statutes, is amended to read as follows:

"§431:10A-116.5 In vitro fertilization procedure coverage. (a) All individual and group accident and health or sickness insurance policies issued or renewed in this State before the effective date of this Act or after June 30, 2015, which provide pregnancy-related benefits shall include in addition to any other benefits for treating infertility, a one-time only benefit for all outpatient expenses arising from in vitro fertilization procedures performed on the insured or the insured's dependent spouse[~~; provided that:~~].

All individual and group accident and health or sickness insurance policies issued or renewed in this State between the effective date of this Act and June 30, 2015, shall offer as an option a one-time only benefit for all outpatient expenses arising from in vitro fertilization procedures performed on the insured or the insured's dependent spouse.

(b) Policies providing an in vitro fertilization procedure benefit shall comply with the following:

(1) Benefits under this section shall be provided to the same extent as the benefits provided for other pregnancy-related benefits;

(2) The patient is the insured or covered dependent of the insured;

(3) The patient's oocytes are fertilized with the patient's spouse's sperm;

(4) The:

(A) Patient and the patient's spouse have a history of infertility of at least five years' duration; or

(B) Infertility is associated with one or more of the following medical conditions:

(i) Endometriosis;

(ii) Exposure in utero to diethylstilbestrol, commonly known as DES;

(iii) Blockage of, or surgical removal of, one or both fallopian tubes (lateral or bilateral salpingectomy); or

(iv) Abnormal male factors contributing to the infertility;

(5) The patient has been unable to attain a successful pregnancy through other applicable infertility treatments for which coverage is available under the insurance contract; and

(6) The in vitro fertilization procedures are performed at medical facilities that conform to the American College of Obstetric and Gynecology guidelines for in vitro fertilization clinics or to the American Society for Reproductive Medicine minimal standards for programs of in vitro fertilization.

[~~(b)~~] (c) For the purposes of this section, the term "spouse" means a person who is lawfully married to the patient under the laws of the State.

[~~(c)~~] (d) The requirements of this section shall apply to all new policies delivered or issued for delivery in this State after June 26, 1987."

SECTION 3. Section 431M-2, Hawaii Revised Statutes, is amended to read as follows:

"§431M-2 Policy coverage. [~~All~~] (a) This subsection shall apply to the following policies and contracts that are issued or renewed in this State before the effective date of this Act or after June 30, 2015: individual and group accident and health or sickness insurance policies [~~issued in this State~~], individual or group hospital or medical service plan contracts, and nonprofit mutual benefit society and health maintenance organization health plan contracts.

All policies and contracts subject to this subsection shall include within their hospital and medical coverage the benefits of alcohol dependence, drug dependence, and mental illness treatment services provided in section 431M-4 [~~except that~~].

(b) This subsection shall apply to the following policies and contracts that are issued or renewed in this State between the effective date of this Act and June 30, 2015: individual and group accident and health or sickness insurance policies, individual or group hospital or medical service plan contracts, and nonprofit mutual benefit society and health maintenance organization health plan contracts.

All policies and contracts subject to this subsection shall offer as an option alcohol dependence, drug dependence, and mental illness treatment benefits. The optional benefits shall be the same as those specified in section 431M-4.

(c) Notwithstanding any other law to the contrary, this section shall not apply to insurance policies that are issued solely for single diseases, or otherwise limited, specialized coverage."

SECTION 4. Within thirty days of the effective date of this Act, the insurance commissioner, under the authority of section 431:14G, Hawaii Revised Statutes, shall mandate each managed care plan affected by this Act to submit a rate filing reflecting the suspension of mandatory benefits as provided by this Act.

The insurance commissioner shall review and may disapprove the rate filings in accordance with chapter 431, article 14G, Hawaii Revised Statutes.

SECTION 5. This Act is not intended to jeopardize the waiver by federal law of the Hawaii prepaid health care act from preemption by any other federal law.

To maintain the effectiveness of the waiver, the governor, after consultation with the state attorney general, may suspend any provision of this Act. Upon effectuating a suspension, the governor shall notify in writing the president of the state senate and the speaker of the state house of representatives.

SECTION 6. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 8. This Act shall take effect upon its approval and shall be repealed on June 30, 2015; provided that, on July 1, 2015, sections 431:10A:116.5 and 431M-2, Hawaii Revised Statutes, shall be reenacted in the same form in which they existed on the day before the effective date of this Act.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	1895
TWENTY-SIXTH LEGISLATURE, 2012
STATE OF HAWAII