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THE SENATE |
S.B. NO. |
615 |
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TWENTY-SIXTH LEGISLATURE, 2011 |
S.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO INFERTILITY PROCEDURES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Chapter 432, article 2, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§432:2- Infertility procedure coverage. (a) All individual and group hospital and medical service plan contracts that provide pregnancy-related benefits shall include coverage for infertility treatment procedures performed on a member or a member's covered dependent; provided that:
(1) Benefits under this section shall be provided to the same extent as the benefits provided for other pregnancy-related services;
(2) The patient has been unable to attain a successful pregnancy through other applicable infertility treatments for which coverage is available under the benefit contract; and
(3) The procedures are performed at medical facilities that are members of the Society for Assisted Reproductive Technologies.
(b) Services provided pursuant to this section shall include diagnosis and diagnostic tests, medications, surgery, in vitro fertilization, embryo transfer, intrauterine insemination, gamete intrafallopian transfer, zygote intrafallopian transfer, intracytoplasmic sperm injection, and no fewer than four completed fresh cycles per lifetime; provided that the implantation of a frozen embryo created during a prior cycle shall not be counted as its own completed fresh cycle against the four-cycle minimum. Notwithstanding any other requirement of this subsection or any other law to the contrary, an insurer may limit coverage for in vitro fertilization, gamete intrafallopian transfer, and zygote intrafallopian transfer to women who are forty-five years old or younger.
(c) For purposes of this section:
"Completed fresh cycle" means egg retrieval, fertilization, and fresh embryo transfer; provided that transfer of a frozen embryo created during a prior cycle shall not be a completed fresh cycle.
"Infertility" means a condition whereby a person is unable to conceive or to produce conception during a period of one year for a woman aged thirty-five years or younger or a period of six months for a woman over age thirty-five; provided that the length of time of a pregnancy that is not carried to term shall be included in the time period required pursuant to this section."
SECTION 2. Section 431:10A-116.5, Hawaii Revised Statutes, is amended to read as follows:
"§431:10A-116.5 [In vitro
fertilization] Infertility procedure coverage. (a) All
individual and group accident and health or sickness insurance policies 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] coverage for infertility
treatment procedures performed on the insured or the insured's covered
dependent [spouse]; provided that:
(1) Benefits under this section shall be provided to
the same extent as the benefits provided for other pregnancy-related [benefits;]
services;
(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)] (3) 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.] are members of the Society for Assisted
Reproductive Technologies.
(b) [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) The requirements of this section shall
apply to all new policies delivered or issued for delivery in this State after
June 26, 1987.] Services provided pursuant to this section shall include
diagnosis and diagnostic tests, medications, surgery, in vitro fertilization,
embryo transfer, intrauterine insemination, gamete intrafallopian transfer,
zygote intrafallopian transfer, intracytoplasmic sperm injection, and no fewer
than four completed fresh cycles per lifetime; provided that the implantation
of a frozen embryo created during a prior cycle shall not be counted as its own
completed fresh cycle against the four-cycle minimum. Notwithstanding any
other requirement of this subsection or any other law to the contrary, an
insurer may limit coverage for in vitro fertilization, gamete intrafallopian
transfer, and zygote intrafallopian transfer to women who are forty-five years
old or younger.
(c) For purposes of this section:
"Completed fresh cycle" means egg retrieval, fertilization, and fresh embryo transfer; provided that transfer of a frozen embryo created during a prior cycle shall not be a completed fresh cycle.
"Infertility" means a condition whereby a person is unable to conceive or to produce conception during a period of one year for a woman aged thirty-five years or younger or a period of six months for a woman over age thirty-five; provided that the length of time of a pregnancy that is not carried to term shall be included in the time period required pursuant to this section."
SECTION 3. Section 432:1-604, Hawaii Revised Statutes, is amended to read as follows:
"§432:1-604 [In vitro fertilization]
Infertility procedure coverage. (a) All individual and group
hospital or medical service plan contracts [which] that 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] coverage for infertility treatment
procedures performed on the subscriber or member or the subscriber's or
member's covered dependent [spouse]; provided that:
(1) Benefits under this section shall be provided to
the same extent as the benefits provided for other pregnancy-related [benefits;]
services;
(2) [The patient is a subscriber or member or
covered dependent of the subscriber or member;
(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 contract; and
[(6)] (3) 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.] are members of the Society for Assisted
Reproductive Technologies.
(b) [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) The requirements of this section shall
apply to all hospital or medical service plan contracts delivered or issued for
delivery in this State after June 26, 1987.] Services provided pursuant
to this section shall include diagnosis and diagnostic tests, medications,
surgery, in vitro fertilization, embryo transfer, intrauterine insemination,
gamete intrafallopian transfer, zygote intrafallopian transfer,
intracytoplasmic sperm injection, and no fewer than four completed fresh cycles
per lifetime; provided that the implantation of a frozen embryo created during
a prior cycle shall not be counted as its own completed fresh cycle against the
four-cycle minimum. Notwithstanding any other requirement of this subsection
or any other law to the contrary, an insurer may limit coverage for in vitro
fertilization, gamete intrafallopian transfer, and zygote intrafallopian
transfer to women who are forty-five years old or younger.
(c) For purposes of this section:
"Completed fresh cycle" means egg retrieval, fertilization, and fresh embryo transfer; provided that transfer of a frozen embryo created during a prior cycle shall not be a completed fresh cycle.
"Infertility" means a condition whereby a person is unable to conceive or to produce conception during a period of one year for a woman aged thirty-five years or younger or a period of six months for a woman over age thirty-five; provided that the length of time that a pregnancy that is not carried to term shall be included in the time period required pursuant to this section."
SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 5. This Act shall take effect on July 1, 2011; provided that this Act shall apply to all policies of insurance issued or renewed on or after July 1, 2011, under plans, contracts, or agreements providing pregnancy-related benefits, as described in sections 431:10A-116.5, 432:1-604, and 432:2‑ , Hawaii Revised Statutes, and encompassed under section 432D-23, Hawaii Revised Statutes.
Report Title:
Health Insurance; Infertility Treatments
Description:
Amends requirements for coverage of infertility treatments to include procedures other than in vitro fertilization; removes requirement that recipients of infertility treatment be married. Requires the covered infertility treatments to be performed at centers that are members of the Society for Assisted Reproductive Technologies. (SD1)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.