THE SENATE	S.B. NO.	789
TWENTY-EIGHTH LEGISLATURE, 2015
STATE OF HAWAII

A BILL FOR AN ACT

RELATING TO IN VITRO FERTILIZATION INSURANCE COVERAGE.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that infertility is a disease of the reproductive system that impairs and substantially limits an individual's major life activity of reproduction.  In the United States, infertility affects approximately seven million women and their partners, and approximately twelve per cent of women of childbearing age have used an infertility service.  Since 1978, in vitro fertilization has provided a necessary solution for many diagnosed with infertility who desire to have a child and be a parent.

     The legislature further finds that since 1987, Hawaii has required insurance coverage for the treatment of infertility through in vitro fertilization.  The current law only provides for a one-time benefit; applies only to the insured or insured's spouse; requires fertilization with the sperm from the patient's spouse; requires a history of infertility for at least five years; requires previous attempts at pregnancy through other applicable infertility treatments for which coverage is available; and applies only to a limited number of medical conditions associated with infertility.

     The purpose of this Act is to provide in vitro fertilization insurance coverage equality for women who are diagnosed with infertility by requiring non-discriminatory coverage and ensuring quality of care in the diagnosis and treatment of infertility.  It is the intent of the legislature to exempt religious institutions and organizations that believe the covered procedures violate their religious and moral teachings and beliefs.

     SECTION 2.  Section 431:10A-116.5, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:

     "(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] lifetime benefit of three in vitro fertilization cycles or a live birth for all outpatient expenses arising from in vitro fertilization procedures performed on the insured or the insured's 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;

     (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:]

(3)  (A)  [Patient and the patient's spouse have] The patient has a history of infertility of [at least five years' duration; or] one year if thirty-five years of age or younger or six months if thirty-six years of age or older; and

         (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;] Uterine factor;

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

             (iv)  [Abnormal male factors contributing to the infertility;] Male factor;

(v) Ovulatory dysfunction; or

(vi) Diminished ovarian reserve;

    [(5)] (4)  The patient has been unable to attain a successful pregnancy through other applicable infertility treatments for which coverage [is] shall be available under the insurance contract[;], unless the individual's physician determines that those treatments are likely to be unsuccessful; and

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

     (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.] "infertility" means a disease, defined by the failure to achieve a successful pregnancy after twelve months or more of appropriate, timed unprotected intercourse or therapeutic donor insemination for women thirty-five years of age or younger or after six months or more, for women over thirty-five years of age."

     SECTION 3.  Section 432:1-604, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:

     "(a)  All individual and group hospital or medical service plan contracts which provide pregnancy-related benefits shall include in addition to any other benefits for treating infertility, a [one-time only] lifetime benefit of three in vitro fertilization cycles or a live birth for all outpatient expenses arising from in vitro fertilization procedures performed on the subscriber or member or the subscriber's or member's 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;

     (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:]

(3)  (A)  [Patient and the patient's spouse have] The patient has a history of infertility of [at least five years' duration; or] one year if thirty-five years of age or younger or six months if thirty-six years of age or older; and

         (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;] Uterine factor;

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

             (iv)  [Abnormal male factors contributing to the infertility;] Male factor;

(v) Ovulatory dysfunction; or

(vi) Diminished ovarian reserve;

    [(5)] (4)  The patient has been unable to attain a successful pregnancy through other applicable infertility treatments for which coverage [is] shall be available under the contract[;], unless the individual's physician determines that those treatments are likely to be unsuccessful; and

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

     (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.] "infertility" means a disease, defined by the failure to achieve a successful pregnancy after twelve months or more of appropriate, timed unprotected intercourse or therapeutic donor insemination for women thirty-five years or younger or after six months or more, for women over thirty-five years."

     SECTION 4.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 5.  This Act shall take effect upon its approval.

INTRODUCED BY:

_____________________________

Report Title:

In Vitro Fertilization Procedure Coverage; Infertility Disability

Description:

Provides insurance coverage equality for women who are diagnosed with infertility by making available to them expanded treatment options, ensuring adequate and affordable health care services.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.