THE SENATE	S.B. NO.	642
THIRTY-THIRD LEGISLATURE, 2025		S.D. 2
STATE OF HAWAII

A BILL FOR AN ACT

RELATING TO INSURANCE.

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

SECTION 1. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A, part I, to be appropriately designated and to read as follows:

"§431:10A-   Standard fertility preservation services; optional coverage. (a) Each policy of individual or group accident and health or sickness insurance issued or renewed in the State after December 31, 2025, shall provide to the policyholder optional coverage for standard fertility preservation services for any insured who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

(b) No policy that provides optional coverage for standard fertility preservation services as required by subsection (a) shall:

(1) Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required optional coverage; or

(2) Discriminate based on the insured's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

(c) Any limitations imposed by a policy shall be based on the covered individual's medical history and clinical guidelines adopted by the insurer. Any clinical guidelines used by the insurer shall be based on the 2018 update to the guidelines developed by the American Society of Clinical Oncology and shall not deviate from the full scope of the guidelines.

(d) For the purposes of this section:

"Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

"Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

"Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the 2018 update to the professional guidelines published by the American Society of Clinical Oncology. "Standard fertility preservation services" include the full scope of services or treatments, without any exclusions or limitations, as defined in the 2018 update to the professional guidelines established by the American Society of Clinical Oncology. "Standard fertility preservation services" do not include:

(1) Any experimental procedures or other procedures not determined to be established medical practices according to the 2018 update to the guidelines developed by the American Society of Clinical Oncology;

(2) Third-party assisted reproduction technology procedures, including donor eggs or surrogates and gestational carriers; and

(3) Any services relating to cryopreservation storage."

SECTION 2. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1, part VI, to be appropriately designated and to read as follows:

"§432:1-   Standard fertility preservation services; optional coverage. (a) Each individual or group hospital or medical service plan contract issued or renewed in this State after December 31, 2025, shall provide to the member optional coverage for standard fertility preservation services for any covered person who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

(b) No plan contract that provides optional coverage for standard fertility preservation services as required by subsection (a) shall:

(1) Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required optional coverage; or

(2) Discriminate based on the covered person's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

(c) Any limitations imposed by a plan contract shall be based on the covered individual's medical history and clinical guidelines adopted by the mutual benefit society. Any clinical guidelines used by the mutual benefit society shall be based on the 2018 update to the guidelines developed by the American Society of Clinical Oncology and shall not deviate from the full scope of the guidelines.

(d) For the purposes of this section:

"Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

"Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

"Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the 2018 update to the professional guidelines published by the American Society of Clinical Oncology. "Standard fertility preservation services" include the full scope of services or treatments, without any exclusions or limitations, as defined in the 2018 update to the professional guidelines established by the American Society of Clinical Oncology. "Standard fertility preservation services" do not include:

(1) Any experimental procedures or other procedures not determined to be established medical practices according to the 2018 update to the guidelines developed by the American Society of Clinical Oncology;

(2) Third-party assisted reproduction technology procedures, including donor eggs or surrogates and gestational carriers; and

(3) Any services relating to cryopreservation storage."

SECTION 3. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:

"§432D-23 Required provisions and benefits. Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A‑116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, and [431:10A-134,] 431:10A-  , and chapter 431M."

SECTION 4. The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A-  , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 3 of this Act, shall take effect for all policies, contracts, plans, or agreements issued or renewed in the State after December 31, 2025.

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect on December 31, 2050.

Report Title:

Insurance; Mandatory Optional Coverage; Standard Fertility Preservation Services; Medically Necessary Treatment

Description:

Requires all health insurance policies, contracts, plans, and agreements issued or renewed after 12/31/2025, to provide optional coverage for standard fertility preservation services for persons undergoing medically necessary cancer-related treatments that may cause iatrogenic infertility. Effective 12/31/2050. (SD2)

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