THE SENATE	S.B. NO.	758
THIRTY-SECOND LEGISLATURE, 2023
STATE OF HAWAII

A BILL FOR AN ACT

RELATING TO FAMILY PLANNING.

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

SECTION 1. The legislature finds that Hawaii has long been a leader in advancing reproductive rights and advocating for access to affordable and comprehensive sexual and reproductive health care without discrimination. However, gaps in coverage and care still exist, and Hawaii's benefits and protections have not included equitable coverage for family planning and infertility treatments. According to the Centers for Disease Control and Prevention, in the United States, about one in four heterosexual women ages fifteen through forty-nine with no prior births have difficulty getting pregnant or staying pregnant.

In the United States, only twenty states have passed laws requiring certain insurers to either cover or offer coverage for infertility diagnosis and treatment. These states include Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, Texas, Utah, and West Virginia. In Hawaii, pregnancy-related coverage is included in accident and health insurance policies as a one-time only benefit for outpatient expenses arising from in vitro fertilization procedures. Unfortunately, the procedure is not covered in the first or second year of infertility but rather in the fifth year of infertility, or the patient is required to provide documentation that infertility is a result of a specified medical condition.

The legislature further finds that access to sexual and reproductive health care is critical for the health and well‑being of all families in Hawaii, particularly by helping people remain healthy and engage in family planning. Ensuring that Hawaii's residents receive comprehensive, quality, and culturally competent sexual and reproductive health care is a prudent economic policy that will improve the overall health of the State's communities.

Accordingly, the purpose of this Act is to ensure comprehensive quality coverage for sexual reproductive health care services, including family planning and infertility treatments, for all Hawaii residents.

SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to part I of article 10A to be appropriately designated and to read as follows:

"§431:10A-   Oocyte cryopreservation procedure coverage. (a) All individual and group accident and health or sickness insurance policies that provide pregnancy-related benefits shall include, in addition to any other benefits for treating and diagnosing infertility, benefits for all outpatient expenses arising from oocyte cryopreservation procedures performed on the insured, including those who are unmarried, 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:

(A) Insured or the insured's dependent spouse has a history of infertility; 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 infertility;

(3) The insured or the insured's dependent spouse has been unable to attain a successful pregnancy through other applicable infertility treatments covered under the insurance contract;

(4) The oocyte cryopreservation procedures are performed at medical facilities that conform to the American College of Obstetricians and Gynecologists' guidelines for oocyte cryopreservation or the American Society for Reproductive Medicine's minimum standards for oocyte cryopreservation programs;

(5) Coverage shall be limited to four completed oocyte retrievals; provided that, if a live birth follows a completed oocyte retrieval, two more completed oocyte retrievals shall be covered; and

(6) The maximum lifetime benefit shall not exceed $100,000.

(b) The requirements of this section shall apply to all new policies delivered or issued for delivery in the State after December 31, 2023.

(c) For the purposes of this section:

"Infertility" means the condition of an individual who is unable to conceive or produce conception during a period of one year if the individual is age thirty-five or younger or during a period of six months if the individual is over the age of thirty-five.

"Spouse" means a person who is lawfully married to the insured under the laws of the State."

SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to part VI of article 1 to be appropriately designated and to read as follows:

"§432:1-   Oocyte cryopreservation procedure coverage. (a) All individual and group hospital or medical service plan contracts that provide pregnancy-related benefits shall include, in addition to any other benefits for treating and diagnosing infertility, benefits for all outpatient expenses arising from oocyte cryopreservation procedures performed on the subscriber or member, including those who are unmarried, 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:

(A) Subscriber or member or the subscriber's or member's dependent spouse has a history of infertility; 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 infertility;

(3) The subscriber or member or the subscriber's or member's dependent spouse has been unable to attain a successful pregnancy through other applicable infertility treatments covered under the insurance contract;

(4) The oocyte cryopreservation procedures are performed at medical facilities that conform to the American College of Obstetricians and Gynecologists' guidelines for oocyte cryopreservation or the American Society for Reproductive Medicine's minimum standards for oocyte cryopreservation programs;

(5) Coverage shall be limited to four completed oocyte retrievals; provided that, if a live birth follows a completed oocyte retrieval, two more completed oocyte retrievals shall be covered; and

(6) The maximum lifetime benefit shall not exceed $100,000.

(b) The requirements of this section shall apply to all hospital or medical service plan contracts delivered or issued for delivery in the State after December 31, 2023.

(c) For the purposes of this section:

"Infertility" means the condition of an individual who is unable to conceive or produce conception during a period of one year if the individual is age thirty-five or younger or during a period of six months if the individual is over the age of thirty-five.

"Spouse" means a person who is lawfully married to the subscriber or member under the laws of the State."

SECTION 4. Section 431:10A-116.5, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) All individual and group accident and health or sickness insurance policies [which] that provide pregnancy-related benefits shall include, in addition to any other benefits for treating and diagnosing infertility, [a one-time only benefit] benefits for all outpatient expenses arising from in vitro fertilization procedures performed on the insured, including those who are unmarried, 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)] (2) The [patient's] oocytes [are fertilized with the patient's spouse's sperm;] or sperm of the insured or of the insured's dependent spouse are used in the in vitro fertilization procedures;

[(4)] (3) The:

(A) [Patient and the patient's spouse have] Insured or the insured's dependent spouse has a history of infertility of at least [five] two 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)] (4) The [patient] insured or the insured's dependent spouse has been unable to attain a successful pregnancy through other applicable infertility treatments [for which coverage is available] covered under the insurance contract; and

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

SECTION 5. Section 432:1-604, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(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 and diagnosing infertility, [a one-time only benefit] benefits for all outpatient expenses arising from in vitro fertilization procedures performed on the subscriber or member, including those who are unmarried, 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)] (2) The [patient's] oocytes [are fertilized with the patient's spouse's sperm;] or sperm of the subscriber or member or the subscriber's or member's dependent spouse are used in the in vitro fertilization procedures;

[(4)] (3) The:

(A) [Patient and the patient's spouse have] Subscriber or member or the subscriber's or member's dependent spouse has a history of infertility of at least [five] two 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)] (4) The [patient] subscriber or member or the subscriber's or member's dependent spouse has been unable to attain a successful pregnancy through other applicable infertility treatments [for which coverage is available] covered under the contract; and

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

SECTION 6. 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 7. The coverage and benefits to be provided by a health maintenance organization under section 6 of this Act shall begin for all policies, contracts, plans, or agreements issued or renewed in the State by a health maintenance organization after December 31, 2023.

SECTION 8. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 9. This Act shall take effect upon its approval.

INTRODUCED BY:

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Report Title:

Health Insurance; Oocyte Cryopreservation; In Vitro Fertilization

Description:

Beginning with policies issued on or after 1/1/2024, requires health insurance policies to cover oocyte cryopreservation in certain circumstances. Removes the one-time benefit limitation for in vitro fertilization, and requires the insured or the insured's dependent spouse to have a history of infertility of at least two years' duration rather than five years'.

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