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Hawaii Infertility Insurance Mandate

Hawaii, like only 14 other states, has an infertility insurance mandate in place that requires insurance plans to provide coverage for fertility treatment and IVF costs. Hawaii law on infertility insurance can be found in Sections 431-lOA-116.5 and 432.1-604 of the Hawaii Revised Statutes.

Hawaii’s infertility insurance law became effective in 1987. According to Hawaii infertility insurance law, all individual and group hospital or medical service plan contracts that provide pregnancy-related coverage must provide a one-time only benefit for outpatient expenses that arise from an in vitro fertilization (IVF) procedure.

Under this Hawaii infertility insurance law, this one-time only IVF benefit is included in addition to any other benefits covering fertility treatments. These IVF benefits are provided to the same extent as other pregnancy-related benefits that are covered under the insurance plan.

Hawaii Infertility Insurance Mandate Limitations

Like many of the infertility insurance mandates, Hawaii’s law on coverage for IVF costs includes certain stipulations. Limitations under Hawaii’s infertility insurance mandate include the following:

  • The patient and the patient’s spouse must have a five-year history with infertility, unless the infertility is associated with the following medical conditions: endometriosis , in utero exposure to diethylstilbestrol (DES), blockage or surgical removal of one or both of the fallopian tubes, or abnormal male factors resulting in infertility
  • The patient must have been unable to achieve pregnancy or carry a successful pregnancy through other applicable fertility treatments that are covered under the plan
  • The IVF procedure must be performed at a fertility clinic or medical facility that conforms to guidelines for IVF established by the American College of Obstetric and Gynecology or the American Society for Reproductive Medicine

Another important limitation of Hawaii’s infertility insurance mandate is that it requires that the patient’s eggs be fertilized with her spouse’s sperm. Under the law, the term “spouse” refers to a person who is lawfully married to the patient under the laws of the State. This appears to exclude individuals and gay couples under the law.

Comments (2)

I have Tri-care but that is not applicable for the one time IVF treatment. Which insurance should I get that will honor the Hawaii infertility Insurance Mandate? Thank you.

Bobbi Jo - HMSA PPO should cover one IVF cycle -or- HMSA HMO should cover IUI & one IVF They cover a lot of the cost, but there are some tests, etc. that are not covered. I'm not sure about other health providers in Hawaii.

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