Hawaii Infertility Mandate
Hawaii Insurance Law Mandating IVF Coverage
The Hawaii law mandates the all health insurers that provide pregnancy related benefits to cover the out patient treatment cost of in vitro fertilization (IVF). This is a one-time only benefit. The law applies to individual and group plans, hospital contracts, and medical services plans.Patients need to meet specific conditions in order to get their IVF covered. You must have at least a five year history of infertility, or show an underlying medical condition. The Hawaii mandate presents a variety of difficult choices for couples trying to get pregnant.
Hawaii Infertility Treatments Covered
In Vitro Fertilization (IVF) is often the last line of treatment for couples trying to conceive. Many other treatments including fertility drugs, artificial insemination, vasectomy reversal, tubal ligation reversal, and more are not subject to this regulation.
The Hawaii regulation also states that a couple must have been unable to obtain a successful pregnancy through other applicable infertility treatments, for which the insurance plan covered. Since most plans don't cover any Artificial Reproductive Technique, this is a rather odd and unhelpful portion of legal language. This poses a difficult choice for couples trying to conceive:
An Interim Solution
For those who don't want to wait consider this:
Hawaii Residents Covered
The Hawaii law applies to "All individual and group accident and health or sickness insurance policies which provide pregnancy-related benefits". This raises the question: what plans provide pregnancy-related benefits? Similar to infertility coverage, most health insurers would rather not cover normal pregnancy. Those that do are required by law.
We have to look at federal and state level laws to determine which plans must comply. The Pregnancy Discrimination Act requires groups of fifteen or more to provide pregnancy-related benefits. A separate Hawaii regulation requires coverage for small groups: those with three or more employees.
If you bought a plan in the individual market, odds are your medical plan does not provide pregnancy-related benefits, and therefor does not need to cover IVF either. Also, plans for employers that self-insure, and employers based on the mainland may not be required to comply.
Source: Hawaii Revised Statutes Sections 431-lOA-116.5