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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.
- How do you afford five years of paying for other infertility treatments
- The law provides a "one time only benefit for IVF"
- What if you need more than one IVF cycle to conceive?
- Do you shoot for multiples?
Infertility Treatments are Tax Deductible How do you afford five years of infertility treatments while waiting for the Hawaii mandate to kick in? What happens if you wait five years for insurance to cover one IVF cycle and you don't get pregnant? How do you afford all these out of pocket costs? One way is to be smart about using the tax code to your advantage.
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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.
In addition the Hawaii mandate stipulates that a patient must have five years of unexplained infertility, or prove that there is an underlying medical condition such as:
- Endometriosis
- Exposure in utero to DES - Diethylstilbestrol
- Blockage of one or both fallopian tubes
- Surgical removal of fallopian tubes
- Abnormal male infertility factors
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:
- Should we pay for other infertility treatments ourselves right away?
- Should we wait five years and go straight for IVF even though other treatments may work?
An Interim Solution
For those who don't want to wait consider this:
- Cut your costs by leveraging tax deductible infertilty and IVF expenses using Schedule A and flexible spending accounts.
- Use supplemental health insurance to create income from your normal delivery to offset your infertility treatment costs, and get additional security for complications.
Hawaii Residents Covered
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
