Coverage Mandate 1:
All individual and group hospital or medical service plan contracts and accident and health or sickness insurance policies that provide pregnancy-related benefits must cover all outpatient expenses from 1 cycle of IVF. Haw. Rev. Stat. Ann. §§ 431:10A-116.5(a), 432:1-604(a).
This one-time only benefit is in addition to any other benefits for treating infertility. Id.
The term “IVF” is not defined.
Scope of Mandate 2:
Coverage Cap 3:
Requirements or Limitations on Coverage 4:
To qualify for the one-time only benefit, all of the following requirements must be met:
- The benefits are provided to the same extent as other pregnancy-related benefits; and
- The patient is the insured/subscriber/member or covered dependent of the insured/subscriber/member; and
- The patient's oocytes are fertilized with the patient's spouse's sperm; and
- (i) The patient and the patient's spouse have a history of infertility for at least 5 years, or (ii) infertility is associated with at least 1 of the following medical conditions: endometriosis, exposure in utero to diethylstilbestrol, blockage/surgical removal of a fallopian tube, or abnormal male factors contributing to the infertility; and
- The patient has been unable to attain a successful pregnancy through other applicable infertility treatments covered by the insurance contract or policy; and
- IVF is performed at medical facilities that conform to the American College of Obstetricians and Gynecologists IVF guidelines or to the American Society for Reproductive Medicine minimal standards for IVF programs.
Haw. Rev. Stat. Ann. §§ 431:10A-116.5(a), 432:1-604(a).“Spouse” means a person who is lawfully married to the patient under the laws of the state. Id. §§ 431:10A-116.5(b), 432:1-604(b).
1 Does the state have a coverage mandate, Y/N. Include effective date of the mandate. Specify if the mandate is to “offer” services or to “cover” them.
2Which insurers are required to comply with the mandate. If not applicable, put N/A.
3Is there a cap (annual/lifetime)?
4Does the law impose age restrictions on eligibility for coverage? Does it limit the number of IVF cycles covered (or require at least a certain number of services be covered)? Does it mandate a waiting period? Other limitations? How is “infertility” defined? Is it inclusive (e.g.: does it apply only to married or -opposite sex couples, or is it inclusive?)
5What, if any, exemptions apply to coverage under the mandate? For example: an exemption for small businesses or religious organizations.