Text of HI SB 615 (2011)

THE SENATE S.B. NO. 615 TWENTY-SIXTH LEGISLATURE, 2011 STATE OF HAWAII A BILL FOR AN ACT relating to INFERTILITY PROCEDURES. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII: SECTION 1. Chapter 432, article 2, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows: "§432:2- Infertility procedure coverage. (a) All individual and group hospital and medical service plan contracts which provide pregnancy-related benefits shall include coverage for infertility treatment procedures performed on a member or a member's covered dependent; provided that: (1) Benefits under this section shall be provided to the same extent as the benefits provided for other pregnancy-related services; (2) The patient has been unable to attain a successful pregnancy through other applicable infertility treatments for which coverage is available under the benefit contract; and (3) The procedures are performed at medical facilities that conform to the American Congress of Obstetricians and Gynecologists guidelines or to the American Society for Reproductive Medicine minimal standards. (b) Services provided pursuant to this section shall include diagnosis and diagnostic tests, medications, surgery, in vitro fertilization, embryo transfer, intrauterine insemination, gamete intrafallopian transfer, zygote intrafallopian transfer, intracytoplasmic sperm injection, and no fewer than four completed fresh cycles per lifetime; provided that the implantation of a frozen embryo created during a prior cycle shall not be counted as its own completed fresh cycle against the four-cycle minimum. Notwithstanding any other requirement of this subsection or any other law to the contrary, an insurer may limit coverage for in vitro fertilization, gamete intrafallopian transfer, and zygote intrafallopian transfer to women who are forty-five years old or younger. (c) For purposes of this section: "Completed fresh cycle" means egg retrieval, fertilization, and fresh embryo transfer; provided that transfer of a frozen embryo created during a prior cycle shall not be a completed fresh cycle. "Infertility" means a condition whereby a person is unable to conceive or to produce conception during a period of one year for a woman aged thirty-five years or younger or a period of six months for a woman over age thirty-five; provided that the length of time of a pregnancy that is not carried to term shall be included in the time period required pursuant to this section." SECTION 2. Section 431:10A-116.5, Hawaii Revised Statutes, is amended to read as follows: "§431:10A-116.5 [In vitro fertilization] Infertility procedure coverage. (a) All individual and group accident and health or sickness insurance policies which provide pregnancy-related benefits shall include [in addition to any other benefits for treating infertility, a one-time only benefit for all outpatient expenses arising from] coverage for [in vitro fertilization] infertility treatment procedures performed on the insured or the insured's covered 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;] services; [(2) The patient is the insured or covered dependent of the insured; (3) The patient's oocytes are fertilized with the patient's spouse's sperm; (4) The: (A) Patient and the patient's spouse have a history of infertility of at least five 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)] (2) The patient has been unable to attain a successful pregnancy through other applicable infertility treatments for which coverage is available under the insurance contract; [and (6)] (3) The [in vitro fertilization] procedures are performed at medical facilities that conform to the American [College] Congress of [Obstetric and Gynecology] Obstetricians and Gynecologists guidelines [for in vitro fertilization clinics] or to the American Society for Reproductive Medicine minimal standards [for programs of in vitro fertilization]. (b) [For the purposes of this section, the term "spouse" means a person who is lawfully married to the patient under the laws of the State (c) The requirements of this section shall apply to all new policies delivered or issued for delivery in this State after June 26, 1987.] Services provided pursuant to this section shall include diagnosis and diagnostic tests, medications, surgery, in vitro fertilization, embryo transfer, intrauterine insemination, gamete intrafallopian transfer, zygote intrafallopian transfer, intracytoplasmic sperm injection, and no fewer than four completed fresh cycles per lifetime; provided that the implantation of a frozen embryo created during a prior cycle shall not be counted as its own completed fresh cycle against the four-cycle minimum. Notwithstanding any other requirement of this subsection or any other law to the contrary, an insurer may limit coverage for in vitro fertilization, gamete intrafallopian transfer, and zygote intrafallopian transfer to women who are forty-five years old or younger. (c) For purposes of this section: "Completed fresh cycle" means egg retrieval, fertilization, and fresh embryo transfer; provided that transfer of a frozen embryo created during a prior cycle shall not be a completed fresh cycle. "Infertility" means a condition whereby a person is unable to conceive or to produce conception during a period of one year for a woman aged thirty-five years or younger or a period of six months for a woman over age thirty-five; provided that the length of time of a pregnancy that is not carried to term shall be included in the time period required pursuant to this section." SECTION 3. Section 432:1-604, Hawaii Revised Statutes, is amended to read as follows: "§432:1-604 [In vitro fertilization] Infertility procedure coverage. (a) All individual and group hospital or medical service plan contracts which provide pregnancy-related benefits shall include [in addition to any other benefits for treating infertility, a one-time only benefit for all outpatient expenses arising from in vitro fertilization] coverage for infertility treatment procedures performed on the subscriber or member or the subscriber's or member's covered 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;] services; [(2) The patient is a subscriber or member or covered dependent of the subscriber or member; (3) The patient's oocytes are fertilized with the patient's spouse's sperm; (4) The: (A) Patient and the patient's spouse have a history of infertility of at least five 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)] (2) The patient has been unable to attain a successful pregnancy through other applicable infertility treatments for which coverage is available under the contract; [and (6)] (3) The [in vitro fertilization] procedures are performed at medical facilities that conform to the American [College] Congress of [Obstetric and Gynecology] Obstetricians and Gynecologists guidelines [for in vitro fertilization clinics] or to the American Society for Reproductive Medicine minimal standards [for programs of in vitro fertilization]. (b) [For the purposes of this section, the term "spouse" means a person who is lawfully married to the patient under the laws of the State. (c) The requirements of this section shall apply to all hospital or medical service plan contracts delivered or issued for delivery in this State after June 26, 1987.] Services provided pursuant to this section shall include diagnosis and diagnostic tests, medications, surgery, in vitro fertilization, embryo transfer, intrauterine insemination, gamete intrafallopian transfer, zygote intrafallopian transfer, intracytoplasmic sperm injection, and no fewer than four completed fresh cycles per lifetime; provided that the implantation of a frozen embryo created during a prior cycle shall not be counted as its own completed fresh cycle against the four-cycle minimum. Notwithstanding any other requirement of this subsection or any other law to the contrary, an insurer may limit coverage for in vitro fertilization, gamete intrafallopian transfer, and zygote intrafallopian transfer to women who are forty-five years old or younger. (c) For purposes of this section: "Completed fresh cycle" means egg retrieval, fertilization, and fresh embryo transfer; provided that transfer of a frozen embryo created during a prior cycle shall not be a completed fresh cycle. "Infertility" means a condition whereby a person is unable to conceive or to produce conception during a period of one year for a woman aged thirty-five years or younger or a period of six months for a woman over age thirty-five; provided that the length of time that a pregnancy that is not carried to term shall be included in the time period required pursuant to this section." SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 5. This Act shall take effect on July 1, 2011; provided that this Act shall apply to all policies of insurance issued or renewed on or after July 1, 2011, under plans, contracts, or agreements providing pregnancy-related benefits, as described in sections 431:10A-116.5, 432:1-604, and 432:2‑ , Hawaii Revised Statutes, and encompassed under section 432D-23, Hawaii Revised Statutes. INTRODUCED BY: _____________________________ Report Title: Health Insurance; Infertility Treatments Description: Amends requirements for coverage of infertility treatments to include procedures other than in vitro fertilization; removes requirement that recipients of infertility treatment be married. The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.