Hawaii 2025 Regular Session

Hawaii Senate Bill SB23 Compare Versions

Only one version of the bill is available at this time.

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1	1	THE SENATE S.B. NO. 23 THIRTY-THIRD LEGISLATURE, 2025 STATE OF HAWAII A BILL FOR AN ACT relating to INSURANCE. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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3	3	THE SENATE S.B. NO. 23
4	4	THIRTY-THIRD LEGISLATURE, 2025
5	5	STATE OF HAWAII
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7	7	THE SENATE
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9	9	S.B. NO.
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13	13	THIRTY-THIRD LEGISLATURE, 2025
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17	17	STATE OF HAWAII
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31	31	A BILL FOR AN ACT
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37	37	relating to INSURANCE.
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43	43	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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47	47	SECTION 1. The legislature finds that reproductive technology, such as in vitro fertilization, is critically important for individuals and couples who desire to have children. While the State's mandate that insurance plans provide a one-time benefit for costs associated with in vitro fertilization procedures, existing coverage does not extend to samesex couples, unmarried individuals, transgender persons, and oppositesex couples for whom male infertility is the relevant factor. Although some insurers independently offer policies that cover female couples or women without male partners, these policies are not guaranteed by law. Finally, oppositesex couples for whom male infertility is the relevant factor are excluded from coverage through the existing statutory requirement. The legislature further finds that the current inequity in the treatment of individuals seeking medical fertility assistance constitutes discrimination based on sex, sexual orientation, and marital status. In vitro fertilization procedures are expensive, costing $12,000 to $15,000 per cycle. Same-sex couples, unmarried individuals, transgender persons, and opposite-sex couples affected by male infertility must unreasonably bear the full cost of the procedures while married opposite-sex couples for whom female infertility is the relevant factor do not bear the same burden. Accordingly, the purpose of this Act is to ensure equal access to in vitro fertilization for all couples, including same-sex couples, transgender persons, and for individuals regardless of marital status. It is further the desire of the legislature that employers offering self-funded plans that fall outside the scope of state regulation voluntarily adopt this inclusive coverage in their policies. SECTION 2. Section 431:10A-103, Hawaii Revised Statutes, is amended to read as follows: "§431:10A-103 Family coverage defined. As used in this part, family coverage means a policy that insures, originally or upon subsequent amendment, an adult member of a family who shall be deemed the policyholder and any two or more eligible members of that family, including spouse, dependent children or any children under a specified age which shall not exceed nineteen years, and any other person dependent upon the policyholder. Benefits under a policy shall be gender neutral, meaning any benefit available to married opposite-sex couples shall also be available to same-sex couples, transgender individuals, and individuals regardless of marital status. Any policy that includes benefits for infertility treatments and related procedures shall recognize the medical necessity and unique reproductive needs of same-sex couples and individuals." SECTION 3. Section 431:10A-116.5, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows: "(a) All individual and group accident and health or sickness insurance policies [which] that 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 procedures performed on the insured or the insured's dependent spouse[;] or the oocyte donor or surrogate of the insured or of the insured's dependent spouse; provided that: (1) Benefits under this section shall be gender neutral, meaning any benefit available to married opposite-sex couples shall also be available for same-sex couples, a transgender person, and individuals regardless of marital status; [(1)] (2) Benefits under this section shall be provided to the same extent as the benefits provided for other pregnancy-related benefits; [(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;] or sperm of the insured or of the insured's dependent spouse are used in the in vitro fertilization procedures; (4) The: (A) [Patient and the patient's spouse have] Insured or the insured's dependent spouse has a history of infertility of at least [five years' duration; or] six months' duration or the necessity of medical intervention to conceive due to physiological or anatomical factors; (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; or (C) Insured and insured's dependent spouse are of the same sex; (5) The [patient] insured or the insured's dependent spouse has been unable to attain a successful pregnancy through other applicable infertility treatments [for which coverage is available] covered under the insurance contract; and (6) The in vitro fertilization procedures are performed at medical facilities that conform to the American College of Obstetricians and [Gynecologists] Gynecologists' guidelines for in vitro fertilization clinics or [to] the American Society for Reproductive [Medicine minimal] Medicine's minimum standards for [programs of in vitro fertilization.] practices offering assisted reproductive technologies. Any individual or group accident and health or sickness insurance policy offered by an employer covering twenty-five employees or more shall include coverage for at least three in vitro fertilization cycles, including all costs associated with fertility preservation and gamete donation, without discrimination on the basis of gender, marital status, or sexual orientation. (b) For the purposes of this section[, the term "spouse"]: "Spouse" means a person who is lawfully married to the patient under the laws of the State. "Transgender person" has the same meaning as defined in section 431:10A-118.3." SECTION 4. Section 432:1-604, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows: "(a) All individual and group hospital or medical service plan contracts [which] that 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 procedures performed on the subscriber or member or the subscriber's or member's dependent spouse[;] or the oocyte donor or surrogate of the subscriber or member or the subscriber's or member's dependent spouse; provided that: (1) Benefits under this section shall be gender neutral, meaning any benefit available to married opposite-sex couples shall also be available for same-sex couples, a transgender person, and individuals regardless of marital status; [(1)] (2) Benefits under this section shall be provided to the same extent as the benefits provided for other pregnancy-related benefits; [(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;] or sperm of the subscriber or member or of the subscriber's or member's dependent spouse are used in the in vitro fertilization procedures; (4) The: (A) [Patient and the patient's spouse have] Subscriber or member or the subscriber's or member's dependent spouse has a history of infertility of at least [five years' duration; or] six months' duration or the necessity of medical intervention to conceive due to physiological or anatomical factors; (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; or (C) Subscriber or member and the subscriber's or member's dependent spouse are of the same sex; (5) The [patient] subscriber or member or the subscriber's or member's dependent spouse has been unable to attain a successful pregnancy through other applicable infertility treatments [for which coverage is available] covered under the contract; and (6) The in vitro fertilization procedures are performed at medical facilities that conform to the American College of Obstetricians and [Gynecologists] Gynecologists' guidelines for in vitro fertilization clinics or to the American Society for Reproductive [Medicine minimal] Medicine's minimum standards for [programs of] in vitro fertilization[.] programs. Any individual or group hospital or medical service plan contract offered by an employer covering twenty-five employees or more shall include coverage for at least three in vitro fertilization cycles, including all costs associated with fertility preservation and gamete donation, without discrimination on the basis of gender, marital status, or sexual orientation. (b) For the purposes of this section[, the term "spouse"]: "Spouse" means a person who is lawfully married to the patient under the laws of the State. "Transgender person" has the same meaning as defined in section 431:10A-118.3." SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 6. This Act shall take effect upon its approval. INTRODUCED BY: _____________________________
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49	49	SECTION 1. The legislature finds that reproductive technology, such as in vitro fertilization, is critically important for individuals and couples who desire to have children. While the State's mandate that insurance plans provide a one-time benefit for costs associated with in vitro fertilization procedures, existing coverage does not extend to samesex couples, unmarried individuals, transgender persons, and oppositesex couples for whom male infertility is the relevant factor. Although some insurers independently offer policies that cover female couples or women without male partners, these policies are not guaranteed by law. Finally, oppositesex couples for whom male infertility is the relevant factor are excluded from coverage through the existing statutory requirement.
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51	51	The legislature further finds that the current inequity in the treatment of individuals seeking medical fertility assistance constitutes discrimination based on sex, sexual orientation, and marital status. In vitro fertilization procedures are expensive, costing $12,000 to $15,000 per cycle. Same-sex couples, unmarried individuals, transgender persons, and opposite-sex couples affected by male infertility must unreasonably bear the full cost of the procedures while married opposite-sex couples for whom female infertility is the relevant factor do not bear the same burden.
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53	53	Accordingly, the purpose of this Act is to ensure equal access to in vitro fertilization for all couples, including same-sex couples, transgender persons, and for individuals regardless of marital status. It is further the desire of the legislature that employers offering self-funded plans that fall outside the scope of state regulation voluntarily adopt this inclusive coverage in their policies.
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55	55	SECTION 2. Section 431:10A-103, Hawaii Revised Statutes, is amended to read as follows:
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57	57	"§431:10A-103 Family coverage defined. As used in this part, family coverage means a policy that insures, originally or upon subsequent amendment, an adult member of a family who shall be deemed the policyholder and any two or more eligible members of that family, including spouse, dependent children or any children under a specified age which shall not exceed nineteen years, and any other person dependent upon the policyholder. Benefits under a policy shall be gender neutral, meaning any benefit available to married opposite-sex couples shall also be available to same-sex couples, transgender individuals, and individuals regardless of marital status. Any policy that includes benefits for infertility treatments and related procedures shall recognize the medical necessity and unique reproductive needs of same-sex couples and individuals."
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59	59	SECTION 3. Section 431:10A-116.5, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:
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61	61	"(a) All individual and group accident and health or sickness insurance policies [which] that 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 procedures performed on the insured or the insured's dependent spouse[;] or the oocyte donor or surrogate of the insured or of the insured's dependent spouse; provided that:
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63	63	(1) Benefits under this section shall be gender neutral, meaning any benefit available to married opposite-sex couples shall also be available for same-sex couples, a transgender person, and individuals regardless of marital status;
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65	65	[(1)] (2) Benefits under this section shall be provided to the same extent as the benefits provided for other pregnancy-related benefits;
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67	67	[(2) The patient is the insured or covered dependent of the insured;]
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69	69	(3) The [patient's] oocytes [are fertilized with the patient's spouse's sperm;] or sperm of the insured or of the insured's dependent spouse are used in the in vitro fertilization procedures;
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71	71	(4) The:
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73	73	(A) [Patient and the patient's spouse have] Insured or the insured's dependent spouse has a history of infertility of at least [five years' duration; or] six months' duration or the necessity of medical intervention to conceive due to physiological or anatomical factors;
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75	75	(B) Infertility is associated with one or more of the following medical conditions:
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77	77	(i) Endometriosis;
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79	79	(ii) Exposure in utero to diethylstilbestrol, commonly known as DES;
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81	81	(iii) Blockage of, or surgical removal of, one or both fallopian tubes (lateral or bilateral salpingectomy); or
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83	83	(iv) Abnormal male factors contributing to [the] infertility; or
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85	85	(C) Insured and insured's dependent spouse are of the same sex;
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87	87	(5) The [patient] insured or the insured's dependent spouse has been unable to attain a successful pregnancy through other applicable infertility treatments [for which coverage is available] covered under the insurance contract; and
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89	89	(6) The in vitro fertilization procedures are performed at medical facilities that conform to the American College of Obstetricians and [Gynecologists] Gynecologists' guidelines for in vitro fertilization clinics or [to] the American Society for Reproductive [Medicine minimal] Medicine's minimum standards for [programs of in vitro fertilization.] practices offering assisted reproductive technologies.
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91	91	Any individual or group accident and health or sickness insurance policy offered by an employer covering twenty-five employees or more shall include coverage for at least three in vitro fertilization cycles, including all costs associated with fertility preservation and gamete donation, without discrimination on the basis of gender, marital status, or sexual orientation.
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93	93	(b) For the purposes of this section[, the term "spouse"]:
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95	95	"Spouse" means a person who is lawfully married to the patient under the laws of the State.
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97	97	"Transgender person" has the same meaning as defined in section 431:10A-118.3."
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99	99	SECTION 4. Section 432:1-604, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:
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101	101	"(a) All individual and group hospital or medical service plan contracts [which] that 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 procedures performed on the subscriber or member or the subscriber's or member's dependent spouse[;] or the oocyte donor or surrogate of the subscriber or member or the subscriber's or member's dependent spouse; provided that:
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103	103	(1) Benefits under this section shall be gender neutral, meaning any benefit available to married opposite-sex couples shall also be available for same-sex couples, a transgender person, and individuals regardless of marital status;
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105	105	[(1)] (2) Benefits under this section shall be provided to the same extent as the benefits provided for other pregnancy-related benefits;
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107	107	[(2) The patient is a subscriber or member or covered dependent of the subscriber or member;]
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109	109	(3) The [patient's] oocytes [are fertilized with the patient's spouse's sperm;] or sperm of the subscriber or member or of the subscriber's or member's dependent spouse are used in the in vitro fertilization procedures;
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111	111	(4) The:
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113	113	(A) [Patient and the patient's spouse have] Subscriber or member or the subscriber's or member's dependent spouse has a history of infertility of at least [five years' duration; or] six months' duration or the necessity of medical intervention to conceive due to physiological or anatomical factors;
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115	115	(B) Infertility is associated with one or more of the following medical conditions:
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117	117	(i) Endometriosis;
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119	119	(ii) Exposure in utero to diethylstilbestrol, commonly known as DES;
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121	121	(iii) Blockage of, or surgical removal of, one or both fallopian tubes (lateral or bilateral salpingectomy); or
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123	123	(iv) Abnormal male factors contributing to [the] infertility; or
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125	125	(C) Subscriber or member and the subscriber's or member's dependent spouse are of the same sex;
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127	127	(5) The [patient] subscriber or member or the subscriber's or member's dependent spouse has been unable to attain a successful pregnancy through other applicable infertility treatments [for which coverage is available] covered under the contract; and
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129	129	(6) The in vitro fertilization procedures are performed at medical facilities that conform to the American College of Obstetricians and [Gynecologists] Gynecologists' guidelines for in vitro fertilization clinics or to the American Society for Reproductive [Medicine minimal] Medicine's minimum standards for [programs of] in vitro fertilization[.] programs.
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131	131	Any individual or group hospital or medical service plan contract offered by an employer covering twenty-five employees or more shall include coverage for at least three in vitro fertilization cycles, including all costs associated with fertility preservation and gamete donation, without discrimination on the basis of gender, marital status, or sexual orientation.
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133	133	(b) For the purposes of this section[, the term "spouse"]:
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135	135	"Spouse" means a person who is lawfully married to the patient under the laws of the State.
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137	137	"Transgender person" has the same meaning as defined in section 431:10A-118.3."
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139	139	SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
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141	141	SECTION 6. This Act shall take effect upon its approval.
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145	145	INTRODUCED BY: _____________________________
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147	147	INTRODUCED BY:
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149	149	_____________________________
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155	155	Report Title: Health Insurance; In Vitro Fertilization; Mandatory Insurance Coverage; Infertility; Same-Sex Couples; Unmarried Individuals; Transgender Persons; Male Infertility; Parity Description: Removes discriminatory requirements for mandatory insurance coverage of in vitro fertilization procedures to create parity of coverage for same-sex couples, unmarried individuals, transgender persons, and opposite-sex couples for whom male infertility is the relevant factor. Requires the insured or the insured's dependent spouse to have a history of infertility of at least six months' duration, rather than five years. Includes need for medical intervention to conceive due to physiological or anatomical factors. The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
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163	163	Report Title:
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165	165	Health Insurance; In Vitro Fertilization; Mandatory Insurance Coverage; Infertility; Same-Sex Couples; Unmarried Individuals; Transgender Persons; Male Infertility; Parity
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169	169	Description:
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171	171	Removes discriminatory requirements for mandatory insurance coverage of in vitro fertilization procedures to create parity of coverage for same-sex couples, unmarried individuals, transgender persons, and opposite-sex couples for whom male infertility is the relevant factor. Requires the insured or the insured's dependent spouse to have a history of infertility of at least six months' duration, rather than five years. Includes need for medical intervention to conceive due to physiological or anatomical factors.
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179	179	The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.