Know your rights: The Hawaii Infertility Mandate

hawaii

The Hawaii infertility mandate, enacted in 1989, requires any fertility coverage, including a single IVF cycle, in any plan that also provides maternity coverage for couples who have been trying unsuccessfully to conceive for 5 years or who have been diagnosed with a condition known to cause infertility.

Attempts to amend the bill in 2012 to include fertility preservation for people of reproductive age diagnosed with cancer and again in 2017 to open access to single women and same sex couples died in committee meetings.

Further information is clarified in the Hawaii Revised Statutes Section 431-10A-116.5. A summary of eligibility requirements, exemptions and services covered is outlined below.

How the mandate defines infertility

To qualify for treatment, you must have one of the following conditions:

  • Unexplained infertility for at least 5 years
  • Endometriosis
  • DES (In Utero to Diethylstilbestrol)
  • Blockage or removal of fallopian tubes (not including voluntary sterilization)
  • Male Infertility

Additional Eligibility requirements

  • Patient must be a policy holder or the spouse (and covered dependent) of the policy holder.
  • Must be diagnosed with infertility (as defined above).
  • Must be unsuccessful achieving pregnancy with less expensive treatment options covered by the plan.
  • Eggs of patient must be fertilized by Husband’s sperm.
  • The IVF procedure must be performed at a fertility clinic or medical facility that conforms to guidelines for IVF established by the American College of Obstetric and Gynecology or the American Society for Reproductive Medicine.

How the law treats male infertility

Like Arkansas, the treatment of male infertility is a mixed bag. On one hand, the law explicitly defines “abnormal male factors” as a cause of infertility but does not explicitly cover “male infertility treatments” and requires that IVF utilize husband’s sperm and wife’s eggs, precluding use of donor sperm.

Services that are covered

The mandate suggests that less expensive fertility treatment options should be covered (and utilized prior to use of IVF) but only specifies that a single cycle of In Vitro Fertilization must be offered to those who qualify.

Limitations on coverage

Only one IVF cycle is required to be covered. Cycles using donor sperm or eggs are not covered under the mandate. Same sex couples or single women are not eligible for treatment under the mandate.

Exemptions

Self-insured organizations are not required to offer coverage.

Tips & Resources

Having a law in place goes a long way to help ensure that you can access treatment should you need it but navigating insurance can be tricky and dedicating a little bit of time to understanding your benefits and your options can help you make a plan that you and your partner feel good about.

Get to know your insurance plan: If you haven’t had to use your health benefits before, here’s a nice primer article to give you an overview of how health insurance works and how to figure out what your out-of-pocket costs are likely to be.

Take advantage of other health benefits you may have: such as HSA/FSA accounts, preventative health services and wellness programs offered through your insurance. Getting healthy as possible can improve the health of your unborn child and potentially improve your chances of conceiving (naturally or with treatment).

Additional Resources: There are several organizations that support people who have trouble getting pregnant including Fertility within Reach (focused on helping people navigate insurance issues) and Resolve (that does both advocacy and peer-led patient support groups). You may also be able to connect with other people in your area via our local forum boards.

References:


Sara SDx

Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.
Sara SDx

Author: Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.