(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 in vitro fertilization procedures performed on the insured or the insured’s dependent spouse; provided that:
Terms Used In Hawaii Revised Statutes 431:10A-116.5
Contract: A legal written agreement that becomes binding when signed.
Dependent: A person dependent for support upon another.
sickness insurance: shall include an accident-only; specified disease; hospital indemnity; long-term care; disability; dental; vision; medicare supplement; short-term, limited-duration health insurance; or other limited benefit health insurance contract regardless of the manner in which benefits are paid; provided that if any of the requirements in the foregoing sections as applied to long-term care insurance conflict with article 10H, the provisions of article 10H shall govern and control. See Hawaii Revised Statutes 431:10A-607
(1) 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;(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) 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) The in vitro fertilization procedures are performed at medical facilities that conform to the American College of 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.
