Report Title:

Infertility Treatment; Mandatory Group Health Coverage; Religious Employer Exemption

Description:

Requires health insurance policies for groups of more than fifty persons that provide pregnancy-related benefits to include coverage for medically necessary expenses of diagnosis and treatment for infertility. Allows exemption for health plans provided by religious employer. (SD1)

THE SENATE

S.B. NO.

157

TWENTY-SECOND LEGISLATURE, 2003

S.D. 1

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to Health.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. Chapter 431, article 10A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§431:10A-    Mandatory group health coverage for infertility; religious employer exemption. (a) All health insurance contracts, plans, or policies delivered or issued for delivery or renewed in this State for groups with more than fifty persons shall provide coverage for medically necessary expenses of diagnosis and treatment of infertility, including but not limited to diagnosis and diagnostic tests, medication, surgery, in vitro fertilization, embryo transfer, artificial insemination, gamete intra fallopian transfer, zygote intra fallopian transfer, intracytoplasmic sperm injection, and four completed egg retrievals per lifetime of the covered person. Coverage for in vitro fertilization, gamete intra fallopian transfer, and zygote intra fallopian transfer may be limited to a covered person who:

(1) Has used all reasonable, less expensive, and medically appropriate treatments, and is still unable to become pregnant or carry a pregnancy;

(2) Has not reached the limit of four completed egg retrievals; and

(3) Is forty-five years of age or younger.

Benefits shall be provided to the same extent as for other pregnancy-related procedures; provided that procedures shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles, and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as apply to other medical or surgical benefits under the policy.

(b) For purposes of this section, "infertility" means a disease or condition that results in the abnormal function of the reproductive system and the inability to:

(1) Impregnate another person;

(2) Conceive after two years of unprotected sexual intercourse if the female partner is under thirty-five years of age, or after one year of unprotected sexual intercourse if the female partner is thirty-five years of age or older or one of the partners is considered medically sterile; or

(3) Carry a pregnancy to live birth.

(c) A religious employer may request, and an insurer shall grant, an exclusion under the policy for coverage of in vitro fertilization, embryo transfer, artificial insemination, zygote intra fallopian transfer, and intracytoplasmic sperm injection, if the required coverage is contrary to the religious employer's bona fide religious tenets.

A "religious employer" is an entity for which the inculcation of religious values is the purpose of the entity, that primarily employs persons sharing the entity's religious tenets, that is not staffed by public employees, and that is a nonprofit organization as defined under section 501(c)(3) of the Internal Revenue Code of 1986, as amended. Any educational, health care, or other nonprofit institution or organization owned or controlled by the religious employer is included in this exemption.

Each religious employer that invokes the exemption shall provide to enrollees upon enrollment with the health plan, written notice listing the infertility services the employer refuses to cover for religious reasons."

SECTION 2. Chapter 432, article 1, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§432:1-    Group health coverage for infertility; religious exemption. (a) All group hospital or medical service plan contracts delivered or issued for delivery or renewed in this State for groups with more than fifty persons shall provide coverage for medically necessary expenses of diagnosis and treatment of infertility, including but not limited to diagnosis and diagnostic tests, medication, surgery, in vitro fertilization, embryo transfer, artificial insemination, gamete intra fallopian transfer, zygote intra fallopian transfer, intracytoplasmic sperm injection, and four completed egg retrievals per lifetime of the covered person. Coverage for in vitro fertilization, gamete intra fallopian transfer, and zygote intra fallopian transfer may be limited to a covered person who:

(1) Has used all reasonable, less expensive, and medically appropriate treatments, and is still unable to become pregnant or carry a pregnancy;

(2) Has not reached the limit of four completed egg retrievals; and

(3) Is forty-five years of age or younger.

Benefits shall be provided to the same extent as for other pregnancy-related procedures; provided that procedures shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles, and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as apply to other medical or surgical benefits under the contract.

(b) For purposes of this section, "infertility" means a disease or condition that results in the abnormal function of the reproductive system and the inability to:

(1) Impregnate another person;

(2) Conceive after two years of unprotected sexual intercourse if the female partner is under thirty-five years of age, or after one year of unprotected sexual intercourse if the female partner is thirty-five years of age or older or one of the partners is considered medically sterile; or

(3) Carry a pregnancy to live birth.

(c) A religious employer may request, and an insurer shall grant, an exclusion under the policy for coverage of in vitro fertilization, embryo transfer, artificial insemination, zygote intra fallopian transfer, and intracytoplasmic sperm injection, if the required coverage is contrary to the religious employer's bona fide religious tenets.

A "religious employer" is an entity for which the inculcation of religious values is the purpose of the entity, that primarily employs persons sharing the entity's religious tenets, that is not staffed by public employees, and that is a nonprofit organization as defined under section 501(c)(3) of the Internal Revenue Code of 1986, as amended. Any educational, health care, or other nonprofit institution or organization owned or controlled by the religious employer is included in this exemption.

Each religious employer that invokes the exemption shall provide to enrollees upon enrollment with the health plan, written notice listing the infertility services the employer refuses to cover for religious reasons."

SECTION 3. Section 431:10A-116.5, Hawaii Revised Statutes, is amended to read as follows:

"[[]§431:10A-116.5[]] In vitro fertilization procedure coverage. All individual health insurance policies and group health insurance policies [which] for groups of fifty or less persons 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; provided that:

(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 Obstetric and Gynecology guidelines for in vitro fertilization clinics or to the American Fertility Society minimal standards for programs of in vitro fertilization[.]; and

(7) The term "spouse" means a person who is lawfully married to the patient under the laws of the State.

The requirements of this section shall apply to all new policies delivered or issued for delivery in this State after June 26, 1987."

SECTION 4. Section 432:1-604, Hawaii Revised Statutes, is amended to read as follows:

"[[]§432:1-604[]] In vitro fertilization procedure coverage. All individual hospital and medical service plan contracts and group hospital or medical service plan contracts [which] for groups of fifty or less persons 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; provided that:

(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 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) 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) The in vitro fertilization procedures are performed at medical facilities that conform to the American College of Obstetric and Gynecology guidelines for in vitro fertilization clinics or to the American Fertility Society minimal standards for programs of in vitro fertilization[.]; and

(7) The term "spouse" means a person who is lawfully married to the patient under the laws of the State.

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."

SECTION 5. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:

"§432D-23 Required provisions and benefits. Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A-116.5, 431:10A-   , 431:10A-116.6, 431:10A-119, 431:10A-120, and 431:10A-121, and chapter 431M."

SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 7. This Act shall take effect upon its approval.