S.C.R. NO.














Requesting the auditor to assess the social and financial effects of requiring health insurers to provide infertility procedure coverage.



WHEREAS, infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children; and


WHEREAS, in the United States, infertility affects about 7.3 million women and their partners, approximately twelve percent of the reproductive age population, or one in eight couples; and


WHEREAS, most infertility cases eighty-five to ninety percent - are treated with conventional medical therapies such as medication or surgery; and


WHEREAS, since 1978, assisted reproductive technology, and most commonly in vitro fertilization, has provided another solution for many would-be parents; and


WHEREAS, while vital for some patients, in vitro fertilization and similar treatments account for less than three percent of infertility services, and about seven-hundredths of one percent (0.07 percent) of health care costs in the United States; and


WHEREAS, since 1987, Hawaii has required insurance coverage for the treatment of infertility through in vitro fertilization under certain qualifying conditions; and


WHEREAS, the existing law has a number of shortcomings, as it covers only one form of assisted reproductive technologies, in vitro fertilization; provides a one-time only benefit; requires fertilization with sperm from the patient's spouse; and applies only to an insured or an insured's covered spouse who has a history of infertility of at least five years or a limited number of medical conditions associated with infertility; and


WHEREAS, for those couples who do not meet these requirements whether for medical or other reasons the assisted reproductive technologies not covered under existing law may cost $15,000 to $20,000 per procedure, and must often be repeated before a successful live birth; and


WHEREAS, in the nearly twenty-five years since the enactment of the Hawaii law requiring coverage of in vitro fertilization, there have been substantial changes and improvements in assisted reproductive technologies, which could provide couples in Hawaii with additional treatment options appropriate for their specific infertility diagnosis; and


WHEREAS, section 23-51, Hawaii Revised Statutes, requires that "[b]efore any legislative measure that mandates health insurance coverage for specific health services, specific diseases, or certain providers of health care services as part of individual or group health insurance policies, can be considered, there shall be concurrent resolutions passed requesting the auditor to prepare and submit to the legislature a report that assesses both the social and financial effects of the proposed mandated coverage"; and


WHEREAS, section 23-51, Hawaii Revised Statutes, further provides that "[t]he concurrent resolutions shall designate a specific legislative bill that:


(1) Has been introduced in the legislature; and


(2) Includes, at minimum, information identifying the:


(A) Specific health service, disease, or provider that would be covered;


(B) Extent of the coverage;


(C) Target groups that would be covered;


(D) Limits on utilization, if any; and


(E) Standards of care.


For purposes of this part, mandated health insurance coverage shall not include mandated optionals"; and


WHEREAS, section 23-52, Hawaii Revised Statutes, further specifies the minimum information required for assessing the social and financial impact of the proposed health coverage mandate in the Auditor's report; and


WHEREAS, S.B. No. 615, as amended, mandates infertility procedure coverage for all individual and group accident and health or sickness insurance policies that provide pregnancy-related benefits; and


WHEREAS, the Legislature believes that infertility procedure coverage, as provided in S.B. No. 615, as amended, will provide the people of Hawaii with expanded treatment options for assisted reproductive technologies that are appropriate for the specific infertility diagnosis of a patient and that will assist in ensuring adequate and affordable health care services for the people of this State; now, therefore,


BE IT RESOLVED by the Senate of the Twenty-sixth Legislature of the State of Hawaii, Regular Session of 2012, the House of Representatives concurring, that the Auditor is requested to conduct an impact assessment report, pursuant to sections 23-51 and 23-52, Hawaii Revised Statutes, of the social and financial impacts of mandating infertility procedure coverage for all individual and group accident and health or sickness insurance policies that provide pregnancy-related benefits, effective from the time provided in S.B. No. 615, as amended; and


BE IT FURTHER RESOLVED that the Auditor is requested to submit findings and recommendations to the Legislature, including any necessary implementing legislation, no later than twenty days prior to the convening of the Regular Session of 2013; and


BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Auditor and to the Insurance Commissioner, who, in turn, is requested to transmit copies to each insurer in the State that issues health insurance policies.









Report Title:

Sunrise Review; Mandatory Infertility Procedure Coverage