THE SENATE
S.B. NO.
2051
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII
A BILL FOR AN ACT
relating to INSURANCE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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 same—sex couples, unmarried individuals, transgender persons, and opposite—sex 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, opposite—sex 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. [Underlined: 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 [[Struck through: which]] [Underlined: that] provide pregnancy‑related benefits shall include[Underlined: ,] 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[[Struck through: ;]] [Underlined: or the oocyte donor or surrogate of the insured or of the insured's dependent spouse;] provided that:
[Underlined: (1)] [Underlined: 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;][Underlined: ]
[[Struck through: (1)]] [Underlined: (2)] Benefits under this section shall be provided to the same extent as the benefits provided for other pregnancy-related benefits;
[[Struck through: (2)] [Struck through: The patient is the insured or covered dependent of the insured;]][Struck through: ]
(3) The [[Struck through: patient's]] oocytes [[Struck through: are fertilized with the patient's spouse's sperm];] [Underlined: or sperm of the insured or of the insured's dependent spouse are used in the in vitro fertilization procedures;]
(4) The:
(A) [[Struck through: Patient and the patient's spouse have]] [Underlined: Insured or the insured's dependent spouse has] a history of infertility of at least [[Struck through: five years' duration; or]] [Underlined: 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 [[Struck through: the]] infertility; [Underlined: or]
[Underlined: (C)] [Underlined: Insured and insured's dependent spouse are of the same sex;][Underlined: ]
(5) The [[Struck through: patient]] [Underlined: insured or the insured's dependent spouse] has been unable to attain a successful pregnancy through other applicable infertility treatments [[Struck through: for which coverage is available]] [Underlined: 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 [[Struck through: Gynecologists]] [Underlined: Gynecologists'] guidelines for in vitro fertilization clinics or [[Struck through: to]] the American Society for Reproductive [[Struck through: Medicine minimal]] [Underlined: Medicine's minimum] standards for [[Struck through: programs of in vitro fertilization.]] [Underlined: practices offering assisted reproductive technologies.]
[Underlined: 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[[Struck through: , the term "spouse"]][Underlined: :]
[Underlined: "Spouse"] means a person who is lawfully married to the patient under the laws of the State.
[Underlined: "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 [[Struck through: which]] [Underlined: that] provide pregnancy-related benefits shall include[Underlined: ,] 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[[Struck through: ;]] [Underlined: or the oocyte donor or surrogate of the subscriber or member or the subscriber's or member's dependent spouse; ]provided that:
[Underlined: (1)] [Underlined: 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;]
[[Struck through: (1)]] [Underlined: (2)] Benefits under this section shall be provided to the same extent as the benefits provided for other pregnancy-related benefits;
[[Struck through: (2)] [Struck through: The patient is a subscriber or member or covered dependent of the subscriber or member;]]
(3) The [[Struck through: patient's]] oocytes [[Struck through: are fertilized with the patient's spouse's sperm;]] [Underlined: 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) [[Struck through: Patient and the patient's spouse have]] [Underlined: Subscriber or member or the subscriber's or member's dependent spouse has] a history of infertility of at least [[Struck through: five years' duration; or]] [Underlined: 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 [[Struck through: the]] infertility; [Underlined: or]
[Underlined: (C)] [Underlined: Subscriber or member and the subscriber's or member's dependent spouse are of the same sex;][Underlined: ]
(5) The [[Struck through: patient]] [Underlined: 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 [[Struck through: for which coverage is available]] [Underlined: 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 [[Struck through: Gynecologists]] [Underlined: Gynecologists'] guidelines for in vitro fertilization clinics or to the American Society for Reproductive [[Struck through: Medicine minimal]] [Underlined: Medicine's minimum] standards for [[Struck through: programs of]] in vitro fertilization[[Struck through: .]] [Underlined: programs.]
[Underlined: 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[[Struck through: , the term "spouse"]][Underlined: :]
[Underlined: "Spouse"] means a person who is lawfully married to the patient under the laws of the State.
[Underlined: "Transgender person" has the same meaning as defined in section 431:10A-118.3.]"[Underlined: ]
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:
_____________________________
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.