HB 1864: Insurance; Mandatory Coverage; Standard Fertility Preservation Services; Iatrogenic Infertility; Medically Necessary Treatment

A BILL FOR AN ACT

RELATING TO INSURANCE.

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

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

     "§431:10A-     Standard fertility preservation services coverage.  (a)  Each individual or group policy of accident and health or sickness insurance issued or renewed in the State after December 31, 2026, shall provide to the policyholder, or any dependent of the policyholder who is covered under the policy, coverage for standard fertility preservation services for any insured who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

     (b)  No policy that provides coverage for standard fertility preservation services as required by subsection (a) shall:

     (1)  Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required coverage; or

     (2)  Discriminate based on the insured's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

     (c)  Except as provided in subsection (b), any limitations imposed by a policy shall be based on the insured's medical history and clinical guidelines adopted by the insurer.  Any clinical guidelines used by the insurer shall be based on the 2018 update to the American Society of Clinical Oncology guidelines and shall not deviate from the full scope of the guidelines.

     (d)  For the purposes of this section:

     "American Society of Clinical Oncology guidelines" means the clinical practice guidelines on fertility preservation in people with cancer published by the American Society of Clinical Oncology.

     "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

     "Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

     "Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" includes the full scope of services or treatments, without any exclusions or limitations, as defined in the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" does not include:

     (1)  Any experimental procedures or other procedures not determined to be established medical practices according to the 2018 update to the American Society of Clinical Oncology guidelines;

     (2)  Third-party assisted reproduction technology procedures, including donor egg, sperm retrieval, or surrogates and gestational carriers; and

     (3)  Any services relating to cryopreservation storage."

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

     "§432:1-     Standard fertility preservation services coverage.  (a)  Each individual or group hospital or medical service plan contract issued or renewed in this State after December 31, 2026, shall provide to the subscriber or member, or any dependent of the subscriber or member who is covered under the plan contract, coverage for standard fertility preservation services for any covered person who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

     (b)  No plan contract that provides coverage for standard fertility preservation services as required by subsection (a) shall:

     (1)  Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required coverage; or

     (2)  Discriminate based on the covered person's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

     (c)  Except as provided in subsection (b), any limitations imposed by a plan contract shall be based on the covered person's medical history and clinical guidelines adopted by the mutual benefit society.  Any clinical guidelines used by the mutual benefit society shall be based on the 2018 update to the American Society of Clinical Oncology guidelines and shall not deviate from the full scope of the guidelines.

     (d)  For the purposes of this section:

     "American Society of Clinical Oncology guidelines" means the clinical practice guidelines on fertility preservation in people with cancer published by the American Society of Clinical Oncology.

     "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

     "Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

     "Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" includes the full scope of services or treatments, without any exclusions or limitations, as defined in the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" does not include:

     (1)  Any experimental procedures or other procedures not determined to be established medical practices according to the 2018 update to the American Society of Clinical Oncology guidelines;

     (2)  Third-party assisted reproduction technology procedures, including donor egg, sperm retrieval, or surrogates and gestational carriers; and

     (3)  Any services relating to cryopreservation storage."

     SECTION 3.  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-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, and [431:10A-134,] 431:10A-   , and chapter 431M."

     SECTION 4.  The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A-   , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 3 of this Act, shall take effect for all policies, contracts, plans, or agreements issued or renewed in the State after December 31, 2026.

     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.

Report Title:

Insurance; Mandatory Coverage; Standard Fertility Preservation Services; Iatrogenic Infertility; Medically Necessary Treatment

Description:

For policies, contracts, plans, and agreements issued or renewed after 12/31/2026, requires insurers, mutual benefit societies, and health maintenance organizations to provide coverage for standard fertility preservation services for persons undergoing medically necessary treatment that may cause iatrogenic infertility.  (CD1)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

RELATING TO INSURANCE.

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

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

     "§431:10A-     Standard fertility preservation services coverage.  (a)  Each individual or group policy of accident and health or sickness insurance issued or renewed in the State after December 31, 2026, shall provide to the policyholder or any dependent of the policyholder who is covered under the policy, coverage for standard fertility preservation services for any insured who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

     (b)  No policy that provides coverage for standard fertility preservation services as required by subsection (a) shall:

     (1)  Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required coverage; or

     (2)  Discriminate based on the insured's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

     (c)  Except as provided in subsection (b), any limitations imposed by a policy shall be based on the insured's medical history and clinical guidelines adopted by the insurer.  Any clinical guidelines used by the insurer shall be based on the 2018 update to the American Society of Clinical Oncology guidelines and shall not deviate from the full scope of the guidelines.

     (d)  For the purposes of this section:

     "American Society of Clinical Oncology guidelines" means the clinical practice guidelines on fertility preservation in people with cancer published by the American Society of Clinical Oncology.

     "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

     "Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

     "Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" includes the full scope of services or treatments, without any exclusions or limitations, as defined in the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" does not include:

     (1)  Any experimental procedures or other procedures not determined to be established medical practices according to the 2018 update to the American Society of Clinical Oncology guidelines;

     (2)  Third-party assisted reproduction technology procedures, including donor egg, sperm retrieval, or surrogates and gestational carriers; and

     (3)  Any services relating to cryopreservation storage."

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

     "§432:1-     Standard fertility preservation services coverage.  (a)  Each individual or group hospital or medical service plan contract issued or renewed in this State after December 31, 2026, shall provide to the subscriber or member or any dependent of the subscriber or member who is covered under the plan contract, coverage for standard fertility preservation services for any covered person who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

     (b)  No plan contract that provides coverage for standard fertility preservation services as required by subsection (a) shall:

     (1)  Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required coverage; or

     (2)  Discriminate based on the covered person's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

     (c)  Except as provided in subsection (b), any limitations imposed by a plan contract shall be based on the covered person's medical history and clinical guidelines adopted by the mutual benefit society.  Any clinical guidelines used by the mutual benefit society shall be based on the 2018 update to the American Society of Clinical Oncology guidelines and shall not deviate from the full scope of the guidelines.

     (d)  For the purposes of this section:

     "American Society of Clinical Oncology guidelines" means the clinical practice guidelines on fertility preservation in people with cancer published by the American Society of Clinical Oncology.

     "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

     "Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

     "Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" includes the full scope of services or treatments, without any exclusions or limitations, as defined in the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" does not include:

     (1)  Any experimental procedures or other procedures not determined to be established medical practices according to the 2018 update to the American Society of Clinical Oncology guidelines;

     (2)  Third-party assisted reproduction technology procedures, including donor egg, sperm retrieval, or surrogates and gestational carriers; and

     (3)  Any services relating to cryopreservation storage."

     SECTION 3.  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-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, and [431:10A-134,] 431:10A-   , and chapter 431M."

     SECTION 4.  The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A-   , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 3 of this Act, shall take effect for all policies, contracts, plans, or agreements issued or renewed in the State after December 31, 2026.

     SECTION 5.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 6.  This Act shall take effect on January 1, 2050.

Report Title:

Insurance; Mandatory Coverage; Standard Fertility Preservation Services; Iatrogenic Infertility; Medically Necessary Treatment

Description:

For policies, contracts, plans, and agreements issued or renewed after 12/31/2026, requires insurers, mutual benefit societies, and health maintenance organizations to provide coverage for standard fertility preservation services for persons undergoing medically necessary treatment that may cause iatrogenic infertility.  Effective 1/1/2050.  (SD2)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

RELATING TO INSURANCE.

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

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

     "§431:10A-     Standard fertility preservation services coverage.  (a)  Each individual or group policy of accident and health or sickness insurance issued or renewed in the State after December 31, 2026, shall provide to the policyholder or any dependent of the policyholder who is covered under the policy, coverage for standard fertility preservation services for any insured who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

     (b)  No policy that provides coverage for standard fertility preservation services as required by subsection (a) shall:

     (1)  Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required coverage; or

     (2)  Discriminate based on the insured's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

     (c)  Except as provided in subsection (b), any limitations imposed by a policy shall be based on the insured's medical history and clinical guidelines adopted by the insurer.  Any clinical guidelines used by the insurer shall be based on the 2018 update to the American Society of Clinical Oncology guidelines and shall not deviate from the full scope of the guidelines.

     (d)  For the purposes of this section:

     "American Society of Clinical Oncology guidelines" means the clinical practice guidelines on fertility preservation in people with cancer published by the American Society of Clinical Oncology.

     "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

     "Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

     "Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" include the full scope of services or treatments, without any exclusions or limitations, as defined in the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" does not include:

     (1)  Any experimental procedures or other procedures not determined to be established medical practices according to the 2018 update to the American Society of Clinical Oncology guidelines;

     (2)  Third-party assisted reproduction technology procedures, including donor egg, sperm retrieval, or surrogates and gestational carriers; and

     (3)  Any services relating to cryopreservation storage."

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

     "§432:1-     Standard fertility preservation services coverage.  (a)  Each individual or group hospital or medical service plan contract issued or renewed in this State after December 31, 2026, shall provide to the subscriber or member or any dependent of the subscriber or member who is covered under the plan contract, coverage for standard fertility preservation services for any covered person who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

     (b)  No plan contract that provides coverage for standard fertility preservation services as required by subsection (a) shall:

     (1)  Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required coverage; or

     (2)  Discriminate based on the covered person's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

     (c)  Except as provided in subsection (b), any limitations imposed by a plan contract shall be based on the covered person's medical history and clinical guidelines adopted by the mutual benefit society.  Any clinical guidelines used by the mutual benefit society shall be based on the 2018 update to the American Society of Clinical Oncology guidelines and shall not deviate from the full scope of the guidelines.

     (d)  For the purposes of this section:

     "American Society of Clinical Oncology guidelines" means the clinical practice guidelines on fertility preservation in people with cancer published by the American Society of Clinical Oncology.

     "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

     "Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

     "Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" include the full scope of services or treatments, without any exclusions or limitations, as defined in the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" does not include:

     (1)  Any experimental procedures or other procedures not determined to be established medical practices according to the 2018 update to the American Society of Clinical Oncology guidelines;

     (2)  Third-party assisted reproduction technology procedures, including donor egg, sperm retrieval, or surrogates and gestational carriers; and

     (3)  Any services relating to cryopreservation storage."

     SECTION 3.  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-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, and [431:10A-134,] 431:10A-   , and chapter 431M."

     SECTION 4.  The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A-   , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 3 of this Act, shall take effect for all policies, contracts, plans, or agreements issued or renewed in the State after December 31, 2026.

     SECTION 5.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 6.  This Act shall take effect on January 1, 2050.

Report Title:

Insurance; Mandatory Coverage; Standard Fertility Preservation Services; Iatrogenic Infertility; Medically Necessary Treatment

Description:

For policies, contracts, plans, and agreements issued or renewed after 12/31/2026, requires insurers, mutual benefit societies, and health maintenance organizations to provide coverage for standard fertility preservation services for persons undergoing medically necessary treatment that may cause iatrogenic infertility.  Effective 1/1/2050.  (SD1)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

RELATING TO INSURANCE.

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

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

     "§431:10A-     Standard fertility preservation services coverage.  (a)  Each individual or group policy of accident and health or sickness insurance issued or renewed in the State after December 31, 2026, shall provide to the policyholder or any dependent of the policyholder who is covered under the policy, coverage for standard fertility preservation services for any insured who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

     (b)  No policy that provides coverage for standard fertility preservation services as required by subsection (a) shall:

     (1)  Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required coverage; or

     (2)  Discriminate based on the insured's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

     (c)  Except as provided in subsection (b), any limitations imposed by a policy shall be based on the insured's medical history and clinical guidelines adopted by the insurer.  Any clinical guidelines used by the insurer shall be based on the 2018 update to the American Society of Clinical Oncology guidelines and shall not deviate from the full scope of the guidelines.

     (d)  For the purposes of this section:

     "American Society of Clinical Oncology guidelines" means the clinical practice guidelines on fertility preservation in people with cancer published by the American Society of Clinical Oncology.

     "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

     "Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

     "Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" include the full scope of services or treatments, without any exclusions or limitations, as defined in the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" does not include:

     (1)  Any experimental procedures or other procedures not determined to be established medical practices according to the 2018 update to the American Society of Clinical Oncology guidelines;

     (2)  Third-party assisted reproduction technology procedures, including donor egg, sperm retrieval, or surrogates and gestational carriers; and

     (3)  Any services relating to cryopreservation storage."

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

     "§432:1-     Standard fertility preservation services coverage.  (a)  Each individual or group hospital or medical service plan contract issued or renewed in this State after December 31, 2026, shall provide to the subscriber or member or any dependent of the subscriber or member who is covered under the plan contract, coverage for standard fertility preservation services for any covered person who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

     (b)  No plan contract that provides coverage for standard fertility preservation services as required by subsection (a) shall:

     (1)  Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required coverage; or

     (2)  Discriminate based on the covered person's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

     (c)  Except as provided in subsection (b), any limitations imposed by a plan contract shall be based on the covered person's medical history and clinical guidelines adopted by the mutual benefit society.  Any clinical guidelines used by the mutual benefit society shall be based on the 2018 update to the American Society of Clinical Oncology guidelines and shall not deviate from the full scope of the guidelines.

     (d)  For the purposes of this section:

     "American Society of Clinical Oncology guidelines" means the clinical practice guidelines on fertility preservation in people with cancer published by the American Society of Clinical Oncology.

     "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

     "Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

     "Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" include the full scope of services or treatments, without any exclusions or limitations, as defined in the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" does not include:

     (1)  Any experimental procedures or other procedures not determined to be established medical practices according to the 2018 update to the American Society of Clinical Oncology guidelines;

     (2)  Third-party assisted reproduction technology procedures, including donor egg, sperm retrieval, or surrogates and gestational carriers; and

     (3)  Any services relating to cryopreservation storage."

     SECTION 3.  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-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, and [431:10A-134,] 431:10A-   , and chapter 431M."

     SECTION 4.  The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A-   , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 3 of this Act, shall take effect for all policies, contracts, plans, or agreements issued or renewed in the State after December 31, 2026.

     SECTION 5.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 6.  This Act shall take effect on July 1, 3000.

Report Title:

Insurance; Mandatory Coverage; Standard Fertility Preservation Services; Iatrogenic Infertility; Medically Necessary Treatment

Description:

For policies, contracts, plans, and agreements issued or renewed after 12/31/2026, requires insurers, mutual benefit societies, and health maintenance organizations to provide coverage for standard fertility preservation services for persons undergoing medically necessary treatment that may cause iatrogenic infertility.  Effective 7/1/3000.  (HD2)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

RELATING TO INSURANCE.

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

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

     "§431:10A-     Standard fertility preservation services coverage.  (a)  Each individual or group policy of accident and health or sickness insurance issued or renewed in the State after December 31, 2026, shall provide to the policyholder or any dependent of the policyholder who is covered under the policy, coverage for standard fertility preservation services for any insured who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

     (b)  No policy that provides coverage for standard fertility preservation services as required by subsection (a) shall:

     (1)  Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required coverage; or

     (2)  Discriminate based on the insured's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

     (c)  Except as provided in subsection (b), any limitations imposed by a policy shall be based on the insured's medical history and clinical guidelines adopted by the insurer.  Any clinical guidelines used by the insurer shall be based on the most recent American Society of Clinical Oncology guidelines and shall not deviate from the full scope of the guidelines.

     (d)  For the purposes of this section:

     "American Society of Clinical Oncology guidelines" means the clinical practice guidelines on fertility preservation in people with cancer published by the American Society of Clinical Oncology.

     "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

     "Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

     "Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the most recent American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" include the full scope of services or treatments, without any exclusions or limitations, as defined in the most recent American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" does not include:

     (1)  Any experimental procedures or other procedures not determined to be established medical practices according to the most recent American Society of Clinical Oncology guidelines;

     (2)  Third-party assisted reproduction technology procedures, including donor egg, sperm retrieval, or surrogates and gestational carriers; and

     (3)  Any services relating to cryopreservation storage."

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

     "§432:1-     Standard fertility preservation services coverage.  (a)  Each individual or group hospital or medical service plan contract issued or renewed in this State after December 31, 2026, shall provide to the subscriber or member or any dependent of the subscriber or member who is covered under the plan contract, coverage for standard fertility preservation services for any covered person who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

     (b)  No plan contract that provides coverage for standard fertility preservation services as required by subsection (a) shall:

     (1)  Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required coverage; or

     (2)  Discriminate based on the covered person's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

     (c)  Except as provided in subsection (b), any limitations imposed by a plan contract shall be based on the covered person's medical history and clinical guidelines adopted by the mutual benefit society.  Any clinical guidelines used by the mutual benefit society shall be based on the most recent American Society of Clinical Oncology guidelines and shall not deviate from the full scope of the guidelines.

     (d)  For the purposes of this section:

     "American Society of Clinical Oncology guidelines" means the clinical practice guidelines on fertility preservation in people with cancer published by the American Society of Clinical Oncology.

     "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

     "Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

     "Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the most recent American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" include the full scope of services or treatments, without any exclusions or limitations, as defined in the most recent American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" does not include:

     (1)  Any experimental procedures or other procedures not determined to be established medical practices according to the most recent American Society of Clinical Oncology guidelines;

     (2)  Third-party assisted reproduction technology procedures, including donor egg, sperm retrieval, or surrogates and gestational carriers; and

     (3)  Any services relating to cryopreservation storage."

     SECTION 3.  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-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, and [431:10A-134,] 431:10A-   , and chapter 431M."

     SECTION 4.  The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A-   , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 3 of this Act, shall take effect for all policies, contracts, plans, or agreements issued or renewed in the State on or after December 31, 2026.

     SECTION 5.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 6.  This Act shall take effect on July 1, 3000.

Report Title:

Insurance; Mandatory Coverage; Standard Fertility Preservation Services; Iatrogenic Infertility; Medically Necessary Treatment

Description:

For policies, contracts, plans, and agreements issued or renewed after 12/31/2026, requires insurers, mutual benefit societies, and health maintenance organizations to provide coverage for standard fertility preservation services for persons undergoing medically necessary treatment that may cause iatrogenic infertility.  Effective 7/1/3000.  (HD1)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

relating to insurance.

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

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

     "§431:10A-     Standard fertility preservation services coverage.  (a)  Each individual or group policy of accident and health or sickness insurance issued or renewed in the State after December 31, 2026, shall provide to the policyholder, and individuals under twenty-six years of age covered under the policy, coverage for standard fertility preservation services for any insured who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

     (b)  No policy that provides coverage for standard fertility preservation services as required by subsection (a) shall:

     (1)  Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required coverage; or

     (2)  Discriminate based on the insured's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

     (c)  Any limitations imposed by a policy shall be based on the insured's medical history and clinical guidelines adopted by the insurer.  Any clinical guidelines used by the insurer shall be based on the 2018 update to the American Society of Clinical Oncology guidelines and shall not deviate from the full scope of the guidelines.

     (d)  For the purposes of this section:

     "American Society of Clinical Oncology guidelines" means the clinical practice guidelines on fertility preservation in people with cancer published by the American Society of Clinical Oncology.

     "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

     "Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

     "Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" include the full scope of services or treatments, without any exclusions or limitations, as defined in the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" does not include:

     (1)  Any experimental procedures or other procedures not determined to be established medical practices according to the 2018 update to the American Society of Clinical Oncology guidelines;

     (2)  Third-party assisted reproduction technology procedures, including donor egg or surrogates and gestational carriers; and

     (3)  Any services relating to cryopreservation storage."

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

     "§432:1-     Standard fertility preservation services coverage.  (a)  Each individual or group hospital or medical service plan contract issued or renewed in this State after December 31, 2026, shall provide to the subscriber or member, and individuals under twenty-six years of age covered under the plan contract, coverage for standard fertility preservation services for any covered person who may undergo a medically necessary treatment that may directly or indirectly cause iatrogenic infertility.

     (b)  No plan contract that provides coverage for standard fertility preservation services as required by subsection (a) shall:

     (1)  Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting, or otherwise restricting the availability of the required coverage; or

     (2)  Discriminate based on the covered person's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions.

     (c)  Any limitations imposed by a plan contract shall be based on the covered person's medical history and clinical guidelines adopted by the mutual benefit society.  Any clinical guidelines used by the mutual benefit society shall be based on the 2018 update to the American Society of Clinical Oncology guidelines and shall not deviate from the full scope of the guidelines.

     (d)  For the purposes of this section:

     "American Society of Clinical Oncology guidelines" means the clinical practice guidelines on fertility preservation in people with cancer published by the American Society of Clinical Oncology.

     "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.

     "Medically necessary treatment that may directly or indirectly cause iatrogenic infertility" means any cancer‑related medical treatment with a likely side effect of infertility.

     "Standard fertility preservation services" means the procedures to preserve fertility as outlined and established according to 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" include the full scope of services or treatments, without any exclusions or limitations, as defined in the 2018 update to the American Society of Clinical Oncology guidelines.  "Standard fertility preservation services" does not include:

     (1)  Any experimental procedures or other procedures not determined to be established medical practices according to the 2018 update to the American Society of Clinical Oncology guidelines;

     (2)  Third-party assisted reproduction technology procedures, including donor egg or surrogates and gestational carriers; and

     (3)  Any services relating to cryopreservation storage."

     SECTION 3.  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-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, and [431:10A-134,] 431:10A-   , and chapter 431M."

     SECTION 4.  The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A-   , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 3 of this Act, shall take effect for all policies, contracts, plans, or agreements issued or renewed in the State on or after December 31, 2026.

     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.

Report Title:

Insurance; Mandatory Coverage; Standard Fertility Preservation Services; Iatrogenic Infertility; Medically Necessary Treatment

Description:

For policies, contracts, plans, and agreements issued or renewed after 12/31/2026, requires insurers, mutual benefit societies, and health maintenance organizations to provide coverage for standard fertility preservation services for persons undergoing medically necessary treatment that may cause iatrogenic infertility.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

STAND. COM. REP. NO.  1068-26

Honolulu, Hawaii

                , 2026

RE:   H.B. No. 1864

      H.D. 2

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2026

State of Hawaii

Madame:

     Your Committee on Consumer Protection & Commerce, to which was referred H.B. No. 1864, H.D. 1, entitled:

"A BILL FOR AN ACT RELATING TO INSURANCE,"

begs leave to report as follows:

     The purpose of this measure is to, beginning after December 31, 2026, require insurers, mutual benefit societies, and health maintenance organizations to provide coverage for standard fertility preservation services for persons undergoing medically necessary treatment that may cause iatrogenic infertility.

     Your Committee received testimony in support of this measure from the Department of Commerce and Consumer Affairs; Department of Health; State Health Planning and Development Agency; Facing Our Risk of Cancer Empowered; Hawaii Society of Clinical Oncology; Association for Clinical Oncology; Fertility Institute of Hawaii; Advanced Reproductive Medicine & Gynecology of Hawaii, Inc.; Blood Cancer United; America Cancer Society Cancer Action Network; Hawaii Association of Health Plans; Hawaii Medical Service Association; Alliance for Fertility Preservation; Oncology Nursing Society; Hawaiʻi Women Lawyers; and nine individuals.

     Your Committee finds that some cancer treatments can cause iatrogenic infertility when chemotherapy, radiation, and surgery damage reproductive cells, reproductive organs, or endocrine functioning.  These treatments can also adversely impact the ability to carry a pregnancy.  Although patients facing iatrogenic infertility have recognized, effective options for preserving fertility, the high cost of these procedures and the narrow window to obtain services means these procedures are unattainable for many people.  This measure assists in the offsetting of those costs by mandating coverage for standard fertility preservation services.

     Your Committee has amended this measure by:

     (1)  Requiring insurers, mutual benefit societies, and health maintenance organizations to base clinical guidelines on the 2018 update to the American Society of Clinical Oncology guidelines, rather than the most recent guidelines;

     (2)  Clarifying that, for purposes of health maintenance organizations, the mandated coverage under this measure applies after December 31, 2026, rather than on or after; and

     (3)  Making technical, nonsubstantive amendments for the purposes of clarity, consistency, and style.

     As affirmed by the record of votes of the members of your Committee on Consumer Protection & Commerce that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 1864, H.D. 1, as amended herein, and recommends that it pass Third Reading in the form attached hereto as H.B. No. 1864, H.D. 2.

Respectfully submitted on behalf of the members of the Committee on Consumer Protection & Commerce,

STAND. COM. REP. NO.  555-26

Honolulu, Hawaii

                , 2026

RE:   H.B. No. 1864

      H.D. 1

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2026

State of Hawaii

Madame:

     Your Committee on Health, to which was referred H.B. No. 1864 entitled:

"A BILL FOR AN ACT RELATING TO INSURANCE,"

begs leave to report as follows:

     The purpose of this measure is to, beginning December 31, 2026, require insurers, mutual benefit societies, and health maintenance organizations to provide coverage for standard fertility preservation services for persons undergoing medically necessary treatment that may cause iatrogenic infertility.

     Your Committee received testimony in support of this measure from the Department of Health; State Health Planning and Development Agency; Hawaii Society of Clinical Oncology; Association for Clinical Oncology; Advanced Reproductive Medicine & Gynecology; Fertility Institute of Hawaii; Facing Our Risk of Cancer Empowered; America Cancer Society Cancer Action Network; Hawaii Medical Service Association; Hawaiʻi Women Lawyers; Worth the Wait; Hawaii Association of Health Plans; Oncology Nursing Society; Alliance for Fertility Preservation; and six individuals.  Your Committee received comments on this measure from the Department of Commerce and Consumer Affairs and Office of the Auditor.

     Your Committee finds that life-saving treatment for certain serious medical conditions such as cancer can result in medically induced infertility.  Your Committee further finds that without insurance, fertility preservation measures, such as egg, sperm, or embryo freezing, can cost thousands or tens of thousands of dollars up front, making these services prohibitively expensive for many patients and their families.  This measure seeks to promote fairness and equity in health care by reducing financial barriers that can prevent patients with medically induced infertility from seeking fertility preservation services.

     Your Committee has amended this measure by:

     (1)  Removing language that limited dependent coverage for fertility services to only those dependents twenty-six years of age or younger;

     (2)  Clarifying when policies or plan contracts may impose limits based on the policyholder's or covered person's medical history;

     (3)  Requiring insurers, mutual benefit societies, and health maintenance organizations to base clinical guidelines on the most recent American Society of Clinical Oncology guidelines, rather than the 2018 update to the American Society of Clinical Oncology guidelines;

     (4)  Amending the definition of "standard fertility preservation services" to exclude sperm retrieval; and

     (5)  Changing the effective date to July 1, 3000, to encourage further discussion.

     As affirmed by the record of votes of the members of your Committee on Health that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 1864, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 1864, H.D. 1, and be referred to your Committee on Consumer Protection & Commerce.

Respectfully submitted on behalf of the members of the Committee on Health,