In Hawaii, state law requires insurers to cover the cost of in-vitro fertilization (IVF) but only to a select few. State legislators are considering proposed upgrades to the legislation so that coverage is expanded to include more fertility treatment options and to make them available to a greater number of residents.

At this time, all providers of accident and health insurance that cover pregnancy-related expenses must also include coverage for outpatient expenses for just one cycle of IVF. As for the patient seeking fertility treatment, there must be a medically documented five-year history of infertility, proof that previous attempts at other covered fertility treatments have been tried and failed, and proof that infertility is caused by specific medical conditions:

  • Endometriosis
  • In-utero exposure to DES (diethylstilbestrol)
  • Blockage or surgical removal of one or both fallopian tubes
  • Male infertility

Additionally, the single IVF cycle is available only to married couples and only if the husband's sperm fertilizes the egg, which is a bit tricky when the husband is the infertile spouse.

When the first IVF cycle fails for a married woman meeting all the criteria, she must pay the costs for future cycles, estimated to be $15,000 to $20,000 per cycle in Hawaii. All women who are single, divorced, widowed, cohabitating, or experiencing infertility due to reasons not outlined in Hawaii Rev. Stat. 431:10A-116.5 and 432.1.604 must foot the entire bill themselves.

Critics of the law claim it discriminates against all unmarried women. Attorney Naunanikinau Kamalii contends it creates two classes of Hawaiian women. "It's discriminatory that there are two classes of women sitting in the same office, paying the same premium, and the only distinction between the ones who get to do it and the ones who don't is that one is married," according to Kamalii.

Piilani Smith, a single woman, encountered that discrimination at age 44 when she sought IVF treatment to start a family. She says traditional Hawaiian culture considers the birth of every child a sacred event but marriage is not. Traditionally, marriage is less important than the custom of ohana (extended family). The high value of every child’s birth is evidenced by the lack of a word for illegitimacy in the native language. There is no word for it because no child is ever illegitimate.

The amendment working its way through the legislative process is Senate Concurrent Resolution 35 (SCR 35), which calls for the state audit of the social and economic impacts of expanding coverage for fertility issues.

Source: Associated Press. "Hawaii weighs expanded coverage for infertility." Star Advertiser. Apr 15, 2014. Web. Apr 24, 2014.