HB1864 requires most health insurance policies, hospital and medical service plan contracts, and health maintenance organization plans issued or renewed in Hawaii after December 31, 2026, to cover standard fertility preservation services for insured persons who are facing medically necessary treatment that may directly or indirectly cause iatrogenic infertility. The bill is aimed primarily at cancer-related treatment, and it defines the covered services by reference to the 2018 American Society of Clinical Oncology fertility preservation guidelines.
The bill also limits how insurers may apply exclusions or restrictions. It bars denials or limitations based on prior diagnosis, prior fertility treatment, life expectancy, disability, medical dependency, perceived quality of life, or other health conditions. Any remaining limits must be tied to medical history and the ASCO-based clinical guidelines. The bill expressly excludes experimental procedures, third-party assisted reproduction technologies such as donor egg, sperm retrieval, surrogacy, and gestational carriers, and cryopreservation storage costs.
HB1864 amends chapters 431 and 432 of the Hawaii Revised Statutes to create a new mandated insurance benefit for fertility preservation and to extend that benefit to health maintenance organizations through the required-benefits statute. It affects insurers, mutual benefit societies, HMOs, policyholders, and covered dependents by requiring coverage in policies and plans issued or renewed after December 31, 2026. The measure also standardizes the scope of coverage by tying it to ASCO clinical guidelines and by specifying exclusions, thereby limiting insurer discretion over benefit design.
The available voting history shows strong and unanimous support at each recorded stage, with all committee and conference votes passing 5-0, 4-0, 4-0, and 3-0 respectively. That pattern suggests broad bipartisan agreement that fertility preservation coverage should be added to Hawaii’s mandated health benefits. The bill was ultimately transmitted to the Governor, indicating it advanced with little visible opposition in the recorded proceedings.
No committee transcripts were provided, and the recorded votes show no dissent, so there is no documented floor or committee controversy in the available materials. The main policy issues apparent from the text are the scope of required coverage and the exclusions: insurers may be concerned about cost, administrative standards, and the mandate to follow ASCO guidelines without deviation, while advocates would likely focus on access for patients facing infertility-causing treatment. The bill also draws a boundary by excluding experimental procedures, third-party assisted reproduction, and storage, which may reflect compromise over how far the mandate should extend.