Insurance Information

Insurance and billing FAQs

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FAQ.

Fertility Insurance Information for Hawaii

Health insurance is indispensable, but it can certainly add to the complexities of the choices you make when pursuing infertility treatment. Many people believe infertility treatment is unaffordable. The truth is that many fertility treatments and services are often covered by health insurance.

The Fertility Institute of Hawaii (FIH) participates with almost all of Hawaii’s insurance plans, including:

• HMSA
• HMAA
• HMA
• Kaiser Permanente Added Choice
• Hawaii Electricians Fund
• Hawaii Laborers Trust Fund
• CIGNA
• Aetna
• Horizon Blue Cross and Blue Shield
• UHC
• MDX
• Tricare Standard

HMSA HMOs: Hawaii IPA, Straub, Hawaii Health Partners, Castle Health Group, Oahu Physicians Group, and Pacific Health Care Group.

Some insurances that will require a referral including Kaiser HMO, Tricare Prime, and HMSA HMOs not listed above. Therefore, no referral is needed for the listed HMO groups.

If you do not see your insurance listed above, please contact our billing office (808.380.8231) to inquire about coverage. Certain tests and/or procedures will only be covered if your plan provides infertility benefits. We encourage all patients to contact member services for benefit information specific to your policy.

While most Hawaii-based insurances will cover IVF and a few will cover other infertility services, Medicare, Medicaid and Quest insurances will not cover any infertility treatment services or treatments.

IVF Costs

Please see our IVF Costs page for more detailed information about the costs of IVF treatment

Hawaii State Insurance Mandate for IVF

In 1987, the state of Hawaii mandated that insurances cover one cycle of IVF if patients meet certain criteria. The Hawaii law concerning infertility insurances can be found in Sections 431-lOA-116.5 and 432.1-604 of the Hawaii Revised Statutes. Like many of the infertility insurance mandates, Hawaii’s law on coverage for IVF costs includes certain stipulations. Limitations under Hawaii’s infertility insurance mandate include the following:

• The patient and the patient’s spouse must have a five-year history with infertility, unless the infertility is associated with the following medical conditions: endometriosis, in utero exposure to diethylstilbestrol (DES), blockage or surgical removal of one or both of the fallopian tubes, or abnormal male factors resulting in infertility.
• The patient must have been unable to achieve pregnancy or carry a successful pregnancy through other applicable fertility treatments that are covered under the plan.
• The IVF procedure must be performed at a fertility clinic or medical facility that conforms to guidelines for IVF established by the American College of Obstetric and Gynecology or the American Society for Reproductive Medicine
• The patient’s eggs will be fertilized with her spouse’s sperm. Under the law, the term “spouse” refers to a person who is lawfully married to the patient under the laws of the State. Unfortunately, this appears to exclude individuals and gay couples under the law. **Of note, not all insurance adhere to this part of the mandate.  Some will allow same-sex and single females coverage under the mandate.  The billing team at FIH can help answer questions for you.  You can contact them at billing@armghawaii.com or 808.380.8231.

The legislature is currently reviewing this mandate so changes may occur in the future.  The providers at FIH have and will continue to submit testimony in order to improve the benefits for our patients.