Hawaii law (HRS 431:10A-116.5 and 432:1-604) requires individual and group plans that provide pregnancy benefits to cover all outpatient expenses of one IVF cycle, as a one-time benefit. As ASRM describes it, eligibility requires the patient's own eggs and her spouse's sperm, plus 5 years of infertility or a listed cause. A 2026 law, HB 1864 (Act 218), adds fertility preservation for cancer patients in plans issued or renewed after December 31, 2026. Picture as of October 2026.
| Point | Hawaii rule |
|---|---|
| Plans included | Individual and group insurance policies and hospital or medical service plan contracts that provide pregnancy-related benefits |
| What is covered | All outpatient expenses of one IVF cycle, as a one-time-only benefit |
| Eggs and sperm | The patient's eggs fertilized with her spouse's sperm (spouse meaning a person lawfully married to the patient) |
| Infertility required | At least 5 years of infertility, or infertility associated with endometriosis, in utero DES exposure, blocked or removed fallopian tubes, or abnormal male factors |
| Treatment order | Other covered infertility treatments must have failed |
| Facility | Must meet ACOG or ASRM standards |
Source: ASRM ReproductiveFacts.org, Hawaii page (accessed October 2026).
ASRM gives the IVF law's effective date as June 26, 1987, while KFF's table (May 2020) dates it to 1989 and 2003. Triage Cancer's chart labels the statute with a 2024 date, which suggests a later amendment. Whether that amendment changed the spouse or 5-year requirements could not be confirmed, so ask your insurer for the current eligibility rules.
HB 1864, which became Act 218 (signed July 9, 2026, according to NFP), requires insurers, mutual benefit societies and HMOs to cover standard fertility preservation, following 2018 ASCO guidelines, for people whose medically necessary cancer treatment may cause infertility. It applies to policies issued or renewed after December 31, 2026. Storage, experimental procedures and third-party reproduction are excluded.
Both Hawaii laws bind state-regulated plans only. State mandates do not apply to self-insured employer plans, which cover 67% of US workers with employer coverage (healthinsurance.org, June 2026); NFP confirms self-insured group plans are not required to add the new fertility preservation coverage. Your plan documents or HR department can tell you which kind of plan you have.
Map to the Positive describes IVF as a 4 to 6 week process. Several of its steps are outpatient, which is what Hawaii's law refers to:
Since only one cycle is covered, the book's advice to ask detailed questions before you start matters even more, including how many embryos will be transferred and whether a fresh or frozen transfer is planned.
The cycle is explained phase by phase in Chapter 35 of Map to the Positive, IVF demystified, in Station IV, with side effects, myths and a full list of questions for your specialist. The same station covers when to see a specialist, choosing a doctor and the treatment ladder.
Take 30 days. If it does not give you more clarity than everything you have read for free so far, ask for a refund and you get every cent back. We cannot promise you a pregnancy. We can promise you will not be guessing.
References: State and Territory Infertility Insurance Laws: Hawaii (ASRM ReproductiveFacts.org) (accessed 2026-10-30) · Coverage and Use of Fertility Services in the U.S., Appendix 1: Private Insurance (KFF) (2020-05) · Health Insurance: Fertility Services (Triage Cancer state laws chart) (2025-09) · Gov. Green Completes Bill Signing Season and Issues Veto Decision (Office of the Governor, Hawaii) (2026-07-15) · HB1864 CD1 (2026), Relating to Insurance (Hawaii State Legislature) (2026) · Hawaii Fertility Preservation Coverage Law (NFP) (2026-07-28) · Q. Does the ACA require infertility treatment to be covered by health insurance? (healthinsurance.org) (2026-06-18)