Lawmakers are once again considering a measure to require insurance companies to offer in-vitro fertilization coverage to same-sex couples, unmarried couples and unmarried women.

Advocates of the measure say the current system amounts to discrimination because only married, heterosexual couples currently qualify for the benefit.

Planned Parenthood, in supporting Senate Bill 502, wrote that, at present, “insurance coverage discriminates against and essentially restricts a person’s reproduction based on their sex, sexual orientation and/or marital status. This kind of discrimination simply has no place in Hawaii law.”

The LGBT Caucus of the Democratic Party also offered testimony in strong support of the measure, which passed the state Senate and is up for a vote in the House this week.

Sen. Maile shimabukuro (D, Kalaeloa-­Waianae-Makaha), who introduced the bill, said this is the third session at which such legislation has been presented. She said similar measures weren’t passed in previous sessions in part because insurance companies were concerned about expenses.

“It was pretty heartbreaking last session because the bill made it all the way to the conference committee and, unfortunately, the insurance companies were concerned, understandably, about the added costs. They had raised an issue saying that under the Affordable Care Act, there was some kind of provision that said if you mandate new insurance coverage, then the state’s on the hook. That was a big concern on everyone’s mind because we weren’t sure of the price tag and the implications this would have,” Shimabukuro said.

She also said insurance companies may have to raise prices on their health plans if the bill goes into effect: “They’re going to have to figure it out on their own how they’re going to add these additional benefits to the membership and cover those additional costs.”

Rep. Bertrand Kobayashi (D, Diamond Head-Kaimuki-­Kapahulu), who supported the bill with reservations, said, “There’s a very fine line between whether this is the expansion of an existing mandatory benefit or whether this is a new benefit because it covers new beneficiaries.”

Supporters of the bill may feel increases in insurance premium costs in exchange for wider IVF coverage is justifiable, as advocates argue this legislation is a civil rights issue.

The American Civil Liberties Union stated in its testimony that “IVF can cost upward of $20,000 per cycle. While opposite-sex married couples are guaranteed a process to alleviate the majority of the procedure’s cost, same-sex married couples and unmarried women may be forced to shoulder the financial burden alone.”

The ACLU also highlighted that, at present, no insurance plans offer IVF coverage to male couples, who would rely on a surrogate mother to conceive a child.

Kaiser Permanente, which insures about 250,000 people in the state, opposed the bill. According to its testimony, Kaiser doesn’t get involved in IVF procedures that require third-party assisted reproduction “because of the complex legal issues and inherent medical risks.”

Kaiser’s legal and government relations consultant also wrote that it is problematic if a third-party individual involved in assisted reproduction is not Kaiser-insured.

“Third party” refers to egg and sperm donors, surrogate mothers, and gestational carriers.

Kaiser clarified that it supports equal coverage for women seeking IVF services, both single and married.

The Hawaii Medical Service Association also objected to the bill. HMSA’s government relations director wrote that it would be more difficult to accurately diagnose an individual as infertile were the required time to do so shortened from five years to 12 months, as the bill recommends.

Shimabukuro said a five-year waiting period makes becoming pregnant more difficult for potential mothers, as age generally correlates with a decrease in fertility.

“Twelve months, from my understanding, was more the national standard. Hawaii kind of deviated from what the standard was for determining infertility,” she said.

“For a lot of us professional women, due to having to go to school and work, we delay motherhood till later in life. This measure’s very close to my heart because I have friends that are struggling to get pregnant and have kids. I think it’s a very important issue not just for women, but other types of couples that don’t fit into the current mold that the bill is trying to change,” Shimabukuro said.