The California Insurance Equality Act prohibits insurance providers from issuing policies that treat registered domestic partners and spouses differently. This applies to all group health insurance policies issued, amended, delivered or renewed in California on or after January 2, 2005 (or January 1, 2005 for all other insurance policies).

Coverage for domestic partners and spouses must be provided under the same terms and conditions. This law protects those who meet the definition of domestic partner set forth in California Family Code section 297, which covers same-sex couples over age 18 and opposite-sex couples where at least one partner is age 62 or older. Insurance companies may require proof of domestic partnership only if proof of marriage is required. A copy of a valid Declaration of Domestic Partnership issued by the State of California or by another state or local government qualifies as proof. (CA Health & Safety Code 1374.58; CA Ins. Code 381.5 and 10121.7.)

Insurance companies that provide policies with family coverage must extend similar coverage to reciprocal beneficiaries. This applies to indemnity plans, not HMOs. (Section 431:10A-601 Hawai'i Revised Statues.) A reciprocal beneficiary relationship is a legal partnership between two people who are prohibited by state law from marrying one another, which include but are not limited to relationships such as brother and sister of the half as well as to the whole blood, uncle and niece, aunt and nephew, widowed mother and her unmarried son, and two persons of the same sex/gender. (HRS 572C-2.)

Under Maine law, all insurers selling group insurance products that include coverage for spouses must also offer to include coverage for domestic partners under the same terms and conditions. It is the employer's choice whether or not to elect this coverage. (H.B. 1256.)

Same-sex couples are allowed to marry in Massachusetts and are entitled to all of the benefits offered to opposite-sex married couples.

Under the New Jersey Domestic Partnership Act, insurers are required to offer dependent coverage for a covered person's State-registered domestic partner when dependent coverage is available under a health plan. The State of New Jersey's Domestic Partnership Registry is open to same-gender couples and to oppsite-gender couples where both partners are age 62 or older. (New Jersey, Ch. 246, P.L. 2003.)

Under Vermont's Civil Union laws, individual and group insurance policies that provide coverage for spouses and dependents must provide equivalent coverage for parties to a civil union and their dependents. (Sec. 18.8 V.S.A. section 4063a.(b).)

While Virginia law used to prohibit insurance providers from selling products that covered domestic partners, in 2005 the Code of Virginia was amended to state that in addition to spouses and dependent children, coverage under an insurance policy may be extended to insure 'any other class of persons as may mutually be agreed upon by the insurer and the group policyholder.' (See Code Section 38.2-3525.A.2.)

West Virginia's Insurance Commission refuses to permit insurance companies from issuing policies that cover domestic partners because the definition of 'dependent' in the State's insurance law does not include domestic partners. (State Code Chapter 33, Article 16, Section 33-16-1a(d).) Employers with self-insured plans may extend domestic partner coverage.