A growing percentage of employers are adding fertility benefits to their employee benefits packages as they look for ways to boost recruitment and retention as well as to fulfill other goals such as supporting diversity, equity and inclusion (DEI).
International Foundation research confirms that the prevalence of these benefits is on the rise. Preliminary data from the 2022 Employee Benefits Survey shows that 40% of U.S. organizations offer at least one fertility benefit.
In her article “Starting the Conversation About Fertility Benefits” in the January/February issue of Benefits Magazine, author Betsy Campbell discusses considerations for structuring these emerging benefits. Campbell is chief engagement officer for RESOLVE: The National Infertility Association.
Such benefits can be attractive to employees who have delayed childbirth while they focused on their education and careers. “Another factor is that families are built in many ways, including by single parents and same-gender couples who want the same coverage as their partnered colleagues and opposite-gender couples,” Campbell writes.
Review Current Coverage
Employers and plan sponsors looking to implement or enhance fertility benefits should start by reviewing their current fertility and maternity coverage and consider how fertility coverage may affect health care costs.
The average cost of one cycle of IVF in the United States is $10,000 to $12,000, and the cost of medications used with in vitro fertilization (IVF) runs from $5,000 to $7,000 each time. However, Campbell explains that not offering fertility coverage can increase the likelihood that members will choose multiple embryo transfer during IVF. They may do so in hopes of increasing the chance of a successful transfer because the expense of IVF may limit the number of attempts they can make. However, multiple embryo transfers increase the risk of multiple births and, in turn, the risks of preterm birth, low birth weight and disability.
Structuring a Fertility Benefit
Following are common coverage structures for fertility benefits:
-Fertility coverage without IVF: Services and benefits may include fertility medications, genetic testing, counselors and other non-IVF fertility treatments.
-Fertility coverage with limited IVF
-Fertility coverage with unlimited IVF
-Unlimited fertility coverage with IVF and medical management
Here is a look at the types of fertility benefits offered by organizations overall, according to preliminary data from the 2022 Employee Benefits Survey and a comparison with results from past editions of the survey.
-28% cover fertility medications (8% covered in 2016, 14% in 2018, and 24% in 2020)
-30% cover IVF treatments (13% in 2016, 17% in 2018, 24% in 2020)
-14% cover visits with counselors (e.g., geneticists, surrogacy, etc.) (4% in 2016, 8% in 2018, 14% in 2020)
-16% cover genetic testing to determine infertility issues (up slightly from 11% in 2018, 12% in 2020. This question was not asked in 2016.)
-17% cover non-IVF fertility treatments (6% in 2016, 11% in 2018, 11% in 2020).
Most employers limit fertility coverage by setting a lifetime maximum dollar benefit, although some place a limit on the number of IVF cycles, with three being the median number covered, according to Campbell. Covering cycles rather than a dollar amount is considered best practice because as dollar limits are reached patients may feel greater pressure to transfer multiple embryos, which increases the health risks and health care cost for mother and baby, she writes.
There has been some speculation that states could enact legislation related to embryos following the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization. It is uncertain at this time how this might affect IVF treatments.
Other Considerations
Fertility Preservation Benefits
Fertility preservation benefits are another area of fertility benefits that employers may want to consider. This includes freezing of eggs, sperm, reproductive issue and/or embryos. Campbell explains that women who want to delay pregnancy are not the only ones who would seek this benefit. Employees diagnosed with cancer during their reproductive years may be at risk for infertility from their treatment. Medically induced infertility may also affect people undergoing treatment for sickle cell anemia, lupus and other autoimmune diseases. The percentage of organizations offering these benefits has grown according to the Employee Benefits Survey. Preliminary data from the 2022 survey showed that 14% of organizations cover egg harvesting/freezing services, up from 10% in 2020 and 6% in 2018.
Using a Specialty Vendor
There are third-party payers that work directly with employers to provide fertility coverage that supplements the employer’s existing health plans. These programs vary in how they structure benefits in terms of cost sharing between employers and employees, so it’s important to research and compare programs.
Conclusion
The fertility benefits “landscape is changing, with employees placing greater value on benefits than ever before and more employers expanding their benefits in a competitive labor market,” Campbell concludes. “Evaluating whether to provide fertility coverage is likely an important conversation for employers to begin having.”
Kathy Bergstrom, CEBS
Senior Editor, Publications at the International Foundation of Employee Benefit Plans
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