Designing a fertility benefits plan

Infertility is more common than most people think. Today, as many as one in seven couples trying to conceive will experience infertility. It is estimated that by the year 2025, almost 10 million couples can experience challenges of having a baby.

This is a growing issue for employers. Employees are increasingly realizing how to “commodify” themselves in an incredibly competitive job market and are making greater demands than they may have in the past, especially when it comes to workplace benefits.

With the coronavirus pandemic shifting individual priorities and boosting employee leverage, more companies are introducing fertility benefits as a core job benefit to stay competitive and attract and retain employees.

Read more: Benefits in action: Ally’s fertility benefits helped this employee get on the road to pregnancy

A recent one CNBC news report reported that as of 2020, more than two-fifths (42%) of large US employers—those with more than 20,000 employees—offered coverage for IVF treatment, while nearly one-fifth (19%) offered egg freezing. For smaller companies with more than 500 employees, these figures were 27% and 11% respectively.

We don’t just see this in industries like healthcare, where medical centers struggle to compete for nursing talent. Pandemic burnout is forcing many employees in a variety of sectors to completely rethink their careers. We also see this as an issue of importance among industries with aging, male-dominated populations seeking reproductive benefits as employers seek to diversify and future-proof their workforce.

By way of contrast, in 2018, about 80% of people who underwent fertility treatments had little or no fertility coverageand more than half used credit cards or tapped their 401(k) to pay for them.

Proprietary research conducted by Evernorth/eviCore shows that 62% of plans and 61% of employer groups plan to increase their fertility benefit offerings in the next 3-5 years.

Not all fertility benefits are created equal – so it’s important for HR benefits administrators to ask some key questions when considering adding this important offering for your employees.

Will your benefit fairly meet the diverse needs of your workforce?

• There are many different ways to build a family, and it’s important that your fertility benefit supports your employees on the path that best meets their needs – whether it’s IVF or other fertility treatments, male infertility treatments, surrogacy or adoption .

Is your benefit based on the latest clinical research?

• Fertility science is evolving rapidly, and it’s important that your plan can keep up to ensure your employers are getting safe and proven evidence-based treatments — reducing costs for you and them, and increasing the chance of a successful cycle.
• Choose a partner with in-house clinical expertise—not just reproductive endocrinologists, but genetic lab specialists, lab clinicians, fetal medicine specialists.
• Make sure the benefit policy is consistent with the latest clinical guidelines and recommendations from the American College of Obstetrics and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM).

Will the benefit provide your employees with access to fertility experts and a convenient network?

• Helping new fertility patients get connected to higher quality providers is critical to increasing their chances of success and getting them the care they need.
• The two critical network issues that are important to ensure you address benefit addresses are network quality and ease of access. For fertility patients, this includes access to high-quality reproductive endocrinologists and laboratories that provide these specialized fertility treatments and services. Look for a partner that incorporates guideline compliance, outcomes and member experience data into their overall view of network performance.
• A high quality network is only valuable if it is used effectively by members. To meet those needs, providers in the network must be as convenient as possible and members must have access to assistance in scheduling appointments, locating providers, and assistance in resolving access/convenience issues.
• Make sure your benefit includes general lab and genetic lab coverage for members. Going to an in-network reproductive endocrinologist (REI) only to find out that the labs used are out of network is a common challenge.
• Where and how patients get their fertility medications matters—especially when patients need as many as 15 prescriptions in a single cycle. Fertility drugs are considered specialty drugs and are often not stocked at a retail pharmacy due to the complexity and precision involved in each individual case. Using easily accessible pharmacy providers who specialize in fertility will give members the best possible results.

Will your benefit also help support your employee’s mental health?

• Fertility treatments can be physically and emotionally draining. Access to support resources can help reduce many of the stressors associated with treatment and enable them to get the most value from their benefits, including peace of mind.

As more companies add fertility benefits, considering these questions will position you and your business to best meet the needs of your employees. Evidence shows that employees are increasingly making employment decisions based on certain benefits – such as coverage for fertility treatment – and this will help you maintain your company’s competitive advantage.