Birth of a New Trend: Commonly Covered Fertility Benefits

If today’s average worker is all about achieving work/life balance, he is going to be less enamored by free snacks, biweekly chair massages or on-site fitness center and more interested in flexible hours, extended paid vacation time, and work-from-home options. Forward-looking young adults are also attracted to another work benefit: generous fertility coverage.

Assisted reproductive technology (ART) is an umbrella term that refers to in vitro fertilization (IVF), the use of donor eggs to conceive, and gestational surrogacy. What were once considered alternative treatments are now mainstream and widely accepted in both liberal and conservative circles. According to the Centers for Disease Control and Prevention, the number of ART procedures doubled between 2007 and 2017, and nearly 12 percent of childbearing-age women have received some form of infertility services. Furthermore, this benefit is not just popular among traditional families. Approximately 63 percent of the LGBTQ population are expected to use ART, foster care, or adoption to establish a family.

Value

There is a reason fertility benefits are coveted on par with healthcare insurance.  These services are expensive; very expensive. For example, IVF averages about $20,000 per round when you include the cost of consultations, genetic screenings, and medication. Egg freezing to delay family planning can cost $10,000 or more. For young adults, early or midcareer, that’s a lot of money.

Worse yet, at least half the patients who opt for IVF fail to conceive and engage in a second round. About a third undergo three or more rounds of treatment, with a cost running $50,000 and up.

People who do not possess this level of savings end up borrowing money to finance fertility treatments. More than half pay by credit card, a quarter take out a personal loan, and 14 percent withdraw money from their 401(k) plan. Here’s an interesting anecdote: One woman quit a high-paying position to take a job at Starbucks because the company offers generous IVF coverage – even to part-time workers.

Considering the cost/value proposition, it’s easy to see why workers are motivated to seek out an employer willing to help foot the bill. One of biggest perks for employers offering fertility benefits is that they can help secure a worker with a long-term perspective. Not only is it reasonable to expect a worker who uses these benefits to stick around for several years, but the sheer loyalty gained out of appreciation is priceless. After all, when an employer makes it affordable for a worker to achieve her dreams – you can’t really put a value on that. The gift of a child has a way of eliciting eternal gratefulness. 

Available Benefits

Fertility benefits run the gamut of infertility diagnosis and medication to IVF and intrauterine insemination (IUI). Additional family planning benefits may include egg freezing, donor eggs or embryos, and/or gestational surrogacy. The range of available fertility benefits is extensive and therefore employer coverage plans vary considerably.

However, according to International Foundation of Employee Benefit Plans, the most commonly covered fertility benefits (in order starting with highest prevalence) are:

1. In-vitro fertilization treatments
2. Fertility medications
3. Genetic testing to diagnose infertility
4. Non-IVF fertility treatments
5. Counselor visits
6. Egg harvesting and egg freezing

Limitations

Employer fertility benefits often have coverage limitations. For example, it is common for plans to require that less invasive treatments, such as fertility medications or IUIs, be pursued before permitting more expensive procedures such as IVF. It is also worth noting that most plans max out coverage at a certain dollar amount. The problem is that workers can get close to their limit deploying the required step-up procedures that don’t work, then fall short of the type of coverage that does work. That can leave even a worker who enjoys generous employer coverage with a substantial out-of-pocket bill.

Some plans may not even cover cheaper options, such as the purchase of sperm (average price is $1,000 per 0.5 cc vial). Less popular is coverage of surrogacy and fertility preservation for the trans community (such as egg or sperm freezing) – which runs afoul of discrimination when it comes to their options for a biological child.

As another means to help address family planning, some employers have begun to offer third-party supplemental insurance policies to fill in fertility gaps in traditional health plans. 

How Many Employers Provide Fertility Benefits?

One reason fertility benefits offer a substantial recruitment advantage is that, while many Americans use them – comparatively few employers offer them. In 2018, over 70 percent of IVF patients had no employer coverage for fertility treatments. Fortunately, those numbers are improving. Between 2016 and 2018, the number of employers with 500 or more workers offering some form of fertility benefit increased from 24 percent to 31 percent.

As would be expected, smaller employers are less likely to cover fertility treatments. According to the International Foundation of Employee Benefit Plans, only 10 percent of employers with 50 workers or less offer fertility benefits, although this number also continues to rise.

Recruitment Communication

It can tricky to determine how to convey fertility information during the recruitment process. Certainly prospects are hesitant to ask pointed questions since this would tip off their desire to have children and thus spend time away from work. On the other hand, a recruiter may be anxious to tout fertility benefits more to young candidates, perhaps forgetting that a woman in her forties may be interested, as might an older man with a younger wife. It’s best not to make assumptions about the prospects of any candidate during the interview process.

As such, employers may want to consider a standard procedure for communicating all benefits, including fertility coverage, during the recruitment process. For example, include a handout flyer that details fertility coverage along with other company materials. To help address specific questions, consider including answers to FAQs that a candidate may be hesitant to ask, such as:

• Is evaluation by a specialist covered?
• What fertility treatments are covered?
• Is genetic testing included?
• Are there limitations on the coverage?
• Are there requirements before moving onto IVF?
• Are there dollar caps or cycle caps?
• Are there age restrictions?
• Are there marital status restrictions?
• What are the annual or lifetime maximums?
• What is the length of time required on the existing policy?
• Are co-pays, co-insurance, or deductibles consistent with those for other health benefits?
• Are medication costs included in any annual or lifetime maximums, or are they carved out separately?

It may be a good idea for employers to describe the limitations to their coverage from the outset in order to manage expectations. You wouldn’t want to sabotage company trust when the worker learns options are limited due to his circumstances, or how big her portion of the tab could run. 

A Growing Trend – To Mitigate a Growing Trend

With more women in the workforce and the two-income family becoming a societal norm, it’s only natural that family planning is delayed. This means that women are opting to become pregnant at older ages, and as a result getting and staying pregnant has become more difficult. Moreover, the surge in young adult populations and widespread acceptance of alternative family arrangements has led to more same-sex couples and single people seeking help to have children. 

Bear in mind that, for now, employer coverage is optional. However, given the fact that the US birthrate continues to fall – 2018 yielded the lowest number of births in 32 years – there is growing concern that population growth is not robust enough to drive future economic growth. This concern has led as many as sixteen different states to pass laws mandating various levels of health insurance coverage of fertility benefits. For example, Massachusetts requires that health insurers cover infertility diagnosis and treatment. One expert surmises that infertility insurance laws have yielded about 95,000 babies in Massachusetts over the past 30 years.

As a final thought, don’t forget to pair fertility coverage offerings with generous paid maternity and paternity benefits and/or a dependent care reimbursement account. Creating a family friendly compensation package can not only help attract the best and brightest among today’s young adults, but helps ensure loyalty and sustainability in a time when job-hopping has become the millennial norm.

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