Infertility Insurance Coverage Benefits for Essential Employees

Providing infertility insurance coverage can not only help employers attract new employees but also play a key role in retaining employees. It is still a big problem for many men and women who are struggling to have a family to afford the costly fertility treatments and medications.

In this article, we are going to discuss the benefits of fertility insurance, healthcare coverage for infertility, and how they are utilized for essential employees.

The issue of infertility insurance coverage is a very serious one. Below are some statistics regarding infertility:

• Approximately 1 out of 10 American women between the ages of 15 and 44 have trouble getting or staying pregnant. (According to the Centers for Disease Control and Prevention)
• Approximately 1 out of every 65 children born in the United States are conceived after infertility treatment (NYT, January 30, 2019).

Many people don’t have access to infertility treatment. It’s simply because there’s no provision for infertility care in their insurance coverage or because the benefit is not enough. Moreover, there is usually no backup plan when people lack the financial means to pay for family building options. It includes adoption, infertility treatment, and third-party options (Surrogates), by themselves. Lastly, dealing with the financial implications of access to infertility treatment takes a toll. Describing her experience, one patient who went through the process said, “The financial piece made the emotional piece more difficult.”

Infertility Awareness Increases, Understanding Remains Low

There is no doubt that infertility awareness is at an all-time high. More and more people from different backgrounds are sharing their experiences, stories, and struggles with infertility. For instance, ex-US first lady Michelle Obama talked about the miscarriages she had. She also shared her experience using IVF in her book titled, “Becoming”. This sparked a public dialogue among women, most notably those of African-American origin.

It is a sharp reminder that anyone can suffer from infertility. The issue is regardless of race, occupation, religion, economic status, or sexual orientation. However, while there is an increase in the awareness of infertility, awareness of the factors affecting fertility remains low. More importantly, a lot of people – especially women– don’t understand how much the ability to get pregnant decreases with age. For many of them, this starts at the age of 35.

Lack of Understanding as a Global Issue

Not just in the United States, but in many countries of the world, men and women don’t understand the factors that impact the ability to become pregnant and have a healthy baby. One of the consequences of this is that people misjudge the impact age has on fertility. And, as a result, they delay childbearing for too long.

This is seen as a big problem in the United Kingdom such that a national campaign was launched to educate young people about fertility.

Infertility Insurance Coverage Differs

A large number of people know that insurance coverage for infertility treatment is lower than they expect it to be. Also, it is not consistent for every fertility insurance provider and varies by employer, industry, and state. However, it is good to note that some US states do have coverage mandates.

Even in cases where an employer provides an infertility health benefit, there may be some restrictions regarding the procedures covered. Moreover, the financial value of the benefit may be too low to be helpful. Importantly, limited infertility coverage can make fertility treatment out of reach for many people. In fact, a survey suggested that 30 percent of couples don’t pursue or stop fertility treatment because of cost.

Many Factors Limit the Infertility Coverage:

• Dollar limits for care: For instance, if an employer or the fertility insurance provider does not cover more than $5000 out of treatment cost, this may reduce access to infertility treatment. An IVF cycle costs around $12,000, and two or more cycles are often required.
• Treatment restrictions: An infertility benefit may be designed in such a way that only medications (not the whole IVF treatment) are covered. A benefit plan may not also include other important procedures like genetic screening or egg freezing and storage.
• Activating the Coverage: There can be conditions one should meet before activating the fertility coverage. For example, an employee may need to have unprotected sexual intercourse for six or twelve months. It may exclude single men and women as well as same-sex couples. However, some employers do provide equal access to infertility benefits for singles, heterosexuals, and same-sex couples.

These coverage limits for necessary infertility care can result in large out-of-pocket payments by workers. Surely, such limitations can put infertility treatment out of their reach.

Employer Fertility Benefit Trends Are Improving

Over the last couple of years, reports have shown that the banking, media, and tech industries are the first to offer meaningful fertility benefits to employees. One of the reasons for this is to gain a competitive edge by attracting new workers and retaining old ones.

Many tech firms even said that they would cover egg freezing and storage with the hope that it will motivate women to wait before having children. However, other industries and employers are yet to understand the advantages of providing this family-friendly fertility benefit.

Surveys have shown that employees tend to be more productive, satisfied, and loyal to the company when fertility benefits are included in their health benefits package. Also, they are more like to stay longer.

A 2017 survey of 10,000 IVF patients with employer full IVF coverage reported:

• 62% are more likely to stay in their jobs for a longer period of time.
• 53% are more willing to neglect their employer’s shortcomings.
• 22% are more likely to put in more work.
• 88% of female patients who have their IVF fully covered by their employer chose to go back to the same employer after maternity leave.

Attitudes About Infertility Coverage Are Shifting

According to a New York Times article titled, “IVF Coverage is the Benefit Everyone Wants,” the issue of infertility insurance coverage or fertility benefits have become less about ambitious women who postponed childbearing for too long. Now, it is more a matter of “corporate diversity and inclusion.”

This new attitude is improving infertility insurance coverage in many places:

• According to Mercer, a benefits consulting company, 44% of US big employers (with up to 20,000 employees) provided some kind of IVF coverage in the year 2018, up from 37 percent in 2017.
• Previously, P&G offered an infertility benefit covering up to $5000 in costs. This year, they increased it to $40,000.
• Companies such as Viacom, Cerner, Unilever, and MassMutual do not cover genetic screening for embryos, which typically costs around $5000. This test helps check for genetic diseases and embryos that are more likely to lead to a miscarriage.

The best fertility benefits from any insurance provider are one that promotes a better outcome for the would-be mother, baby, and employer.

The Takeaways

• 12-13 % of every 100 US couples have difficulty becoming pregnant.
• Worldwide, over 8 million children have been born through IVF and other advanced fertility technologies since the first “test-tube” baby was delivered in 1978.
• Infertility coverage is not adequate for many people. Usually, it doesn’t cover most of the procedures used in infertility treatment.
• Some of the well-known returns of fertility benefits include employee productivity, satisfaction, and retention.
• The need to cover a large part or the entire cost of fertility treatment makes the treatment inaccessible for many people.

Luckily, health specialists, firms, and patient groups are doing their best to make family-building options accessible to everyone. Although progress is being made, there is more work to be done.

The financial planning that comes along with infertility treatments can seem overwhelming for hopeful parents. Coastal Fertility gladly offers complete guidance when dealing with your fertility treatment insurances, fertility insurance provider, as well as finance options. If you have any questions about your insurance coverage regarding an infertility treatment, please don’t hesitate to contact us at (949) 726-0600 to schedule a consultation or visit us at www.CoastalFertility.com.

Julianna Nikolic

Chief Strategy Officer Julianna Nikolic leads strategic initiatives, focusing on growth, innovation, and patient-centered solutions in the reproductive sciences sector. With 26+ years of management experience and a strong entrepreneurial background, she brings deep expertise to advancing reproductive healthcare.