Infertility doesn't discriminate — it affects all people equally, regardless of gender, geography, or socioeconomic status. One in six people worldwide are infertile, a condition that the World Health Organization and American Medical Association recognize as a disease.
Today's employees are also starting families later in life, contributing to an
To address this growing need and employee expectations for access to affordable, high-quality fertility care, many employers under the guidance of forward-thinking benefit advisers are enhancing their
A study from Fertility IQ found that 61% of employees who received this kind of coverage said they felt more loyal and committed to their employer and 53% stayed at their jobs longer. In addition, 88% of women who were able to access in vitro fertilization (IVF) with support from their employer
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These benefits are more than an important component of an organization's health and well-being strategy. When delivered effectively, comprehensive fertility and family building benefits can reduce downstream healthcare costs driven by high-risk maternity and costly neonatal intensive care unit claims, as well as play a key role in an employer's recruitment and retention strategy.
Many employers are unsure where to start in building a robust plan design for fertility and family building benefits. Whatever tack they take, it's important to ensure there are no precertification or medical diagnosis requirements that discriminate against single parents by choice, oncology patients, or members of the LGBTQIA+ community.
Programs also should feature clinical education and guidance, emotional support and assistance in directing members to high-quality care, as well as culturally competent care to ensure members have access to fertility providers who are as diverse as they are. A managed network of specialists should feature reproductive endocrinologists, reproductive urologists, surgeons and immunologists.
Another key component includes data-driven care for accurate reporting that also offers a real-time view into outcomes and treatment pathways to engage in early intervention with members during crucial stages of treatment. For instance, if the vendor learns a member has become pregnant, it can reach out to offer support or connect the member with pregnancy resources. This is also beneficial for patients who have underlying conditions that may make it hard to conceive or navigate a healthy pregnancy.
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Demonstrated clinical outcomes are the best indicators of fertility and family building success and an important driver of overall program savings and member satisfaction. Employers should consider benchmarks when evaluating fertility benefit providers such as pregnancy rate per IVF transfer, miscarriage rate and single embryo transfer rate.
Finally, employers that offer this benefit need to keep an eye on recent court rulings and state legislative activity that can cast uncertainty over the already complex landscape of fertility treatment.
As part of its free toolkit for employers, the nonprofit Midwest Business Group on Health developed a series of action steps to assist its members in evaluating the current benefits strategy and putting an implementation plan in place. They include:
1. Assess employee needs. Understand employees' needs for fertility coverage through surveys, basic demographics and/or claims data. Consider the need for comprehensive fertility coverage, as well as satisfaction with current or prospective offerings.
2. Use data. Claims data can determine the number of members accessing fertility benefits, as well as the incidence of multiple and/or premature births within each group. Compare data to national averages. Ask potential vendor partners to use real data to demonstrate how they could improve the fertility experience.
3. Review current benefit plan design. If a fertility benefit is already in place, be sure to understand if the current structure excludes members of populations who desire family building but don't fit into a "traditional" family model. Consider the needs of diverse employee groups and the benefits of offering mental health services, access to navigation advocates, and additional benefits for surrogacy, adoption and foster care.
4. Choose the right partner. Develop a solid understanding of the differences in service models. Ask prospective partners to provide information on clinical outcomes, as well as how they deliver care and manage their network of providers. Ask them to demonstrate how they can improve the patient journey, accommodate the diverse needs of covered lives and how they can reduce medical spend.
5. Have an implementation plan. The smooth implementation of a new or enhanced fertility benefit includes building awareness, educating key stakeholders and integrating with other benefits. Inform all vendor partners of the organization's fertility benefits strategy and develop a system for cross referrals between point solutions, carriers, providers, employee assistance programs and leave partners. A robust communications strategy is critical. Use creative messaging and a variety of educational resources and mediums. Track the effectiveness of these communications and regularly refresh the strategy.
6. Continually evaluate the plan. Define and track success metrics and don't hesitate to change course as needed. Success measures should be based on the employer's specific population with quality data from the fertility partner. Don't rely on estimates or projections. Involve partners in making improvements and be sure to celebrate the creation of new families in the organization!
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While fertility and family building treatment can be expensive, adding coverage can mitigate costs employers might otherwise incur such as reducing premature births and/or multiple births. In addition to medical cost savings, employers gain the ability to recruit and retain top talent, increase employee engagement and productivity, and make progress toward diversity, equity and inclusion objectives.
In viewing infertility for what it is – a disease – employers' fertility and family building benefits strategies should be aligned with other conditions such as diabetes and cardiovascular disease. In doing so, they will discover that offering these benefits makes sense from not only a clinical standpoint, but also as a sound business practice.
