What HR benefits managers need to know when 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, nearly 10 million couples may experience challenges having a baby. 

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

With the coronavirus pandemic having shifted individual priorities and boosted employee leverage, more companies are introducing fertility benefits as a core employment benefit to remain competitive and attract and retain employees.

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

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

We’re not just seeing this in industries like health care, where medical centers are struggling to compete for nursing talent. Pandemic burnout is forcing many employees across a variety of sectors to rethink their careers entirely. We are also seeing 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 workforces. 

For sake of contrast, in 2018, about 80% of people who underwent fertility treatments had little or no fertility coverage, and more than half resorted to credit cards or tapped their 401(k) to pay for it.

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

Not all fertility benefits are created equal — so it is important for HR benefits administrators to ask a few key questions if you’re thinking about adding this important offering for your employees. 

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

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

Is your benefit based on the latest clinical research?

• Fertility science is evolving quickly, and it is important that your plan can keep up to ensure that your employers are getting safe and proven evidence-based treatments – reducing costs to you and them, and increasing the odds of a successful cycle. 
• Choose a partner with clinical expertise in house — not just reproductive endocrinologists, but genetic lab specialists, lab clinicians, maternal fetal medicine specialists.
• Ensure the benefit policy aligns to 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 offer your employees access to fertility experts and a convenient network? 

• Helping new fertility patients get plugged into higher quality providers is critical for increasing their chance of success and getting them the care they need.  
• The two critical network issues that are important to ensure your benefit addresses is network quality and convenience of access.  For fertility patients, this includes access to high quality reproductive endocrinologists and labs who provide these specialized fertility treatments and services. Look for a partner who is incorporating guideline adherence, outcomes, and member experience data into their overall view of network performance.
• A high quality network is only valuable if effectively used by members. To meet those needs, providers in-network must be as convenient as possible and members need access to assistance with scheduling appointments, locating providers, and help with resolving access/convenience issues.
• Make sure your benefit is inclusive of general lab and genetic lab coverage for members.  Going to a network reproductive endocrinologist (REI) only to find out that the labs utilized 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 medications are considered specialty medications and often aren’t stocked at a retail pharmacy due to the complexity and precision involved in each individual case. Leveraging easily-accessible pharmacy providers who specialize in fertility will provide members the best possible results.

Is your benefit going to help support your employee’s mental health too?

• Fertility treatments can be physically and emotionally grueling. Having access to support resources can help minimize many of the stressors associated with treatment and allow them to get the most value from their benefit, including peace of mind.

As more companies add fertility benefits, considering these questions up front 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 fertility treatment coverage - and will help you maintain your company’s competitive advantage.