Fertility benefits broadening to cover more procedures
Fertility benefits are offered with many major medical plans, but advisers may want to investigate further into the products available, as fertility benefits often do not cover all that employees think they do. This could leave employers and employees with a hefty bill in end.
A little more than half of fertility plans offer coverage for evaluation from a specialist when seeking fertility treatment, but that is where coverage begins to plunge. Only 24% of fertility plans cover in vitro fertilization and only 5% cover egg freezing, according to Mercer’s 2015 National Survey of Employer-Sponsored health plans.
Mark Slitt, public relations expert for Cigna, says fertility benefits are a new and evolving trend toward non-traditional benefits and should be approached as “quality of life” benefits instead of a “medical necessity.”
Also see: “Top employer-provided benefits of 2016.”
“As the workforce evolves, some employers are willing to offer a fertility benefit versus an infertility benefit that can help single people or same-sex couples have children,” Slitt says. “The premise is that employers are competing for that talent and are looking for ways to differentiate their employee benefits in order to hire and retain the best people.”
While most medical plans have a set maximum on what is covered for fertility plans, some vendors, like Progyny, are attempting change the way these benefits are offered as well as how much is covered from the specialist evaluation down to in vitro, in vivo and other special procedures for fertilization.
“Some employers might cover some benefit for fertility such as meds related to fertility services, but they are not covering the technology like IVF technology,” says Karin Ajmani, president of healthcare services at Progyny. “Our mission is to increase access to care, increase access to more comprehensive benefits, so that the outcome is that somebody can achieve pregnancy faster using the best and right technology the first time and have a single healthy child.”
Ajmani adds that Progyny has been able to identify several patterns of ROI, should fertility coverage expand to the technology and other departments of fertilization. “When you do devote a bit more toward that fertility benefit up front, because if the benefit is more comprehensive you are now avoiding all of the downstream expenses such as high-risk maternity and preterm birth related to that high multiples rate,” she says.
Increasing the coverage of certain parts of fertility treatment like egg freezing is something that Ajmani says is needed for today’s modern couple, who may not want to start a family until later in life. While 5% of large employers cover egg freezing, 11% of employers with 10,000 or more employees offer this benefit, and geographically 83% of large employers cover some type of infertility in Northeast America, while 47% offer coverage in the West, according to Mercer’s survey.
Also see: “Mercer alliance brings fertility benefits to market.”
“Now that we have one in five women having their first child after the age of 35, you are going to have more people suffering from infertility,” Ajmani says. “You can transfer a fertilized egg up until the age of 45 and have a successful child because it is not the uterine age but the egg age that is the defining factor for success.”
Intel Corp. quadrupled its fertility benefit coverage to $40,000 in October of 2015, but tech companies are not the only ones signing on for increasing coverage. “The clients that are enrolling in our program or rolling out the program in 2017 are really across the spectrum,” Ajmani says. “In fact, there’s not many of our prospects for 2017 that are tech, but instead retail, telecommunications, media and school districts.”