The Benefits of Infertility Coverage for You and Your Employer

By: Huffington Post, Dr. David Adamson

How family friendly is your workplace? It depends on your perspective. If you and your partner are among the 1 in 8 American couples facing infertility, you’d give your employer a high score if they offered a benefit package that covers treatment for infertility services. After all, it’s the employer that decides your benefits, not an insurance company.

According to the International Foundation of Employee Benefit Plans (IFEBP), 24% of employers surveyed now offer some level of fertility services as part of their health care benefits. If you work for a large American company – with more than 500 employees – you’re more likely to have some type of infertility benefit than if you’re employed by a small or mid-size company.

The Centers for Disease Control and Prevention (CDC) reports that 17% of women aged 25-44, and 9.4% of men the same age, sought treatment for their infertility. Infertility is defined as a medical disease and has evidence-based treatments including ovarian stimulation, other medications, surgery, artificial insemination (IUI) and Advanced Reproductive Technology (ART) such as in-vitro fertilization (IVF).

Fewer than 5% of infertility patients undergo IVF although probably 20% or more could benefit from treatment. The number of IVF cycles in the US is growing at a rate of 6% annually, driven by women waiting longer to start families, increased acceptance of ART, obesity, use of donor eggs and same sex marriage.

Whatever infertility treatment you may need, there are clear benefits when employers cover needed care. These include higher employee satisfaction and morale and the ability to attract and retain the best talent. Tech companies like Apple and Facebook have been among the first to recognize the competitive advantage of offering broader coverage.

Companies also earn positive PR when they show support for families and family building. The benefits of offering coverage are reflected in the diversity of large employers that offer some type of coverage – from Ace Hardware and Starbucks to Ford and Gap.

Employers offer a range of explanations for why they cover infertility treatment, beyond competition for hires, including that employees “asked for the benefit” and “it’s the right thing to do.” Still, many companies – especially small and mid-size – are either reluctant to offer a benefit or provide very limited coverage because they may not understand the potential cost savings of offering coverage compared to not offering coverage. Many are also unaware of new and innovative ways to structure this benefit to drive quality and help control costs.

Years of experience demonstrate that offering an infertility benefit is cost effective. Southwest Airlines and Massachusetts – with the broadest state mandate – found the benefit adds less than 1% of total premium dollars spent.

Studies also show that including infertility services as part of a healthcare benefit package may result in long-term savings and better outcomes compared with the short-term savings of no coverage. If couples are paying for their own infertility treatment, they may not always make the best choices and may take inappropriate risks with treatment. This can result in less than optimal outcomes so the cost may ultimately be higher.

Employees who have access to infertility benefits can actually have overall lower health care costs because they are making decisions with their doctors based on medical practice, not on personal financial concerns” states Julie Stich, CEBS, director of research at IFEBP. For example, couples paying on their own may skip recommended genetic screening that could reveal genetic issues that cause repeated miscarriage, or forego other important tests.

Couples paying for IVF may also opt to have multiple embryos transferred to try and improve their chances of pregnancy. This poses a greater risk of multiple births with serious health complications to babies and mothers including low birth weight, disability and increased C-section rates. These affect quality of life and carry potentially very high medical costs for employers – especially time spent in the neonatal ICU (NICU). Employers also face higher costs associated with employee absenteeism, lost productivity plus short and long-term disability related to multiple births.

So, what should a good infertility benefit look like? Dr. Mark Perloe, medical director at Georgia Reproductive Specialists, says an effective infertility benefit must include coverage for IVF, genetic screening and embryo evaluation, and must mandate that only a single embryo can be implanted for a “safer, healthier pregnancy outcome, which is obviously the best thing for the employer.”

As large employers think about designing a fertility benefit to achieve the best results in quality and cost, they are looking at steering employees to high-quality infertility clinics that favor implanting only one embryo in hopes of producing a single baby, according to Brenna Haviland Shebel from the National Business Group on Health (NBGH) who has been researching the issue.

RESOLVE reminds us that infertility is a treatable disease and that treatment and coverage should not be viewed as “elective.” While there’s progress among large companies to cover care, there is room for everyone to do much better – especially given supporting data about cost and outcomes.

To learn more about employer coverage options, visit ARC Fertility for information on the employer program. RESOLVE also offers resources including how to ask your employer for coverage.

No matter the size of your company, if you want your employer to offer infertility coverage or improve their benefit, don’t give up! Offering coverage is “trending” and it’s the right thing to do – not just for tech companies!