November used to be the beginning of holiday shopping in earnest, but now it’s the time for shopping for better health coverage. Welcome to Open Enrollment, coming to your place of employment sooner than you think.
Every year around November, employers who offer health insurance benefits give their employees a chance to trade up for better coverage or change health care plans to what suits their lifestyle best.
One of the biggest (and newest) offerings on the health care insurance front? Fertility benefits. And whether you’re thinking of starting a family soon, adding to your family, or kicking that can down the road, fertility coverage is something you should look for in a potential employer’s perks.
Fertility Coverage Now Has Dedicated Dedicated Providers
All health care is expensive, but navigating the maze of fertility treatments is especially costly. Many companies, particularly larger ones and Silicon Valley entities (even companies like Starbucks are offering fertility benefits part-time baristas), are trying to attract and keep loyal employees, and fertility benefits fit that bill.
And, there are now speciality providers that offer solely fertility benefits, and work closely with companies to keep those perks competitive.
WINFertility, a large family-building benefits management company, is one of those specialists.
“Employees will have the most to gain this open enrollment season when it comes to family-building because more employers are offering fertility, and other family-building benefits, than ever before,” WINFertility Chief Commercial Officer Peter Nieves tells Parentology.
He continues, “This is tied to a great increase in consumer demand for assisted reproductive services. Millennials are delaying family building to focus on education and careers, and this often means by the time they are ready to start building their family, they may have passed their prime fertility years.”
In fact, even if your company doesn’t offer a fertility benefit at present, making management aware of its importance for recruiting and retainment is a smart move.
Karin Ajmani, Chief of Strategic Development at fertility provider Progyny, urges employees to push for better coverage, albeit in a nice way.
“It’s important for the employee to express to their HR or benefits team how important family building is to them and the need for a fertility benefit,” Ajmani tells Parentology. “ Let them know infertility is a disease and should be treated as one, the high cost associated with fertility treatment, and how grateful you would be if they provided a comprehensive and inclusive family building benefit.”
What Are the Official Laws Regarding Fertility Coverage?
While many medical categories and treatments are mandated through law, like the Affordable Care Act (ACA), fertility coverage is spottier on the national level.
According to the National Conference of State Legislatures (NCSL), since the 1980s, only 16 states have passed laws demanding insurers either cover or offer coverage for infertility treatment.
“…Of those states, 14 have laws that require insurance companies to cover infertility treatment and two states—California and Texas—have laws that require insurance companies to offer coverage for infertility treatment,” the NCSL states.
The ACA doesn’t cover fertility treatments, so, if you’re not in one of those paltry 16 states, you need to find a company that offers it because it wants to, not because it’s forced to. That’s where companies like WINFertility and Progyny come in, helping to assemble company fertility policy.
What Encompasses Fertility Benefits?
Fertility treatments can be summed up in one word: expensive. And while there’s a range of options to choose from, ranging from stashing sperm or eggs in the deep freeze for a later conception date to adoption, the most common fertility treatment is in vitro fertilization, or IVF.
IVF is time-consuming and labor-intensive, particularly for women. Months of injected hormones are required to harvest eggs, sperm must be collected, embryos created, and finally, placed in utero. Then it’s a watch and wait situation to see if an embryo implants and stays put. This entire rigamarole is called a “cycle” of IVF; about half of all families who undergo the treatment need at least two cycles.
The cost for these IVF cycles is pricey, and out of reach for most families without coverage.
“Employer-sponsored fertility benefits can be life-changing for individuals that need treatment, especially those that do not live in a state that mandates fertility coverage. Without a benefit, IVF treatment can cost almost $30,000 depending on the city of treatment, medications used and genetic testing required,” Nieves explains. “Given that the average salary in the US is $51,000, an employer-sponsored benefit can truly make a difference for someone not able to otherwise afford treatment. In addition, employers that offer a fertility benefit can work with a fertility benefit management company to help employees make the most efficient use of their benefit dollars.”
Other treatments, like the aforementioned sperm and egg freezing, are less expensive and give employees more peace of mind; they can work hard, child-free, for longer before beginning a family. It’s a great way to recruit ambitious Millennials who want a family, but need to build their own careers first.
The Advantage of a Family Building Benefits Management Company
Companies like WINFertility and Progyny make sure companies offer the perfect subset of fertility benefits, customized to the employee base.
One of the best options offered by these companies is the one-on-one counseling offered, for explaining the treatments and benefits every step of the way. WINFertility, for instance, offers what’s called a WIN nurse to those undergoing IVF and other treatments.
“Today’s employees want a benefit that’s tailored to their life and specific situation. Employers that partner with family-building benefit solutions like WIN are giving their employees direct access to expert fertility nurse care managers that guide the employee through every step of their personal family-building journey,” Nieves says.
Accessing this help is key.
“Through their employer-sponsored benefit, employees are able to discuss medications and medical procedures with a clinical expert (with a minimum of 5 years of experience in a fertility clinic) 24 hours a day, 7 days a week. WIN nurses provide clinical oversight throughout the process. This oversight improves outcomes, and helps employees optimize their benefit dollars,” Nieves continues.
Progyny agrees: optimal coverage means personalized care and access.
“…optimal coverage eliminates dollar maximums, removes barriers to care and is inclusive to all prospective parents. Patients should be able to access the best treatment for them the first time, and have access to a large network of high-quality doctors,” Ajmani said.
And that includes the emotional component, too.
“Additionally, ultimate care has emotional support,” Ajmani adds. “Fertility treatments may be financially and physically difficult, but they also take an emotional toll. Having someone be there through the entire journey and access to digital support tools and education can make a huge difference. Progyny provides this service by matching our members with a dedicated Patient Care Advocate who operates as an expert on all things fertility.”
WINFertility Outlines What Fertility Support Should Look Like
The World Health Organization (WHO) categorizes infertility as a disease, although it’s a complex one with many different causes. The emotional distress due to infertility issues can be devastating, affecting every aspect of life, including work performance. Thus, companies see including fertility benefits as improving their bottom lines, and having an advocate is key.
“A fertility journey is one that can be quite emotional, filled with ups and downs,” Nieves says. “Patients can connect with a WIN nurse care manager to ask questions about specific treatment options that have been presented by their doctor, learn proper medication injection procedures, or even call to discuss their test results.”
Sometimes further emotional support is necessary.
“WIN also connects patients with a reproductive behavioral health specialist to offer emotional support and guidance to the patient and their partner if needed,” Nieves adds. “Instant access to this education and emotional support can make all the difference.”
Do Your Due Diligence When It Comes to Fertility Benefits
As the employee, you’re the customer. If you’re looking for good fertility benefits for your next job, or you’d like your current company to hop on board, know what’s desirable on the fertility front. Are you interested in IVF, adoption, or surrogacy? A good plan should cover them all.
“In order to make sure you’re fully informed, ask what exactly your benefits will cover,” Ajmani advises.”When interviewing for a potential job and inquiring about fertility benefits, ask about all treatment options, if there are any pre-authorizations, if there are dollar maximums or clinic restrictions, and how employees can learn more and utilize the tools available to them.”
Fertility Benefits Insurance: Sources
WINFertility
Progyny
National Conference of State Legislatures