Why not offering a family building benefits package often leads to higher costs and poorer outcomes

A comprehensive, family-building benefits package that includes a managed fertility benefit can reduce organizations’ healthcare costs and improve outcomes. Plan designs with restrictions that limit coverage to infertility diagnoses may not only exclude LGBTQ+ and single participants from using the benefit; they can also lead to the use of less effective treatments.

With an unmanaged benefit, cost-based treatment decisions can lead to poor outcomes. Individuals may opt for lower cost, less effective treatment with a higher chance of producing multiple, high-risk births. Multiple birth pregnancies put both the parent and babies at risk, often resulting in costly high-risk pre-natal care, increased C-section rates, neonatal intensive care unit (NICU) admissions and premature birth with long-term health consequences. The March of Dimes reports more than half of twins and nearly all triplets and other higher-order multiples are born prematurely. Average medical costs for pre-term infants (less than 37 weeks) exceeded $76,000 and average spending for low-birthweight status was more than $114,000, according to a 2020 study in Nature.  

A clinically managed fertility benefit can eliminate inappropriate use of costly procedures and support the use of effective and efficient treatments. A managed program connects individuals with clinical experts who can recommend personalized and appropriate care and treatment options. Clinical oversight leads to safer pregnancies, fewer C-sections, pre-term births and NICU costs. With clinically managed guidance, IFEBP reports employees with access to infertility benefits can have lower healthcare costs, basing their decisions on medical evidence rather than financial concerns.

Designing an inclusive benefits program

An inclusive benefits approach with successful outcomes depends on good program design. To address the needs of an evolving workforce, family-building benefits should include a managed fertility benefit with clinical advocacy, fertility preservation, gestational surrogacy and adoption. To meet diverse individual needs, some organizations are waiving the definition of infertility and considering offering a single lifetime benefit maximum that covers a variety of services. You should review any plan design changes or amendments to ensure they meet the organization’s needs and comply with rules and requirements.

A digital health solution can further enhance benefits by offering members access to video consultations, fertility-tracking wearables and other technology-enabled care. Emotional support and behavioral counseling can also help intended parents with complex choices and managing stress.

Prevalence of employer coverage

The International Foundation for Employee Benefit Plans (IFEBP) reports some 75 percent of organizations offer coverage for fertility medications and 74 percent cover IVF treatments, but the type and amount of coverage varies widely. Less than one-third (31 percent) offer egg harvesting or freezing services, IFEBP reports. The Foundation’s 2020 benefits study also found 16 percent of organizations offer financial assistance for adoption.

Because workers now expect more robust support from their employers when it comes to family-building benefits, organizations need to adjust their offerings to make sure these benefits attract and retain talent as intended.

Source: IFEBP, Employee Benefits Survey, 2020

Because workers now expect more robust support from their employers when it comes to family-building benefits, organizations need to adjust their offerings to make sure these benefits attract and retain talent as intended.

Attitudes and social trends around family-building are changing

Even before the pandemic, benefits to support family-building began shifting beyond traditional coverage of infertility treatment. In vitro fertilization, fertility preservation and egg freezing, gestational surrogacy, and adoption are now part of a broader, more inclusive conversation around fertility.

Growing social equity concerns are propelling many employers to re-evaluate their benefits strategy to meet the needs of a diverse and changing workforce. A comprehensive approach to family-building, regardless of gender identity or relationship status, can be critical to talent attraction and retention. 

The need for family building benefits

There are many reasons couples and individuals may need help building a family. These include male or female infertility, a desire for fertility preservation due to medical issues or delayed childbirth, or assistance for same-sex couples or single individuals who want a child. Individuals or couples may need a sperm or egg donor, gestational carrier/surrogate or adoption support.

Even before the pandemic, benefits to support family building began shifting beyond traditional coverage of infertility treatment. In vitro fertilization, fertility preservation and egg freezing, gestational surrogacy and adoption are now part of a broader, more inclusive conversation around fertility.

Nationally, an estimated 10 percent to 15 percent of couples seek medical care to address infertility after one year of unprotected intercourse. A 2018 Pew Research Center study found one-third (33 percent) of US adults report they or someone they know has used some type of fertility treatment to have a baby. Family Equality’s 2019 survey on family building found nearly two-thirds (63 percent) of LGBTQ+ millennials — aged 18-35 — are considering expanding their families by becoming first-time parents or having more children. Most survey respondents said they were looking to foster care, adoption and assisted reproductive technology to grow their families.

While the desire for a family is strong, fertility treatments are expensive. Costs range widely depending on the type of treatment or service. National average costs reported by the Advanced Fertility Center of Chicago range from $50 for semen analysis to $28,000 for an in vitro fertilization (IVF) cycle with donor eggs. According to FertilityIQ, a fertility education and assessment site, the average patient undergoes two to three IVF cycles spending nearly $50,000 in treatment. For couples or individuals pursuing gestational surrogacy, the costs can exceed $150,000. For those pursuing adoption, costs typically range from $20,000 to $45,000 for a private agency adoption, according to the Child Welfare Information Agency.

Source: Advanced Fertility Center of Chicago, Fertility Treatment Cost Averages

Health plan coverage for fertility treatments is often limited and can vary considerably. Nineteen states have passed infertility coverage laws. Thirteen of these states include coverage for IVF, and 10 states cover services related to medically-induced infertility. While self-insured plans are generally exempt from state mandates, they often offer some coverage for fertility services, typically with limits on the number of treatment cycles they will cover.

Even when fertility coverage is available, inequities may exist. Black and Hispanic women report barriers within the healthcare system preventing them from receiving counseling related to fertility treatment. Same-sex couples and LGBTQ+ individuals face unique challenges on their journey to parenthood. Plans may limit coverage to “medical necessary” testing and treatment of infertility, and women without a male partner may find it more difficult to satisfy carrier definitions of “infertility” than heterosexual couples would.

Making family-building benefits part of a larger family-friendly benefits strategy

As employers recognize the importance of enhancing their programs to foster a more diverse and inclusive culture, the number of organizations offering family-building benefits continues to grow. FertilityIQ’s annual workplace index finds the number of organizations enhancing their programs, including fertility, adoption and foster care, grew 8 percent in 2021. The index evaluates employer policies based on the broadness of their benefit design, accessibility, flexibility and the provision of non-financially-conflicted information. While technology, financial services, and consulting firms continue to lead the way in offering comprehensive coverage, other industries such as retail, consumer packaged goods, industrial production and healthcare services are expanding their benefits.

Family-building benefits, along with flexibility, maternal health programs, generous parental and caregiving leave and childcare support yield rewards for both participants and organizations. While participants highly value the financial and emotional support offered to their families, organizations benefit from more loyal, less distracted workers and better managed, cost-efficient care. A 2016 study from FertilityIQ found more than half (53 percent) of IVF patients whose treatment was covered by their employer were more likely to stay longer in their jobs.

Family-building benefits demonstrate an organization’s commitment to supporting families and achieving greater equity in access to benefits.