Four Considerations for Designing a Fertility Benefit

The right fertility benefit provides the right treatment to meet each individual member’s needs while delivering value to the plan.
Four Considerations for Designing a Fertility Benefit

Family planning can be unexpectedly complex, especially for millennials and younger generations who are delaying childbirth due to many factors including prioritizing career and education goals. In fact, after years of decline the birth rate among women aged 25-44 increased just 1% in 2021.

Starting a family can be unexpectedly complex for employees, especially for the 48 percent of millennials who are delaying childbirth due to career and education (among other changing dynamics). Many would-be parents are caught off guard by the cost and the complexity of fertility care, and the range of benefit coverage, when they discover they need assistance to achieve or maintain a pregnancy.

Some plans elect to cover basic fertility testing, while some have comprehensive coverage for their employees. And still, some plans have no fertility coverage at all. Over time, states have begun to mandate varying levels of employer coverage; however, nearly 40% of employers with 500 or more employees still don’t offer any coverage.

Companies are facing pressures from various sources, including state mandates, their own employees, and the market to start offering more comprehensive fertility benefits. In fact, our research shows that by 2025 as much as 62 percent of plans and 61 percent of employer groups plan to increase their fertility offering.

Regardless of coverage level, advances in reproductive medicine result in patients increasingly turning to assisted reproductive technologies (ART) to help start their families. There are many treatment options ranging from hormonal support to intrauterine insemination (IUI), in vitro fertilization (IVF) and egg freezing. There are also approximately 500 available fertility clinics in the US– all of which offer various services at different price points and with varying success rates.

While offering the right fertility program can be complex, having a fertility benefit allows plans to control some of the variability, minimize some of the complexity for patients and control long term costs associated with fertility and infant/maternity care.

Here are four areas that are important to consider when adding to or enhancing a plan’s fertility benefits.

1. A geographically convenient and balanced network of fertility providers and labs with quality measures in place

A diagnosis of infertility comes with a lot of information to process, including where to seek treatment. A balanced network takes the guesswork out of where members receive the best care. Not all fertility service providers are the same, and not all achieve the same success rates, which is why a plan-provided benefit can go a long way in alleviating the stress of finding the right care.

2. Incorporation of a fertility-focused specialty pharmacy that can support the unique needs of fertility patients

Where and how patients get their fertility medications matters – especially when patients need as many as 15 prescriptions in a single cycle1. 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 pharmacy providers who specialize in fertility will provide members the best possible results, and allow them to get the most value from their benefit, including peace of mind.

3. Flexible fertility benefit options to meet diverse member needs

In today’s diverse workforce, plans are looking for more inclusive benefit options. As plan sponsors expand coverage for fertility and family building benefits, working with a trusted partner that offers flexible, customizable options is desired. Flexible options go beyond basic fertility testing and treatment, and include IUI, IVF and egg freezing, as well as benefits for couples struggling with male infertility, individuals, same sex couples and other non-traditional families.

4. A patient engagement model with high-touch support and integration with digital tools 

Going through fertility treatments is a challenging process, and support resources can help minimize many of the stressors associated with treatment. Helping patients understand fertility coverage, access medications and providers in a convenient way is essential for delivering the best patient care and driving optimal treatment decisions that support the member’s goal of starting a family.

Here are a few additional questions plan sponsors should ask when considering fertility benefits:

  • Can I offer services to meet all of my members’ needs?
  • Are the benefits configurable for my specific member population?
  • How do I estimate the financial impact to my company?
  • How does the provider engage with my members?

For some, the decision to start a family is one of the most important and impactful decisions that they will make in their lives. And encountering challenges when starting a family can have substantial ramifications on a member’s mental, physical and financial health. Plan sponsors have the unique opportunity to support their members during a time of personal crisis by putting the tools and benefits in place to be by their side every step of the way.

Originally published on 5/12/20 and updated on 3/13/23.

See how our solutions can help
FamilyPath has expanded benefit offerings across family-planning, fertility, pregnancy and postpartum care for employers and health plans. Evernorth is committed to addressing disparities in this category of health benefits and has designed an end-to-end, inclusive benefit in family-planning care for members across both in-house capabilities and new partnership solutions.

1 Freedom Fertility Pharmacy data, Feb. 2023