Once upon a time, catered lunches, unlimited vacation, or swank on-site fitness centers were the most alluring carrots employers could dangle in order to attract top talent. Today another employer benefit has joined the ranks of the most-coveted work perks: generous fertility coverage.
The use of assisted reproductive technology (or ART, a blanket term that covers in vitro fertilization, the use of donor eggs to conceive, and gestational surrogacy) doubled between 2007 and 2017, according to the Centers for Disease Control and Prevention. Approximately 11.9% of women have received any infertility services—which includes non-ART treatments, such as intrauterine insemination (IUI) and drug therapy—in their lifetimes. Not to mention, 63% of LGBTQ people planning families expect to use ART, foster care, or adoption to become parents. Considering that fertility interventions often total tens of thousands of dollars, it’s not difficult to see the appeal of an employer who’s willing to help foot the bill.
Every person, couple, and family has different needs when it comes to fertility treatments—they’re never one-size-fits-all. And what your employer may cover can vary just as widely as the procedures themselves, only adding to the stress of family-building.
Let’s demystify these benefits so that you can take full advantage of yours—or advocate for yourself in the event that they’re lacking. Here are seven questions you might be asking yourself:
- How Common Are Fertility Benefits?
- What Types of Fertility Benefits Might Be Available to Me?
- Are There Laws Mandating Fertility Coverage?
- What Are the Limitations of Fertility Benefits?
- How Can I Advocate for (Better) Fertility Benefits?
- What Are My Options if I Don’t Have Any or Enough Fertility Benefits?
- What Questions Should I Ask About Fertility Benefits?
1. How Common Are Fertility Benefits?
Fertility benefits have a way to go before they’re as standard as a 401(k), but they’re on the rise. “There’s a greater awareness and more acknowledgement and interest in providing more inclusive benefits,” says Julie Stich, associate vice president of content at the International Foundation of Employee Benefit Plans (IFEBP). Employers are seeing that fertility treatments are a relatively low-cost benefit that employees value.
According to a 2018 survey by IFEBP, 31% of employers with 500 or more employees offer some kind of fertility benefit, up from 24% in 2016. In vitro fertilization (IVF) is the most common treatment covered, followed by fertility medications, genetic testing, non-IVF fertility treatments, counselor visits, and egg harvesting or freezing. Smaller employers are less likely to cover fertility treatments than big corporations—IFEBP found that only 10% of employers with 50 or fewer employers offered fertility benefits—but this still reflects an uptick from 4% in 2016.
“As time goes on and companies across spaces fight to attract and retain talent, more and more employers are adding or expanding their family building coverage,” says Selena Yang, Director of Communications at Progyny, a fertility benefits provider.
2. What Types of Fertility Benefits Might Be Available to Me?
The umbrella of fertility benefits may encompass anything from infertility diagnosis and medication scaling up to intrauterine insemination (IUI) and IVF. More expansive plans might include egg freezing, donor eggs or embryos, and/or gestational surrogacy.
“A traditional coverage plan will typically cover diagnostic testing and maybe a round of IUI or part of a round of IVF,” Yang says, “but this is really dependent on the employer’s coverage plan.”
In a growing number of cases, employers are also turning to third-party insurance providers—including not only Progyny but also Maven, Carrot, and others—that focus on providing supplemental policies to fill in gaps in traditional health plans.
3. Are There Laws Mandating Fertility Coverage?
Sixteen states have infertility insurance coverage laws in place. However, they range widely in what exactly they stipulate.
For example, Massachusetts, which has one of the most generous laws, mandates that insurance companies cover infertility diagnosis and treatment. On the flip side, Hawaii only requires insurance plans to cover one cycle of IVF and you have to be trying to conceive for five years prior. Other state laws focus on the type of plan (case in point: Arkansas exempts HMOs from their mandate).
“It’s all over the place,” says Barbara Collura, CEO of RESOLVE. “Having said that, we know that because of state laws, a lot of people have been able to build families.” Collura estimates that over the past 30 years around 95,000 babies were born in Massachusetts thanks to its infertility insurance laws.
4. What Are the Limitations of Fertility Benefits?
With state policies so few and far between, you may feel as though you’ve struck gold if you see the word “fertility” in your employer’s summary of coverage. But be sure to read the fine print before rejoicing. Chances are that you won’t have no-holds-barred access to treatments.
Victoria Niño—a senior sales leader who blogs about infertility and founded an infertility support group—recalls her dismay when she learned that the fertility benefit in her own insurance plan only covered her diagnosis. “I guess [my policy] probably said ‘diagnosis’ in there somewhere, but I just saw ‘infertility coverage,’ and I got stoked,” she says. But then the doctor’s billing office told her she wasn’t covered for anything beyond the infertility diagnosis she’d already received.
Even if your insurance covers more than just your diagnosis, there are other limitations to be aware of. In many plans certain procedures, like IVF, won’t be authorized until less invasive treatments, such as fertility medications or IUIs, are implemented first, Yang explains. And most coverage maxes out at a certain dollar amount. “One of the biggest problems with this type of coverage is most patients will exhaust their dollar maximums—and waste time—on treatment that isn’t as effective,” Yang says. “By the time IVF is even in play, they most likely would’ve maxed out on their coverage and be forced to pay for the IVF cycle out of pocket.”
Same-sex couples and single parents by choice may be hit especially hard by some of these limitations. “Technically, if a company is going to offer fertility benefits, they will be offered to all employees regardless of sexual orientation or gender identity,” says Amanda Hopping-Winn, chief program officer at the Family Equality Council. “It gets tricky, though, because, in the majority of cases, in order to qualify for these benefits, you must have a diagnosis of infertility,” she adds. “The majority of LGBTQ people seeking to access these benefits are not actually infertile,” they just aren’t in a situation where they can achieve pregnancy via sex. This might mean they must fork over money for 12 IUIs in order to “prove” infertility before a benefit kicks in.
And then there are additional hurdles for these communities—like the fact that insurance doesn’t typically cover purchasing sperm. “For those whose bodies do not produce sperm, purchasing the vials for an unknown donor adds up quickly with an average price tag of $1,000 per 0.5 cc vial,” Hopping-Winn says. Plus, only a handful of policies cover surrogacy, and fertility preservation for the trans community (such as egg or sperm freezing) is an expensive procedure that’s not often covered, leaving them with minimal options for a biological child.
But the outlook for equal benefits isn’t totally gloomy. Stich says she has seen signs that companies are beginning to eliminate these barriers to coverage with better insurance plans and other solutions. “In our survey work, we are seeing a greater trend toward more inclusive benefits across the board,” she says. “With this tight labor market, employers are looking for ways to distinguish themselves to attract top talent,” she adds. “Many employers are at least having the discussion about being inclusive with their benefits, recognizing that how an individual defines ‘family’ is personal.”
5. How Can I Advocate for (Better) Fertility Benefits?
At first glance, the lack of widespread coverage and laundry list of limitations may be disheartening, but all hope is not lost. RESOLVE has found that personal advocacy has been an effective way to convince your company to cover fertility treatments. “When I talk to legislators, they want the personal story, and when I talk to HR folks, they say they same thing,” Collura says. “Don’t discount the power of your voice as an employee, and as somebody who decision-makers want to please.”
Collura recalls an instance where thanks to one woman who advocated for fertility coverage, the entire University of Michigan educational system adopted fertility benefits. She says this same women went on to work at a Fortune 500 chemical company where she was able to successfully advocate for benefits again. “I’m not kidding. It just takes one person,” Collura says.
Risa Kerslake, a freelance writer and infertility blogger, was also able to secure fertility benefits after her husband appealed to his company’s HR department. He shared with them some particular struggles that they were going through, using a specific example of a claim related to their embryo transfer that was denied. “I couldn’t believe when he told me that they were going to offer some fertility coverage. I mean, that’s huge,” Kerslake says. Though their embryo transfer and other aspects of treatment still weren’t covered—which meant they were on the hook for several thousands of dollars paid out of pocket—they were able to get help for fertility medications and things related to diagnosis, like testing, ultrasounds, and clinic visits.
“What we could take advantage of really helped us so much,” she says, and “at the very least, it got the conversation started.” For help getting the conversation started at your own organization, check out Resolve’s sample insurance coverage request letter.
Collura also points to the third-party insurance providers stepping in to help companies supplement their existing insurance policies with fertility benefits. If you have insufficient coverage, you could suggest these options to your employer or reach out to a third-party provider directly (many have contact forms for employees) for help starting a conversation about this option at your workplace.
Hopping-Winn says that she’s seen similar success within the LGBTQ community. “Since insurance companies tend to be massive and bureaucratic with state-specific policies and protocols, we have found that the LGBTQ+ community tends to have better luck advocating for benefits directly with their employers,” she says. “Employers are beginning to realize that LGBTQ+-friendly benefits packages…will be a huge draw in recruiting and retaining a competitive workforce.”
6. What Are My Options if I Don’t Have Any or Enough Fertility Benefits?
Without coverage, fertility treatments can set you back tens of thousands of dollars. Niño says she and her husband easily spent six figures on treatments. To do so, they borrowed from their mortgage and 401(k) accounts and maxed out credit cards. A woman in her infertility support group quit a high-paying job to work as a barista at Starbucks because of their generous IVF coverage, which extends to part-time employees.
Aside from digging deep into your own pockets, you can speak with your medical practice about whether they offer any financing options. There are also organizations, such as the Baby Quest Foundation and the Hope for Fertility Foundation, that offer grants for fertility treatment. If you’re using a specialty pharmacy for medication, speak with them about discounts, Collura suggests.
7. What Questions Should I Ask About Fertility Benefits?
Whether you’re exploring new opportunities or just want to figure out what your current employer offers, you can ask questions to help you understand the extent of fertility benefits available to you.
Ask about which specific treatments or aspects of diagnosis your benefit will cover—such as IUI, IVF, egg freezing, surrogacy, adoption reimbursement, genetic testing, or medications. “When interviewing for a potential job and inquiring about fertility benefits, ask if all the above are covered, if there are any pre-authorizations, if there are dollar maximums or clinic restrictions, and how employees can learn more/take advantage of said benefit,” Yang says.
Of course, you may want to wait until you have an offer before peppering someone with questions about fertility benefits, since bias against parents and mothers in particular still exists. “Since prospective employers are not supposed to ask applicants about their family-building plans, it is probably not in the applicant’s best interest to raise this issue during an interview,” Collura says.
Once you’ve received an offer and are reviewing your overall benefits package—or if you’re exploring your options at your current company—you can ask your HR team questions about fertility benefits, such as:
- Is evaluation by a specialist covered?
- What fertility treatments are covered?
- Is genetic testing included?
- Are there limitations on the coverage?
- Are there requirements before moving onto IVF? You can get specific here:
- What are the requirements before moving onto IVF?
- Are there dollar caps or cycle caps?
- Are there age restrictions?
- Are there marital status restrictions?
- What are the annual or lifetime maximums?
- What is the length of time on the existing policy?
- Are co-pays, co-insurance, or deductibles consistent with those for other health benefits?
- Are medication costs included in any annual or lifetime maximums, or are they carved out separately?
Going through fertility treatments can be a physically, emotionally, and financially draining experience. “You’re not just grieving a loss or grieving your genetics, but you’re hurting your financial state,” Niño says. “I always wondered if we had coverage if I would have been as depressed or stressed. I don’t think so. I think I’d have more hope.”
But keep in mind that your words can be a powerful tool when it comes to securing benefits at work. “Raise your voice. It’s scary, but this is how change happens,” Collura says. “We need to raise our voices to change the status quo.”