Two fertility experts detail the pros and cons of a fertility benefit plan.
In an effort to attract and retain top talent, employers are offering a variety of family-friendly benefits including fertility services, according to a new survey.
According to the Employee Benefits Survey 2016, conducted by the International Foundation of Employee Benefit Plans, a quarter of employers (24%) with 500 or more employees offer fertility services as part of their healthcare benefits. Nineteen percent cover in vitro fertilization (IVF) treatments, 12% cover fertility medications and 9% cover non-IVF fertility treatments. Smaller numbers cover visits with counselors (geneticists, surrogacy, etc.), at 6%, or egg harvesting/freezing services, at 4%.
Fertility experts Karin Ajmani, president of healthcare services at Progyny, and Brian A. Levine, practice director, Colorado Center for Reproductive Medicine (CCRM), New York location, talk to Managed Healthcare Executive (MHE) about the details of fertility plans, including cost, implementation pros and cons, and coverage variability.
Q: MHE: What is a fertility benefits plan?
Ajmani: About 25% of employers offer some coverage for infertility treatments and that percentage is growing annually due to the recognition that infertility is a medical condition like any other (in 2015, the World Health Organization officially designated infertility as a disease). Typical infertility benefits are not comprehensive and only cover fertility medications or a very limited amount of infertility treatments. Most infertility benefits currently offer a defined dollar maximum, and do not cover all of the costs associated with the consultation, diagnostic testing, and latest infertility treatment technologies which drive success rates. Therefore, patients suffer longer, with higher rates of infertility treatment failures, higher miscarriage rates, and much higher out of pocket costs (the typical retail rate for one full IVF cycle including diagnostic testing and labs is as high as $20k per cycle). Since the average fertility benefit only covers $10k, and it takes about 3 IVF cycles to obtain a successful live birth, patients are forced to make difficult decisions about what treatments to pursue based on cost, not best practice.
Levine: A fertility benefit plan is additional coverage for fertility and infertility benefits to an existing insurance policy. There are about 15 states where fertility and infertility benefits are ‘mandated’ by the state legislature. With that said, the breadth and depth of coverage can vary quite a bit.
Q: MHE: What is happening in the healthcare landscape that would make this attractive?
Ajmani: Employers are getting hit hard with medical costs related to high-risk pregnancies and NICU expenses as a result of employees seeking infertility treatments. And this trend is only going to increase, as the average age of women having children increases. Currently, one in five couples now have their first child at 35 years of age or older, let alone their second or third child. People struggling to get pregnant don’t stop if they don’t have a fertility benefit; they simply pay out of pocket and begin with less-expensive, less-effective technologies, such as fertility medications or intrauterine insemination (IUI), lending to the high rate of twins. It is widely known that pregnancies involving twins result in much higher prenatal, maternity and neonatal intensive care unit (NICU) expenses. Any employer looking to support their employees during the stressful and expensive journey of infertility will be interested in this benefit. Employees who struggle with infertility face higher rates of depression and absenteeism in the workplace, as well as turnover. The employees who need to utilize their fertility benefit is small, less than 1% per year, but they’re disproportionately more vocal and proactive in their quest to obtain coverage through their employers. In the end, HR and benefits executives recognize that providing coverage is the right thing to do from both a cultural and cost perspective. By enrolling in this type of benefit, human resource directors are able to retain and attract employees, especially millennials. Sixty-eight (68%) percent of millennials take coverage for fertility preservation, such as egg freezing, and infertility coverage into consideration when choosing an employer.
Q: MHE: Why would this be of interest to managed care execs?
Ajmani: Managed care executives are always interested in improving the effectiveness of care, while decreasing costs. Additionally, NICU expenses have historically been difficult to manage, and a benefit like Progyny’s can actually decrease the incidence of NICU expenses related to infertility treatments.
Q: MHE: What are the pros and cons of adding a fertility benefit?
Levine: For those who are thinking about adding fertility benefits to their existing employee benefit packages, it is important to recognize that both the cost of the plans and the scope of the plans can vary widely. Many employees might be excited at first to learn that they have fertility coverage only to later find out that they are only covered for certain treatments at certain clinics. To further complicate the matter, certain insurance companies can dictate where patients can fill their fertility prescriptions since the medications typically come from a specialty pharmacy. It's important when selecting a plan to select a plan that is broad and that also allows for fertility preservation, which includes egg freezing, something that many young female employees might be interested in doing.
Q: MHE: Please talk about the ROI and cultural impact and explain why having this benefit can lower health costs for the employer and employee?
Ajmani: The most significant ROI is related to medical cost avoidance. If someone doesn't have coverage, or has very limited fertility coverage, an employee will still seek treatment and pay out of pocket. This leads people to choose less-expensive, less-effective, treatment options, such as fertility medications and artificial insemination, which have the highest chance of producing twins or multiples (the current rate of multiples through use of fertility treatments is about 27%, as compared to a natural multiples rate of about 1.5%). And if that doesn't work IVF is often utilized, and multiple embryos are transferred per cycle to increase the chance of pregnancy, because option B is a second round of IVF at an average retail rate of $20,000!
The minute a woman gets pregnant with multiples, her employer or plan is now responsible for the costs related to her high-risk maternity care, as well as likely C-section, pre-term birth and NICU expenses. These downstream expenses far outweigh having a comprehensive fertility benefits plan. But just providing a fixed dollar amount of coverage doesn't solve the problem; Progyny has been able to decrease the rate of multiples for people needing fertility treatment to only 4% by providing patient care advocates to help our members through the opaque maze of fertility options, and by including coverage for the latest technologies.
Q: MHE: What are your top recommendations for executives thinking about a fertility benefit plan?
Levine: 1.) Make sure that the benefit package is accepted by the providers in the area; 2.) Make sure that the benefit package does not require the patient to maximize all out of network benefits before using their fertility benefits; 3) Select a plan that is flexible to patients who may want to preserve their fertility as opposed to solely seeking fertility treatment; and 4) Pick a plan that is open to single parents who desire to reproduce with donor eggs/sperm.