Getting Insurance Coverage at Work
RESOLVE is committed to increasing the number of people with access to family building benefits through their employer. That is why we have created the “Coverage at Work” initiative to help empower employees and employers to make decisions that lead to better employer provided family building benefits for all.
So, let’s get started:
If your family building options are not covered through your employer’s healthcare plan or other employee benefits, why don’t you ask for that to change? At this moment, no one cares more about this issue than you, and RESOLVE has the information, tools, and support to help you via our Coverage at Work program. It all begins with making the initial ask. Let’s break down the next steps:
- Download and review the Coverage at Work Employee Toolkit.
- Set up a call with the Coverage at Work team to talk through any questions.
- Draft an email to your HR representative using the template and resources provided in the toolkit.
Understanding Insurance and How You Are Covered
A major impediment to access to treatment to resolve infertility is insurance coverage.
Health insurance guarantees that an individual will not have to bear the entire burden of his/her health care expenses. But in the case of infertility, the majority of patients bear the responsibility of covering the costs of treatment. No one expects to receive the diagnosis of infertility. Yet more than 7 million Americans are subject to that diagnosis.
Depending on the cause of the fertility problem and the therapy used to treat the problem, that cost can be considerable and no one expects that their insurance company will deny them coverage for this medical condition. But most do.
Insurance Coverage – The Basics
Your health insurance policy is an agreement between you and your insurance company. To get this coverage, you or your employer pay or share the cost of a fixed premium each year to an insurer (such as Blue Cross and Blue Shield), who then provides the coverage that pays for various medical expenses.
Your policy lists a package of medical benefits such as tests, drugs and treatment services. The insurance company agrees to cover the cost of certain benefits or expenses listed in your policy. These are called “covered services.” Your policy also lists the kinds of services that are not covered by your insurance company. You have to pay for any uncovered medical care that you receive.
Keep in mind that a medical necessity such as an infertility treatment is not the same as a medical benefit. A medical necessity is something that your doctor has decided is necessary. A medical benefit is something that your insurance plan has agreed to cover. In some cases, your doctor might decide that you need medical care that is not covered by your insurance policy.
Insurance companies determine what tests, drugs and services they will cover. These choices are based on their understanding of the kinds of medical care that most patients need. Your insurance company’s choices may mean that the test, drug or service you need isn’t covered by your policy.
Insurance policies vary widely and may even differ from employer to employer from the same insurer. It is important to thoroughly review and seek clarification about the provisions of a particular plan, paying specific attention to covered benefits, exclusions and restrictions as they relate to reproductive health services and infertility diagnosis and treatment.
In order to get accurate information, your health plan administrator should provide you with a copy of your plan’s Summary Plan Description (SPD). It outlines your benefits, covered services and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services are included and will require a co-payment, the rules for pre-existing conditions, and the circumstances under which your employer can change or terminate a health benefits plan.
Types of Health Insurance Plans
Most people are covered by group insurance policies, which are designed to keep the cost of premiums lower by spreading the expense risks among all the members in the group. Some people do not have access to a group plan and thus purchase individual insurance policies for themselves and their families. However, it is often difficult and very expensive to purchase individual insurance policies. Therefore, it is best to obtain coverage as part of a group if possible.
Insurance is either public or private.
Public insurance includes governmental programs such as: Medicare for the elderly and disabled, Medicaid for the poor, the Veterans Administration for those who have served in the armed forces and TriCare for current military personnel and their families.
Private insurance falls into one of the following categories:
- Commercial Insurance Companies such as Aetna, Cigna, United and others;
- Non-Profit Insurance Companies such as the numerous Blue Cross/Blue Shield plans across the country;
- Self-Insuring Groups such as employers who pay benefit claims directly rather than using an outside insurance carrier (which might be hired to serve as the benefits manager).
Insurers are applying managed care techniques to promote lower cost, high quality care whenever possible and typically offer plans with varied levels of controls ranging from tighter, in-network provider choices in Health Maintenance Organizations (HMOs) to hybrid approaches called Point of Service (POS) plans, to more costly and greater individual choice options known as Preferred Provider Organizations (PPOs).
The Laws and Mandates
The above distinctions become particularly important when determining whether or not a state insurance law applies to your insurance plan.
ERISA. For example, pursuant to the Federal Employee Retirement Income Security Act (ERISA), self-insuring businesses are not required to comply with state insurance mandates, although they may voluntarily provide these mandated benefits. Therefore, a state law requiring insurance companies to cover infertility cannot apply to companies that “self-insure,” that is, which do not purchase insurance policies but instead pay medical claims themselves. This is because ERISA prevents states from being able to regulate self-insured companies. However, if drafted correctly, a federal law requiring insurance for diagnosis and treatment of infertility could overcome ERISA and could require all, or at least more, employers to provide infertility insurance.
Unlike typical pregnancy-related services guaranteed nationally as basic health plan benefits under the National Pregnancy Discrimination Act, infertility treatment services are not similarly ensured. Coverage, particularly for assisted reproductive technologies, is extremely limited. In the United States, only one in five employers provide infertility treatment benefits to their employees and these policies vary widely in their comprehensiveness, reimbursement limits, and eligibility requirements.
Although no federal law requires insurance coverage for infertility treatment, 19 states have enacted some type of infertility insurance coverage law. Each law is different, but most can be generally described as either a mandate to cover or a mandate to offer. Follow this link for complete list of state laws.
Mandate to Cover: is a law requiring that health insurance companies provide coverage of infertility treatment as a benefit included in every policy (policy premium includes cost of infertility treatment coverage).
Mandate to Offer: is a law requiring that health insurance companies make available for purchase a policy which offers coverage of infertility treatment (but the law does not require employers to pay for the infertility treatment coverage).
What You Can Do
More and more women and men in their most active and productive years are being afflicted by the physical and emotional hardships of a treatable disease that continues to be inappropriately viewed as “elective.” If you are infertile and your employer does not currently provide infertility treatment coverage, make a formal request for them to do so. Get the support of others covered by the plan who are experiencing similar infertility problems. RESOLVE encourages you to become your own best advocate for expanded health benefits. The evidence justifying the cost-benefit of such coverage is considerable.
- Visit the RESOLVE Advocacy Network section of this website to sign up for Action Alerts, and learn more about state and federal legislation.
Ten states have health insurance mandates that require employers to provide coverage for IVF treatments. If you live in Arkansas, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New York or Rhode Island, and you need IVF, you might be eligible for coverage. Find out more by reading the details on each of these 10 states and their IVF mandates. Coverage varies widely so only read the state mandate where your employer is headquartered. If you don’t live in one of these states, you do not have a mandate that covers IVF treatments.
There are six other states that have a different kind of mandate and some of those states might cover diagnostic tests so read up on your mandate if you live in California, Louisiana, Montana, Ohio, Texas and West Virginia.
Here is a link to all of the 17 states and their detailed mandates.
If you do NOT live in one of the 10 states listed above or you are a federal employee, active or retired military, veteran, or on Medicare or Medicaid, keep going.
It’s super important that on your quest for seeking fertility insurance coverage you find out if your current health insurance plan is fully-insured or self-insured or you are part of a government/military coverage plan. What does all of this mean and why does it matter? Here’s the break it down:
Fully-Insured is where your employer is getting their coverage from an insurance company and the insurance company dictates what will and will not be covered through a standard benefits plan. The insurance company is taking all the risk of the plan, so it is considered “fully-insured”.
This can present a challenge for those who want to seek coverage from their employer because the employer doesn’t have control of designing the benefits plan. However, insurance companies can offer “IVF Riders” or “Infertility Riders” which are mini-benefits plans just for IVF or infertility. An employer can add this to their standard benefits plan and offer coverage.
Again, the design of the “rider” is done by the insurance company so your employer may not have much say in how many cycles are covered, coverage for medications, etc. But it’s worth asking your Human Resources or Benefits Administrator to request a quote for an “IVF Rider” to see what the insurance company can provide. This Rider would be available to all employees, not just you. Advocating for fertility insurance coverage will go a long way in convincing your HR or benefits administrator that a Rider is worth it!
Self-Insured, which is usually the case for large companies, is where the employer is the decision-maker and they have a big say in dictating what is covered and what is not. In self-insured plans, the employer is taking on all the risk of the plan, which is where the term “self-insured” comes from. One downside to self-insured employers is they are outside of any state mandates. Even if you are in a mandated state, if your employer is self-insured, they do not have to follow the mandate law in that state.
This process is a bit different.If you're a Federal Employee, Active-Duty Service Member, Military Retiree, a Veteran, or covered by Medicaid or Medicare, your insurance is provided by the Federal Government. Here is breakdown of coverage for IVF medical treatments:
Federal Employee: Starting in 2024 and as summarized in the 2024 Federal Benefits Open Season Highlights, linked below, coverage is now required for artificial insemination procedures and medications, as well as the drugs for three cycles of IVF annually.
2024 Federal Benefits Open Season (See overview of Fertility Benefits on page 7)
In addition, there are 24 health plan options that provide broader services, including IVF, as listed in Appendix A, but the benefits vary and not all plans are accessible to everyone.
However, it is our understanding that the following Blue Cross Blue Shield (BCBS) plan is available to all federal employees and covers IVF services and medications:
https://www.fepblue.org/our-plans/-/media/PDFs/Brochures/Standard-and-Basic-Option-brochure-2024.pdf
Please see pages 14 and 16 of the BCBS plan and the additional pages referenced, and as always, read the coverage details carefully before enrolling in any plan.
These changes are a result of federal employees advocating for more comprehensive fertility coverage, so it’s important to maintain pressure on OPM and your HR contacts until all FEHB plans include comprehensive family building benefits. RESOLVE is here to help you advocate. Please email coverageatwork@resolve.org with your name, city, state, and the federal department or agency where you work so we can stay in touch with you.
Infertility Discrimination: Did you know that infertility discrimination is covered by the Americans with Disabilities Act? Just like pregnancy is protected, so too is infertility discrimination. In 1998, the U.S. Supreme Court stated that reproduction is a “major life activity” and conditions that interfere with reproduction should be regarded as disabilities per the American Disabilities Act.
Based on recent settlements, the Equal Employment Opportunity Commission (EEOC) reinforces the rights of individuals undergoing fertility treatments to have their employers provide reasonable accommodations, including excused absences. Learn more about infertility discrimination at EEOC’s Enforcement Guidance on Pregnancy Discrimination and Related Issues (Section I (A)(3)(c). To file a complaint regarding infertility discrimination, visit https://www.eeoc.gov/employees/charge.cfm.
Active Duty Service Member or Military Retiree: If you are covered by TRICARE, it specifically excludes coverage for IVF. Read more here.
Veterans: If you are receiving your healthcare through the Veterans Health Administration, they had been banned from offering IVF, but Congress is allowing the VA to offer IVF for FY 2017 to wounded Veterans. Since this is a brand-new benefit as of October 1, 2016, we do not yet know exactly how wounded Veterans will access this benefit, but contact us at info@resolve.org if you believe you qualify and we will help you navigate the process. Read more about how RESOLVE and its partners advocated for this change in Congress.
Medicare or Medicaid recipient: If you receive your health insurance from Medicare or Medicaid, neither offers infertility or IVF coverage. This is a complicated process to change these policies. If you are covered by Medicare or Medicaid and need IVF, we’d love to hear from you as we advocate to change these policies. Email RESOLVE at info@resolve.org.
Self-Employed or Individual Plan: You are paying for your own health insurance! In most cases, you are getting your health insurance through one of the state or federal exchanges. At this time, most of the exchange plans are mirroring the mandate coverage if you are in one of the eight mandated states listed above.
Otherwise, most plans are not covering IVF. At this time, RESOLVE is not advocating for IVF coverage in all the state exchange plans. We simply do not have the resources to take on this task. If you are frustrated by the lack of IVF coverage offered in individual plans, we’d like to hear from you. Email us at info@resolve.org.
If you are just not sure on what type of insurance plan you have, this is a question your HR department can easily answer for you. Ask them, then come back to this page. We’ll be right here waiting…
Navigating benefits as a union member can be difficult, but there are multiple ways for you to begin the process of requesting new or expanded family-building benefits.
RESOLVE is here with a few tips successfully used by union members to secure better benefits.
You don’t need to be a collective bargaining expert to figure out where to start
The process of collective bargaining for benefits for members of your union is undoubtedly daunting. But you don’t need to be an expert to start the process and make the ask.
RESOLVE recommends consulting your Union’s benefits booklet first. Take a look at the benefits structure and familiarize yourself with the union’s trust before considering bargaining. Putting in the request to your union’s trust could allow you to skip the collective bargaining process altogether. The trust typically makes these decisions and can directly request that family building benefits be added to the plan for you and your fellow union members.
There is strength in numbers
While many Coverage at Work advocates are individuals who ask their employers for benefits, we know that unions are based on strong organizing. Involving other members of your union in making the ask can strengthen the argument and show decision-makers just how many of their members are being impacted.
RESOLVE is here to help, so contact us if you would like to organize a group call to discuss what strategy might work best for your organization and how to present the best-united front. We’ll work with you to create a template request from your group as a whole and support you every step of the way!
Even if you make the ask yourself, you’re not alone
If you feel a single request will suffice in getting the ball rolling, we are all for that, too. You still don’t have to go through this process alone. RESOLVE staff and volunteers with specific union experience are here to help you create a plan of action, submit your request, and navigate the unique structure of your union.
Ready to get started?
Making this ask is all about strategy and it will be different for everyone. Whether you are ready to submit a request on your own or you want to make the ask with your fellow union members, we’re ready to help.
Schedule a time for an initial call to get started and plan your strategy with RESOLVE by emailing CoverageAtWork@resolve.org.
“It was emotionally difficult to share my story and advocate for infertility coverage at work while undergoing treatment. But succeeding in gaining treatment for so many people has made me feel incredibly empowered, and has actually given me a second wind to continue treatment. I feel like my employer values my health and thinks this disease is worth treating. While advocating for infertility coverage at work I also interacted with several people who shared their own personal stories of infertility. There are more of us than I realized.”
“If it were not for guidance from the RESOLVE website about what information and statistics to provide an employer I don’t know that the benefits that will be available next year would have ever existed. Once a year I have emailed the same director of benefits to let me know I am still patiently waiting as are others for fertility coverage. And here we are, finally real change right before my eyes. Thank you God and Thank you RESOLVE.”
"RESOLVE empowered and prepared me to formally approach my employer and request infertility treatment benefits. Infertility coverage was offered for the first time the following year."
"Don't be afraid to ask your HR about fertility coverage. Now more than ever employees have the power in getting what they want from their employer. There are multiple paths a company can take to offer a solution for fertility coverage. As an employee, you can absolutely present them to HR yourself. Most companies only started to offer fertility benefits because an employee asked for it."
“I am a planner and when it comes to infertility it is difficult to plan ahead (as we know) however Resolve’s Coverage at Work Tool Kit truly empowered me to take action and plan ahead. I wasn’t sure what treatments I would need on my infertility journey however I wanted to be prepared and have the option for all treatment being covered by insurance including IVF especially as it was a treatment my husband and I could not afford. Using the tool kit allowed me to advocate for infertility insurance coverage through my employer that included IVF. I know have IVF covered through my employer and I am extremely grateful for my employer offering this benefit to all employees. I will begin IVF soon and am eager to have my miracle baby.”
There’s no one-size-fits-all solution for individuals dealing with infertility just like there’s no one-size-fits-all way to obtain coverage through your employer. Here are additional employee resources for requesting fertility insurance cited by RESOLVE’s Coverage at Work toolkit. Use this information to ask your workplace for fertility insurance benefits.
Additional Resources:
- Mercer 2021 Fertility Benefits Study
- Employee Fertility Benefits: An Evidence-Based Guide – UPDATED 9.24.21
- Family Equality Council: LGBTQ Family Building Survey
- FertilityIQ: The FertilityIQ Family Builder Workplace Index: 2019 – 2020
- Glassdoor: 4 in 5 Employees Want Benefits or Perks More Than a Pay Raise; Glassdoor Employment Confidence Survey
More to Explore:
1 in 8 couples experience an infertility diagnosis, so you likely have many employees that are significantly impacted by this disease. And this statistic does not include the LGBTQ+ community and unpartnered individuals who may also need medical treatment to build their families.
Whether you have received requests from your employees asking for this benefit or are proactively looking to provide coverage for reproductive medical treatment, we have a toolkit and host of resources you will need to make an evidenced-based decision. Below are your next steps:
- Download and review the Coverage at Work Employer Toolkit.
- If desired, set up a call with the Coverage at Work team to help answer questions.
- Reference our Model Benefits included in the toolkit, and reach out to your insurance carrier, broker, and/or specialty vendors that provide fertility benefits to get a quote.
Understanding Infertility and Why You Should Add Benefits
Definitions: “Infertility” means a disease, condition or status characterized by:
- a failure to establish a pregnancy or to carry a pregnancy to live birth after regular, unprotected sexual intercourse, or
- a person’s inability to reproduce either as a single individual or with their partner without medical intervention, or
- a licensed physician’s findings based on a patient’s medical, sexual and reproductive history, age, physical findings and/or diagnostic testing, or
- disability as an impairment of reproductive function.
“Infertility diagnosis and treatment” means the recommended procedures and medications from the direction of a licensed physician that are consistent with established, published, or approved medical practices or professional guidelines from The American College of Obstetricians and Gynecologists (ACOG) and/or The American Society for Reproductive Medicine (ASRM).
“Fertility Preservation for Risk of Infertility” means procedures that are consistent with established medical practices or professional guidelines published by ASRM and/or the American Society of Clinical Oncology (ASCO) for a person who has a medical condition or is expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment to fertility.
“Fertility Preservation for Reproductive Aging and Other Causes” means procedures that are consistent with established medical practices or professional guidelines published by ASRM for women who want to try to protect against future infertility due to reproductive aging or other causes.
Benefits for Infertility Diagnosis and Treatment and Fertility Preservation Services include but are not limited to:
- Consultation and Diagnostic Testing
- Prescription Medications
- Intra-cervical insemination and/or intrauterine insemination (IUI)
- In vitro fertilization (IVF) procedure, which includes ovarian stimulation, oocyte retrieval, and a fresh or frozen embryo transfer
- Intracytoplasmic sperm injection (ICSI)
- Procedures utilized to retrieve oocytes, sperm or reproductive tissue
- Genetic testing (PGT-A, PGT-M, or PGT-SR)
- Fresh embryo transfers
- Frozen embryo transfers
- Cryopreservation of sperm, oocytes, reproductive tissue and/or embryos
There are many fertility insurance coverage myths. Read on as we debunk common myths and break down the facts.
Myth: Adding a fertility coverage benefit to a health benefits package will increase health care costs.
Busted: Studies indicate that including comprehensive fertility coverage may actually reduce costs and improve outcomes.
According to a 2006 employer survey conducted by consulting firm William M. Mercer, and commissioned by RESOLVE: 91% of respondents offering infertility treatment have not experienced an increase in their medical costs as a result of providing this coverage.
Myth: If a health benefits package includes some form of coverage, it does not need to include others.
Busted: There is no one-size-fits-all treatment for infertility, but often patients select treatment based on what is covered in their health benefits plan rather than what is most appropriate treatment.
For example, a woman having trouble conceiving because of blocked fallopian tubes or tubal scarring may opt for tubal surgery, a covered treatment, which can cost $8,000-$13,000 per surgery. Many patients are forced to forgo in vitro fertilization (IVF) because it is not a covered service even though it costs about the same as tubal surgery and statistically is more likely to result in a successful pregnancy.
According to William M. Mercer, “The decline in use of high-cost procedures like tubal surgery would likely offset the cost to include IVF as a benefit and provide improved health outcomes.” (William M. Mercer, Infertility as a Covered Benefit, 1997).
Myth: Offering family building benefits will increase the likelihood that an employee will have a child and then leave.
Busted: A 2016 online consumer survey commissioned by RESOLVE of more than 700 employees pursuing IVF found that those with employer-provided IVF benefits had higher satisfaction with their employer compared to respondents without coverage. Covered employees were less likely to miss time from work due to treatments, psychological stress, depression or other conditions related to infertility; were more likely to recommend their employer as a place to work; and felt their employer listened and met their needs and cared about their well-being.
A 2017 survey conducted by FertilityIQ of patients who had undergone IVF found that employees who had their IVF covered reported being more likely to remain in their job for a longer period (62%), were more willing to overlook shortcomings of their employer (53%) and were more likely to work harder (22%).
More Facts:
- In 2018, a survey conducted by Willis Towers Watson indicated that 55% of companies offered some form of family building benefit to their employees and predicted an increase to 66% of employers by the end of 2019.
- 12% of American women have difficulty becoming pregnant or staying pregnant and will need infertility services
- 63% of LGBTQ millennials are considering having children and may need Assisted Reproductive Technology to have a family.
- In states with mandated infertility insurance, the rate of multiple births is lower than in states without coverage. (New England Journal of Medicine, “Insurance Coverage and Outcomes of In Vitro Fertilization,” August 2002). Couples with insurance coverage are free to make more appropriate decisions with their physicians based on medical necessity rather than financial considerations that often result in multiple births and a high rate of complications during and after pregnancy.
- Comprehensive infertility coverage may reduce premium expense by as much as $1 per member/per month. According to The Hidden Costs of Infertility Treatment in Employee Health Benefits Plans, insurance premiums that now indirectly provide coverage for “hidden” infertility benefits—surgeries to remove scarring in a woman’s fallopian tubes or varicose vein removal for men—were calculated to be adequate to cover more effective and often less expensive treatments such as ovulation induction, intrauterine insemination and in vitro fertilization. (Blackwell, Richard E. and the William Mercer Actuarial Team, 2000)
- The cost of infertility services as a percent of the total health premiums went down after the 1987 Massachusetts mandate. (Study by Griffin and Panak, Fertility & Sterility, 1998).
- According to a 2003 Harris Interactive Poll, 80% of the general population believes infertility treatment should be covered by insurance. (Harris Interactive Inc., Survey, 2003).
Learn about the cost of not offering fertility insurance benefits. According to a survey commissioned by RESOLVE of 702 employees who needed IVF to build their families, those without employer-provided fertility insurance coverage often expressed dissatisfaction and, in some cases, the desire to look for new employment opportunities with employers who provide coverage.
61% of respondents without fertility insurance paid out of pocket costs between $15,001 and $30,000 for one cycle of IVF. While the cost of adding coverage varies based on insurance companies and providers, the benefit of employee retention is easy to see when considering the cost of turnover.
A Center for American Progress study found average costs to replace an employee are:
- 16 percent of annual salary for high-turnover, low-paying jobs (earning under $30,000 a year). For example, the cost to replace a $10/hour retail employee would be $3,328.
- 20 percent of annual salary for midrange positions (earning $30,000 to $50,000 a year). For example, the cost to replace a $40,000 manager would be $8,000.
- Up to 213 percent of annual salary for highly educated executive positions. For example, the cost to replace a $100,000 CEO is $213,000.
A recent Glassdoor survey found that 4 out of 5 employees would prefer benefits to a salary increase.
Given that 1 in 8 couples are diagnosed with infertility and that the cost of offering infertility benefits does not significantly increase health care costs and may save money in the long term, can employers afford the cost of not offering fertility insurance benefits?
"Strong member advocacy in 2015 led the University of Michigan to conduct a 3-year pilot of coverage for IVF services. The successful pilot led to the approval of coverage for IVF services in all University health plans. Increasing the value of benefits for employees is a priority to support recruitment and retention goals, and addressing the member cost of IVF through benefit coverage addresses access and equity, allowing lower-paid employees greater access to these services. The benefit structure allows for coverage only when services are received at the University of Michigan Center for Reproductive Medicine, which helps to ensure that our members are receiving evidence-based, high-quality care. In addition, the inclusion of moderate member cost-sharing and benefit maximums provides meaningful coverage while protecting the plan from excess costs. These parameters support the University’s benefit principles of providing high-quality benefits and being a good steward of University resources."
- University of Michigan
“We believe it is critical that we continuously evaluate our benefits offering and identify how best to support our workforce. An essential aspect of this work is engaging with our employees to understand their needs, and we appreciate programs like RESOLVE that encourage these discussions,” said Marc Serrilli, HR Total Rewards, Vice President, The J.M. Smucker Co. “Through dialogue with our employees, we identified the need for enhanced infertility services, which were made available to employees on February 1, 2022. This enhanced offering builds on our efforts to provide inclusive and accessible family building options via infertility services, adoption reimbursement, and surrogacy reimbursement.”
- J.M. Smuckers Co
"At the Medical College of Wisconsin we believe it is important to provide inclusive benefits for our employees, and that means fertility benefits are a must-have. Infertility is a common and growing diagnosis, and the demand for fertility benefits continues to increase. It is both an important family-friendly benefit for our employees and one way in which we remain competitive in the job market."
- Medical College of Wisconsin
Here are the additional resources for employers seeking fertility insurance facts cited by RESOLVE’s Coverage at Work toolkit. There’s no one-size fits all solution for individuals dealing with infertility, which is why comprehensive family building benefits help foster employee loyalty, retention, and satisfaction.
Additional Resources:
- Mercer 2021 Fertility Benefits Study
- Employee Fertility Benefits: An Evidence-Based Guide – UPDATED 9.24.21
- Family Equality Council: LGBTQ Family Building Survey
- FertilityIQ: The FertilityIQ Family Builder Workplace Index: 2019 – 2020
- Glassdoor: 4 in 5 Employees Want Benefits or Perks More Than a Pay Raise; Glassdoor Employment Confidence Survey
More to Explore
You are taking a great first step in helping your patients secure insurance coverage for the medical treatments they need to build a family. Thank you for joining this access to care movement and sharing this important information about RESOLVE’s Coverage at Work program with your patients. Below are your next steps:
- Download and start using the Coverage at Work Clinic Toolkit.
- If desired, set up a call with the Coverage at Work team to help answer any questions.
- Let us know when you start sharing the information with your patients so we can add your clinic to our Coverage at Work Boosters webpage – email us at coverageatwork@resolve.org.
Learn More
RESOLVE is proud to partner with clinics across the country that are dedicated to expanding access to care for their patients. Together, we’re empowering patients to advocate for family-building benefits with their employers. Contact Magda Halim at mhalim@resolve.org to learn more about how your clinic can join our Coverage at Work Booster program or download the clinic toolkit.
Thank you to the clinics listed below and to the American Society for Reproductive Medicine and Society for Assisted Reproductive Technology for their support of RESOLVE’s Coverage at Work program.
- Atrium Health Carolinas Medical Center Women’s Institute
- Boston IVF, Inc.
- Center for Reproductive Medicine, Alabama
- Center for Reproductive Medicine at Weill-Cornell Medical
- Conceive Fertility Center
- Contra Costa Regional Medical Center
- Embryo Donation International, P.L.
- Fertility Answers
- Fertility Institute of Hawaii
- GENESIS Fertility & Reproductive Medicine
- Heartland Center for Reproductive Medicine
- IVF Florida Reproductive Associates
- Magarelli Fertility
- Oregon Health & Science University
- Pacific Northwest Fertility
- Penn Medicine Lancaster General Health
- Positive Steps Fertility
- Reproductive Care Center
- RMA Michigan
- RMA Philadelphia
- Seattle Reproductive Medicine
- Virginia Fertility and IVF
- Western Fertility Institute
- Wisconsin Fertility Institute
There are many fertility insurance coverage myths. Read on as we debunk common myths and break down the facts.
Myth: Adding a fertility coverage benefit to a health benefits package will increase health care costs.
Busted: Studies indicate that including comprehensive fertility coverage may actually reduce costs and improve outcomes.
According to a 2006 employer survey conducted by consulting firm William M. Mercer, and commissioned by RESOLVE: 91% of respondents offering infertility treatment have not experienced an increase in their medical costs as a result of providing this coverage.
Myth: If a health benefits package includes some form of coverage, it does not need to include others.
Busted: There is no one-size-fits-all treatment for infertility, but often patients select treatment based on what is covered in their health benefits plan rather than what is most appropriate treatment.
For example, a woman having trouble conceiving because of blocked fallopian tubes or tubal scarring may opt for tubal surgery, a covered treatment, which can cost $8,000-$13,000 per surgery. Many patients are forced to forgo in vitro fertilization (IVF) because it is not a covered service even though it costs about the same as tubal surgery and statistically is more likely to result in a successful pregnancy.
According to William M. Mercer, “The decline in use of high-cost procedures like tubal surgery would likely offset the cost to include IVF as a benefit and provide improved health outcomes.” (William M. Mercer, Infertility as a Covered Benefit, 1997).
Myth: Offering family building benefits will increase the likelihood that an employee will have a child and then leave.
Busted: A 2016 online consumer survey commissioned by RESOLVE of more than 700 employees pursuing IVF found that those with employer-provided IVF benefits had higher satisfaction with their employer compared to respondents without coverage. Covered employees were less likely to miss time from work due to treatments, psychological stress, depression or other conditions related to infertility; were more likely to recommend their employer as a place to work; and felt their employer listened and met their needs and cared about their well-being.
A 2017 survey conducted by FertilityIQ of patients who had undergone IVF found that employees who had their IVF covered reported being more likely to remain in their job for a longer period (62%), were more willing to overlook shortcomings of their employer (53%) and were more likely to work harder (22%).
More Facts:
- In 2018, a survey conducted by Willis Towers Watson indicated that 55% of companies offered some form of family building benefit to their employees and predicted an increase to 66% of employers by the end of 2019.
- 12% of American women have difficulty becoming pregnant or staying pregnant and will need infertility services
- 63% of LGBTQ millennials are considering having children and may need Assisted Reproductive Technology to have a family.
- In states with mandated infertility insurance, the rate of multiple births is lower than in states without coverage. (New England Journal of Medicine, “Insurance Coverage and Outcomes of In Vitro Fertilization,” August 2002). Couples with insurance coverage are free to make more appropriate decisions with their physicians based on medical necessity rather than financial considerations that often result in multiple births and a high rate of complications during and after pregnancy.
- Comprehensive infertility coverage may reduce premium expense by as much as $1 per member/per month. According to The Hidden Costs of Infertility Treatment in Employee Health Benefits Plans, insurance premiums that now indirectly provide coverage for “hidden” infertility benefits—surgeries to remove scarring in a woman’s fallopian tubes or varicose vein removal for men—were calculated to be adequate to cover more effective and often less expensive treatments such as ovulation induction, intrauterine insemination and in vitro fertilization. (Blackwell, Richard E. and the William Mercer Actuarial Team, 2000)
- The cost of infertility services as a percent of the total health premiums went down after the 1987 Massachusetts mandate. (Study by Griffin and Panak, Fertility & Sterility, 1998).
- According to a 2003 Harris Interactive Poll, 80% of the general population believes infertility treatment should be covered by insurance. (Harris Interactive Inc., Survey, 2003).
Learn about the cost of not offering fertility insurance benefits. According to a survey commissioned by RESOLVE of 702 employees who needed IVF to build their families, those without employer-provided fertility insurance coverage often expressed dissatisfaction and, in some cases, the desire to look for new employment opportunities with employers who provide coverage.
61% of respondents without fertility insurance paid out of pocket costs between $15,001 and $30,000 for one cycle of IVF. While the cost of adding coverage varies based on insurance companies and providers, the benefit of employee retention is easy to see when considering the cost of turnover.
A Center for American Progress study found average costs to replace an employee are:
- 16 percent of annual salary for high-turnover, low-paying jobs (earning under $30,000 a year). For example, the cost to replace a $10/hour retail employee would be $3,328.
- 20 percent of annual salary for midrange positions (earning $30,000 to $50,000 a year). For example, the cost to replace a $40,000 manager would be $8,000.
- Up to 213 percent of annual salary for highly educated executive positions. For example, the cost to replace a $100,000 CEO is $213,000.
A recent Glassdoor survey found that 4 out of 5 employees would prefer benefits to a salary increase.
Given that 1 in 8 couples are diagnosed with infertility and that the cost of offering infertility benefits does not significantly increase health care costs and may save money in the long term, can employers afford the cost of not offering fertility insurance benefits?
There is no one-size-fits-all solution for individuals dealing with infertility, ust like there’s no one-size-fits-all way to obtain coverage through your employer. Here are additional patient resources that can be used for requesting fertility insurance cited by RESOLVE’s Coverage at Work toolkit. Patients can use this information to ask their workplace for fertility insurance benefits.
Additional Resources:
- Mercer 2021 Fertility Benefits Study
- Employee Fertility Benefits: An Evidence-Based Guide – UPDATED 9.24.21
- Family Equality Council: LGBTQ Family Building Survey
- FertilityIQ: The FertilityIQ Family Builder Workplace Index: 2019 – 2020
- Glassdoor: 4 in 5 Employees Want Benefits or Perks More Than a Pay Raise; Glassdoor Employment Confidence Survey