Employers from all market segments — telecom, retail, tech, professional services and public sector — are becoming more interested in providing infertility benefits to their workforce. Many are recognizing the emotional and financial impact that infertility is creating for employees and the corresponding need for a more comprehensive solution for people going through this often high-stress “life event.”

The data is compelling. The Centers for Disease Control and Prevention reports that one in eight couples has trouble getting pregnant or sustaining a pregnancy, and Allied Market Research projects that fertility will be a $21.6 billion business globally by 2020. With that, the demand by employees is clear.

“Employers offering an infertility benefit are showing their workforce that they recognize infertility is a disease,” says Karin Ajmani, president of Healthcare Services at New York City-based Progyny, which offers a range of infertility services. “It also shows employees they understand that having a family is important, and because men and women are having children in their 30s, women are disproportionately suffering from infertility.”

Infertility drives other costly conditions

Ajmani explains that employees who struggle with infertility face higher rates of depression and absenteeism in the workplace, as well higher turnover.  And while the employees who need to utilize their fertility benefit is small (less than 1% per year), they’re typically more vocal and proactive in their quest to obtain coverage through their employers.  

“HR and benefits executives recognize that providing coverage is the right thing to do from both a cultural and cost perspective,” she says, adding that 85% of employers Progyny serves are adding elected egg freezing to support their female workforce. Ajmani says infertility services are a growing benefit and from her company’s perspective, it is looking to grow its customer base by at least 200% for 2017.

There are no employer legal risks associated with covering the treatment of infertility, as it is defined as a medical benefit under Affordable Healthcare Act and IRS law governing Health Savings Account plans. Contrary to popular belief, it is not a voluntary benefit under the law, such as dental and vision.

Employee support, lower costs

"By moving away from being fixed dollar benefit to a full SMART cycle benefit, coupled with personalized member advocate support, we’ve been able to reduce the average number of cycles needed to achieve pregnancy from three to two cycles," Ajmani says. "And with this benefit, we’ve been able to reduce the rate of becoming pregnant with twins from an average of 28% to less than 4%.”

Then, there are the retention benefits, especially for millennials. Ajmani cites data that says 68% percent of millennials take coverage for fertility preservation, such as egg freezing, and infertility coverage into consideration when choosing an employer. Currently, about 25% of employers offer some coverage for infertility treatments, and that percentage is growing annually due to the recognition of infertility as a medical condition. 

Typical infertility benefits are traditionally not comprehensive, tend to have a limited dollar benefit and may only cover fertility medications, Ajmani says.  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.

“In most all instances, this is being offered as an employer-paid medical benefit, though it is still not covered on an unlimited basis like other disease treatments,” she says.

As a result, patients often suffer longer with higher rates of infertility treatment failures, higher miscarriage rates, and much higher out-of-pocket costs, Ajmani says, noting that the typical retail rate for one full IVF cycle including diagnostic testing and labs is as high as $20,000 per cycle.

“Because the average fertility benefit only covers ten thousand dollars and it takes about three 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,” she says.
 

Comprehensive coverage

Ajmani explains that Progyny’s offering, called Progyny Fertility Benefits, is different because it covers all costs involved in a full treatment cycle, includes access to Progyny’s national network of fertility clinics, and provides patients with patient care advocates who educate and help coordinate all treatments. Progyny’s benefits also include coverage of the latest technologies, such as egg freezing, embryo screening (including PGS and the EEVA (Early Embryo Viability Assessment) Test, fresh and frozen in vitro fertilization (IVF), carrier screening and egg banking. 

“By moving away from being fixed dollar benefit to a full SMART cycle benefit, coupled with personalized member advocate support, we’ve been able to reduce the average number of cycles needed to achieve pregnancy from three to two cycles," Ajmani says. "And that has reduced the rate of becoming pregnant with twins from an average of 28% to less than 4%."

Of course, any smart HR or benefits decision-maker wants to know about return on investment related to an infertility treatment benefit. According to Ajmani, the most significant ROI is related to medical cost avoidance. If someone doesn't have coverage, or has limited fertility coverage, the employee will still seek treatment and pay out of pocket. This leads people to choose less expensive, less effective treatment options, such as standalone fertility medications and artificial insemination that have the highest chance of producing twins or multiples.  

“The minute a woman becomes 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,” Ajmani says, noting that Progyny estimates the average ROI it can deliver to be about 30%. “Those potential downstream expenses far outweigh having a comprehensive fertility benefits plan in place.”