The Needle Starts to Move on Reproductive Health Benefits 

Doctor writing on medical health care record, patients discharge, or prescription form paperwork in hospital clinic
Dec 20 2018

For many years, there was no discernible trend in coverage for infertility treatment in employer health plans. Each year, Mercer’s National Survey of Employer-Sponsored Health Plans stated that around a fourth of employers with 500 or more employees covered IVF. While jumbo employers – those with 20,000 or more employees – were somewhat more likely to provide this coverage, again, for many years there was no real growth trend. Given the ongoing challenge of managing rising health benefit costs, the majority of employers were reluctant to assume both the direct cost of treatment and the added risk for high cost claims from multiple births.

But that seems to be changing. This year, among the largest employers at least, there was significant growth in offerings of all types of infertility treatment coverage. These employers are often the trendsetters for smaller employers, so time will tell if they are the leading edge of a broader movement. Why are we seeing this change now? Certainly, in a tight labor market, employers are looking to distinguish themselves with more family-friendly and inclusive benefits offerings. When coverage is not restricted to women meeting the clinical definition of infertility – as is the case for 44% of employers with 500 or more employees that provide IVF coverage -- these benefits can also make an organization more attractive to LGBT employees.

In addition, emerging innovative vendor solutions are promoting better treatment protocols, robust member-facing tools and resources, and personalized member support to reduce risk and improve outcomes. Employers can also mitigate cost exposure to some extent with benefit limits. More than half of employers that provide coverage include benefit limits – either a dollar limit (33%), or some other type of limit (21%), such as limiting the number of IVF cycles. (Among jumbo employers, benefit limitations are more common: 59% use dollar limits and 28% some other limit.) When a dollar limit is imposed, the median amount is $15,000.

Employers that don’t offer fertility coverage should be advised: Some studies report that over half of working women would consider changing jobs for better reproductive health benefits. Given the need for many organizations to attract and retain top talent, a careful review of your existing program may be warranted.

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