Expanding fertility benefits: Key considerations for health plans

As more health plan members turn to fertility treatments to help build their families, limited—or non-existent—coverage for fertility has left many to navigate the complex and expensive treatments with little financial or emotional support.

Fortunately, health plans looking to provide more comprehensive, whole-person care to their members and meet employer demand have more opportunities than ever to expand their fertility benefits beyond basic infertility care. Here’s what health plans need to know about building modern fertility benefits:

Why health plans need to expand fertility benefits

Currently, many plans only cover diagnostic infertility services, forcing couples facing infertility, as well as same-sex couples and single parents by choice, to pay for fertility services out of pocket. And these services can carry significant costs for members. One study in Northern California found that a successful round of intrauterine insemination (IUI) costs $19,566 out of pocket, and in vitro fertilization (IVF) costs $61,377.

The costs associated with fertility support cause many members to abandon their plans of a biological family altogether. In a survey from Family Equality, 63% of same-sex couples said they couldn’t start a family because insurance wouldn’t cover the treatment.

Expanding fertility benefits can do more than help members begin their family-building journeys. Increased access to fertility coverage also improves outcomes. Birthing parents who live in states that mandate infertility treatment are more likely to have a successful birth resulting from IVF, as well as lower rates of multiple births.

Employers are looking for more

In addition to improved access and outcomes for members, the need for more comprehensive fertility benefits also stems from employers’ desires to support increased demand from their employees. Forty-four percent of employees want help starting a family, but only 29% of large employers currently offer fertility benefits. Additionally, 32% of employers plan to add or expand reproductive health services in the coming year.

With employees demanding more coverage from their employers, health plans can differentiate themselves by offering expanded fertility services to employers, helping them attract and retain employees in a competitive market.

Key components of comprehensive fertility benefits

Expanded fertility care means far more than coverage for infertility. Comprehensive fertility benefits include support for anyone starting a family, whether through fertility treatments, surrogacy, or adoption. To best meet the needs of members and their employers, fertility benefits should include:

IVF/IUI for all members

As of 2022, 20 states mandate insurance coverage for infertility, and only 14 of those include IVF treatment in that mandate. What’s more, insurance often doesn’t cover IVF treatments without a diagnosis of fertility, excluding same-sex couples and single parents by choice. As a result, the vast majority of people pay for IUI and IVF treatment out of pocket, a cost that remains out of reach for many Americans. A study by the American Society for Reproductive Medicine found that 70% of women who undergo IVF go into debt, and 34% stop treatment because they can’t afford it.

Health plans can better support members by increasing coverage for IVF and IUI treatments without the need for an infertility diagnosis. Expanding virtual access to reproductive endocrinologists, fertility coaches, and other specialists can also help provide members with the resources and education necessary to make informed decisions about their fertility journey.

Fertility preservation education

Fertility preservation—freezing eggs or sperm for potential use in the future—can provide a lifeline for members. Individuals pursue fertility preservation for a variety of reasons, including age, cancer treatments, autoimmune diseases, reproductive health conditions like endometriosis, and transgender care. However, many might not know that a fertility preservation option exists. One study found that only 14% of female cancer patients received information on fertility preservation before their cancer treatments. Similarly, only 22% of trans people report receiving fertility preservation education before beginning gender-affirming hormone treatments.

Increasing access to clinically-vetted resources about the implications of certain treatments on fertility—as well as education around the different fertility preservation options available—can help ensure that members who want a biological child in the future are able to, regardless of their health conditions, age, or gender. Members may also benefit from meeting virtually with certain specialists, such as fertility coaches and OB-GYNs, to discuss options before starting treatment.

Preconception care

Preconception care provides personalized, preventative care that addresses risks to potential birthing parents and their partners, whether they plan to conceive now or in the future. It encompasses a wide range of medical, behavioral, and social interventions designed to improve the health of aspiring parents, identify and treat the underlying causes of infertility, minimize the likelihood of pursuing expensive fertility treatments, and reduce risks to the unborn child and birthing parent. Despite these benefits, 86% of women don’t get preconception care from their physician, and 92% of men say their physician hasn’t discussed reproductive health with them.

Like fertility preservation, the first step to increasing the number of members seeking preconception care is through education. Connecting members with trained providers who can identify and treat infertility risk factors—as well as educate members through the process—can make a sizable impact on members' fertility outcomes. Similarly, increasing member health literacy through clinically-vetted content can also help members learn more about their fertility.

Mental health support

Members pursuing fertility treatments often struggle with stress and anxiety throughout the process. Studies have found that people struggling with infertility report the same levels of stress as people with heart disease or cancer. What’s more, stress can impact the chances of conception, as well as the likelihood of a healthy pregnancy through IVF.

Mental health care provides critical wrap-around support for members as they navigate their fertility journeys. Virtual, 24/7 access to mental health specialists can help members navigate the rollercoaster of emotions that often accompany fertility treatments. Some members may also benefit from access to support groups or classes where they can connect with peers going through similar fertility treatments, helping them to feel less alone during and after the process.

Adoption/surrogacy

Adoption and surrogacy are often-overlooked components of fertility benefits but essential nonetheless. For couples who can’t conceive, same-sex couples, and single parents by choice, adoption or surrogacy can be their only path to building their families. However, both of these family-building options may be expensive and complicated. Parents-to-be often have to navigate complex legal obstacles, especially for same-sex couples or those looking for international adoption/surrogacy.

To best support members on their path to parenthood, health plans can provide resources to members along their adoption and surrogacy journeys. Some plans offer virtual access to adoption and surrogacy coaches, who can help parents-to-be find adoption agencies, vet surrogate mothers, and navigate the legalities of both paths.

Maven is your partner in fertility benefits—and beyond

Maven is the leading partner for health plans looking to expand their fertility benefits offerings. Our comprehensive fertility and maternity programs include proactive check-ins, ongoing assessments, community support, and human touchpoints, helping members identify risks early, increase positive outcomes, and prevent expensive complications. Programs are inclusive of all people and paths to parenthood and include:

• Fertility expense support, with or without an infertility diagnosis
• Care Advocates to help members navigate the highs and lows of their fertility journey
• Culturally-humble care
• Access to a vetted network of in-plan fertility clinics
• 24/7 virtual access to care and specialists to support during the fertility journey

Maven drives results for members looking to start or expand their families: 17% of members who are considering fertility treatment avoid treatment, and 55% achieve a successful pregnancy within 12 months. Ready to provide the next level of fertility care to your members? Contact us today.

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