If you’re a new or potential employee, discussing your new company’s benefits is a must. Medical, life, stock options and family leave are all important elements in a company’s benefits package, but the one that might count most for employees of childbearing age are fertility benefits.
What, exactly, should you be asking? Karin Ajmani, Chief of Strategic Development at the fertility benefits provider Progyny, gives Parentology a fertility benefits primer.
First Up: What Exactly Is Covered Under My Benefit?
Even though infertility is classified as a disease by the World Health Organization (WHO), it’s usually not viewed in the same category as other diseases by conventional insurance companies.
For instance, you’re often going to have to “prove” you’ve tried to conceive for a year if you’re under 35, or six months if you’re over 35. This is termed pre-certification, and it’s inherently exclusionary in nature.
“Pre-certification automatically restricts the LGBTQ+ community and single parents by choice,” Ajmani explains. “Pre-certification also commonly requires women to start with less effective technologies, such as IUI [intrauterine insemination], before qualifying to use their IVF [in-vitro fertilization] benefit.”
And not all insurance is created equal. You need to check those lifetime maximums.
“Most coverage is also not comprehensive, meaning it doesn’t cover the full cost of treatment and excludes key technologies. So it’s important to read the fine print about what’s covered and any lifetime coverage maximums,” Ajmani advises. “For example, a benefit with a $15,000 lifetime maximum may at first glance seem generous, but when you peel back the layers, $15,000 is often exhausted well before completing just one cycle of IVF, leaving you paying the rest of the average $25,000 treatment out of pocket. You also should ask if the latest technologies, such as egg freezing and PGT-A embryo screening, are covered at all.”
Ajmani should know, because she’s experienced the enormous cost of IVF firsthand.
“When I needed IVF years ago, I exhausted my husband’s $10,000 benefit on just the consult and diagnostic testing alone. I had to spend an additional $30,000 out of pocket to complete my treatment and pay for the expensive medications, which can cost $7,000-$10,000. I also was surprised that I couldn’t use my benefit to pay for the frozen IVF cycle and PGT-A testing my doctor said I needed.”
Really, what Ajmani (and Progyny) aim for are the most comprehensive fertility benefits. That means no pre-certification hurdles, coverage for full IVF cycles (and multiple ones, because one cycle often isn’t enough), and flexibility for your doctors to make choices based on care, not cost.
Ask If There Are Many In-Network Fertility Clinics
Fertility treatment is deeply personal; you should feel comfortable where you are getting the care. But, just because you like a fertility clinic doesn’t mean your benefit will cover it.
“Do your research before selecting a provider, since many clinics don’t participate in health plan networks,” Ajmani says. “ Ask your clinic which fertility benefits they accept to get the most out of your benefit and avoid high out-of-pocket costs.”
The other pertinent aspect of your coverage is the support offered. You don’t want to simply show up, do an IVF cycle and be left to your own devices, Ajmani says.
“Going through infertility can be by physically and emotionally daunting. My husband and I experienced seven miscarriages and I was subjected to innumerable blood tests, genetic tests, D&C [dilation and curettages], and other painful procedures. At no time did I ever receive a call or even a letter from my health plan.”
Ajmani recommends fertility benefits include emotional support programs; Progyny’s program includes a personal patient care advocate, usually a nurse, to help shepherd you through every step of the process.
If your benefit doesn’t include a personal advocate, you can find help through the national fertility organization RESOLVE.
What If Your Company Lacks a Fertility Benefit? How Do You Ask?
Approach your human resources (HR) department with the idea. Many companies are already implementing family building benefits, as they recognize the recruiting and employee loyalty value of these programs. Conveniently, Progyny has a template to help you get a benefit started at your company, and it’s downloadable.
You can take things to a personal level with HR or your manager and discuss your fertility journey. It’s your choice, and it could make a difference.
“This is entirely up to you — it’s important to decide how much information you feel comfortable sharing. If you need to take time off or arrive late to work while going through fertility treatment, you can share this with your supervisor or simply say that you’re having a medical procedure,” Ajmani says. “Infertility is a disease and the treatments needed to address it are true medical procedures, no different from your colleagues who are undergoing medical procedures like knee surgery or a c-section.”
What About Surrogacy and LGBTQ Specific Fertility Treatments?
Family building is more than just IVF; it should cover things like surrogacy, adoption, egg and sperm freezing, and more. Ask those questions of your HR department, and request fuller coverage if it’s not yet offered.
One particularly unfair stipulation present in many insurance plans is the exemption for “social infertility,” which is infertility not caused by a physical inability to reproduce but social inability. This hits LGBTQ potential parents and blocks their path to coverage.
Progyny has really led the way in terms of assisting LGTBQ family building, offering services like reciprocal IVF, in which one partner donates her eggs to her partner to carry the child. It’s more complex and expensive, but it’s a way for both parents to feel like participants in the process.
Ajmani advises standing strong when dealing with HR departments on exclusionary policies; they are inappropriate in today’s workplace.
“When talking to HR, be sure to find out what treatments are covered under your benefit. If LGBTQ-friendly options such as reciprocal IVF, purchasing of donor tissue, surrogacy and/or adoption are not included, flag the need for more inclusive coverage to your employer. And remind them that you pay the same health care premium as your heterosexual colleagues and deserve equitable coverage!”