The Ins and Outs of Fertility Benefits: How Employers Can Attract Talent and Strengthen Employee Relationships
Earlier this year, I experienced something I’ve only ever seen on TV shows or understood in the most basic sense. I had an ectopic pregnancy, where a fertilized egg implanted outside of my uterus. The pregnancy was not viable. It was life threatening, and I had to have emergency surgery. I lost a fallopian tube in the process.
The after-effects of such a surgery still linger. While physically I’m recovered, the mental and emotional sides come in waves, and I’m sure it will be like this for some time. There hasn’t been a single week that’s gone by where I haven’t taken a moment to pause, reflect and say, “Yeah, I could be dead right now, but I’m not.”
Another thing that lingers is the question of my future fertility.
If there is a chance I lose my second tube, I will need to know my options. My story is my own, but there are plenty of women — and men — who have similar questions. Every year, between 48 million couples and 186 million individuals struggle with issues of infertility.
“A lot of depression can arise around not being able to have a baby,” said Dr. Jane Frederick, specialist in reproductive endocrinology and infertility, HRC Fertility. Many will turn to medical intervention and fertility treatments to grow their families, however the costs can be daunting.
A single consultation for a couple can be anywhere from $200-$400, depending on the state the patient lives in. IVF, or in vitro fertilization, on its own can be anything from $11,000 to $17,000, though if the person requires medication, it could cost up to $25,000. Surrogacy has an $80,000 to $100,000 price tag associated with it.
Fertility treatments themselves encompass a number of different things, from something as simple as a consultation; rounds of lab work, medication, testosterone shots and more; to the pricey option of IVF … and everything in between. Some fertility considerations go so far as to include surrogacy, egg freezing, adoption and even LGBTQIA+ reproductive health care, as well as paternity leave or emotional support after pregnancy loss.
The issue, however, is that “it’s not universally covered,” Dr. Frederick said. “It’s considered elective treatment in the U.S., so unlike in European countries, which have universal health care and fertility treatment is covered, workers in the U.S. really rely on their employers for benefits and coverage.”
But that raises an important question: Do employee benefits packages even help cover the costs of such fertility treatments?
Fertility and Employee Benefits in a Nutshell
The first recorded infertility treatment dates back to the 1850s, when a number of doctors tried their hand at artificial insemination for the first time. Though infertility treatments have been a part of the human experience for quite some time, however, fertility benefits haven’t had as long a shelf life.
“We really started hearing about fertility benefits in the last five to ten years,” said Tammy Olson, area senior vice president, Gallagher.
“We’re still in the middle stages of implementing fertility benefits,” added Jay Kirschbaum, benefits compliance, director and senior vice president, World Insurance Associates. “Some states require some fertility benefits be listed in employers’ health plans. Many large employers already have limited fertility benefit offerings of some type. It is expanding.”
Gallagher’s 2022 Physical & Emotional Wellbeing Report found that 46% of employers are already covering infertility services and/or fertility treatments. However, that does not mean these employers are covering every aspect of the phrase “fertility treatments.”
Consultations (69%) and prescriptive drugs (77%) are the most common treatments covered. Other methods, like intrauterine insemination or egg freezing, 43% and 23% respectively, are covered at a far lesser rate.
“It’s not as costly as it used to be to have these fertility benefits, but it’s still something employers have to look at and analyze when putting together their benefits programs,” Olson said. “It could be a limited benefit under most insurance plans today or it could be something that’s a very rich benefit.”
How Fertility Benefits Enhance the Business
While the uptake is moderate, employers who are looking at fertility benefits are doing so for several key reasons. One of the biggest is retaining talent.
It’s no secret that employees are leaving the workforce in droves, either leaving for better pastures elsewhere or taking time away from the job to figure out what they really want to be doing. A recent McKinsey report noted, “In the United States alone, there were 11.3 million open jobs at the end of May  — up substantially from 9.3 million open jobs in April 2021. Even as employers scramble to fill these positions, the voluntary quit rate is 25% higher than pre-pandemic levels.”
Because of this, The Great Resignation that began in 2021 has morphed into The Great Renegotiation of 2022, where employees are searching out specific benefits and other perks through their jobs. Employers are reacting in turn, looking for countless ways to attract and retain talent, turning fertility benefits into something of a hot commodity.
“Companies are getting the message that they need to be more generous with their package plans,” Dr. Frederick said. “And they’re seeing that fertility-based perks might be the way to go.”
Adding fertility benefits to the package is “another way employers demonstrate that they, first, care about their employees. Fertility benefits tie them closer to their employer because they offer this. And second, it may be a costly benefit, but not every employee is going to use it. It’s a part of a whole package of benefits used to attract and retain talent,” said Kirschbaum.
Maven Clinic, a health care network providing resources for fertility, pregnancy, adoption, parenting and pediatrics, revealed that 70% of millennials would change their job in order to ensure they have fertility coverage. Further, 61% of employees who received fertility coverage from their employer felt more loyal and committed to them.
Even just adding the basic level of coverage can be a game changer.
Some workers, mothers more so than fathers, fear the “parenting penalty,” in which their career prospects wane due to a desire to have a family. Society of Human Resource Management data shows that 69% of working Americans say working mothers are more likely than other employees to be passed up for new jobs. Sixty-five percent of women without children worry about what having a child will mean for their careers, and 41% of working Americans actually view moms in the workplace as less devoted to their work.
But by having fertility benefits, employers demonstrate that they’re open to the family unit. In fact, being able to offer an employee access to start and grow their family gives employers a competitive edge.
“Employees want more life balance and are quitting when they feel they are not getting it. Employers have an opportunity here to be competitive. If employees see that they can talk about their fertility issues, and their company offers these benefits, they see that the company doesn’t view family planning as a negative move in employees’ careers,” Dr. Frederick said.
Another key reason employers are searching out fertility benefits is to enhance diversity, equity and inclusion (DEI) efforts.
In the last few years, DEI has become a core value in the corporate world. Many boast robust plans of action to grow their programs both in an effort to strengthen the talent pool and meet societal demand. Fertility benefits are just another way employers are doing both.
“Our workforce composition has changed,” said Olson.
“Fertility does not just apply to women; it applies to men. Full family planning is becoming more popular. Employers really want their benefit plans to meet the individual and be meaningful. It’s more cost-effective to keep a good employee than to continually be training, and the longevity of these benefits will continue to attract, retain and meet employees where they are.”
Olson stated that access to fertility benefits also promotes a positive culture within the company. It can increase good mental health among employees, which can be improve performance. Also, “it reduces debt,” she said. “It is expensive to have a family, especially when you are using fertility treatments. An employer that can defray some of that cost is really going to make an impact on an employee who might have been considering taking from their 401k.”
What to Review When Implementing Fertility Benefits
Of course, as with any new or expanding benefit, employers will want to think about the potential positive or negative impact that could follow their decision making.
“They should be asking the same questions as they would with any other benefit: How does this fit into the overall benefit package? Does this demonstrate who we are as an employer to our employees and potential employees? Who’s eligible for this benefit and who isn’t?” Kirschbaum said.
Looking a little deeper at eligibility, LGBTQIA+ employees are an underserved group when it comes to fertility benefits. That is because often fertility treatments are seen as a medical benefit for heterosexual couples who are physiologically unable to reproduce without intervention.
Yet, 60% of LGBTQIA+ couples, according to Maven Clinic, plan to use assisted reproductive technology, surrogacy or adoption to expand their families.
“Childbirth is a major milestone for families, regardless of the type or makeup, and it’s considered a core value,” said Olson. “Employers are starting to look at disparities across race, ethnicity, income, sexuality and gender, and are looking at ways their benefits can reflect that need.”
Discrimination class action suits are likely if a company excludes LGBTQIA+ employees from its fertility benefits. In fact, several have come to light in recent years, most recently from LGBTQIA+ workers at an Illinois-based hospital, where the benefit policy states it will only cover fertility costs for opposite-sex couples.
A New York Times article reported that LGBTQIA+ fertility equality activists have been pushing for benefit equality for decades with the end goal of having a future where the ability to create a family is no longer determined by one’s wealth, sexuality, gender or biology: “Fertility equality activists are asking, at a minimum, for insurance companies to cover reproductive procedures like sperm retrieval, egg donation and embryo creation for all prospective parents, including gay couples who use surrogates,” NYT wrote.
“Ideally, activists would also like to see insurance cover embryo transfers and surrogacy fees. This would include gay men who would transfer benefits directly to their surrogate.”
Deciding what type of benefits to include is another key area. Fertility benefits can be a very broad term, and so, before adding coverage, employers should review what treatments and ancillary benefits make sense for their plan to offer.
The good news: “Once the employer has made the policy, it should be easy to maintain,” Kirschbaum said.
Finally, employers should consider what fertility support should look like within their organization and within their culture.
“People need to know they’re not alone … it’s not just about, ‘here’s a check for this procedure.’ It’s also about how the employer can help employees emotionally. How they can help give them the tools for family planning,” Dr. Frederick said. “An employer doesn’t want to come off as family-unfriendly. Employers should want to listen [to] and react to what employees are experiencing.” &