Point Solutions Spotlight: Women’s Health; Moving Beyond Infertility
As employers fight for top talent and work to deliver equitable benefits, family-first benefits have risen to the top of the priority list for most progressive employers, but the definition of family first continues to evolve. An increase in parental and caregiving leave, use of lifestyle accounts, coverage for family planning and infertility including at times travel reimbursement demonstrates an employers’ commitment to their diverse population and the constantly changing definition of family friendly. Women’s health, however, during and beyond childbearing years, is beginning to take center stage.
In recent years, the stigma around infertility and reproductive health issues has lessened. The CDC reports that around 19% of American women struggle to get pregnant. In vitro fertilization (IVF) can cost between $15,000 – $30,000 per cycle without insurance, and surrogacy costs range from a staggering $100,000 – $200,000.1 Given the expense as well as the physical and mental toll of reproductive challenges, employers and lawmakers responded, with almost half of U.S. states requiring fertility insurance coverage. Most of these laws require benefits be provided for the diagnosis and treatment of infertility, as defined by the state. Many require IVF to be a covered benefit for plans that provide pregnancy-related benefits, while others may only mandate that insurers offer coverage options related to infertility for employers to select.
Under these fully insured plans, some restrictions apply and requirements must be made for coverage. For example, coverage may be restricted by various clauses such as the definition of infertility (i.e., 2-year history of infertility, infertility associated with certain conditions such as endometriosis, etc.), lifetime maximums (e.g., $15,000), and approved treating providers. Further, laws may only apply to certain plans, such as those with more than 100 lives.
In Massachusetts, for example, all insurers who provide pregnancy-related benefits must provide coverage for the diagnosis and treatment of infertility, including artificial insemination, IVF, Gamete Intrafallopian Transfer (GIFT), egg banking, and more. Infertility is defined by being unable to conceive during a period of 1 year if the female is 35 or younger, or during a period of 6 months if the female is over 35. There is no legal limit on a number of treatments, however, insurers may set limits based on clinical guidelines and patient medical history.2
Although states with fertility insurance laws often provide a minimum level of coverage, many employers are not subject to those state requirements (i.e., self-insured plans). Therefore, employers must make critical decisions surrounding plan design for infertility or alternative family planning benefits. This analysis should include benchmarking against peer groups to ensure the offering is competitive as well as a cost-benefit analysis to account for the additional spend.
The healthcare system for women’s health is fragmented. The healthcare lifecycle for women is centered around one life stage – childbearing – during which years healthcare spend is considerably higher than for male counterparts (i.e., ages 19-44).3 However, women are experiencing poor outcomes across many health metrics.4 In addition, many women do not feel heard by their healthcare provider, especially women of color who experience considerable disparities in care and health outcomes.
Spring would encourage employers to think about women’s health as a priority and begin to track metrics against standards (i.e., preventive services, primary care, etc.). Thinking about women’s health without infertility at the center is important. Consider creative services around birthing (i.e., doula services), support postpartum (i.e., breast milk storage and shipping), and movement into menopause support. Perhaps most critical is working to support women seeking care and ensuring their voices are heard, a pivotal component in bettering health metrics for women.