Comprehensive coverage for building families

As more Americans look for help starting a family, plan sponsors have responded by expanding fertility coverage and family-building services. 

In 2021, the number of large employers launching or enhancing a family-building benefit grew 8% over the previous year, a study by family-building education company FertilityIQ found.

Today’s employees are looking beyond a limited benefit. They expect end-to-end fertility coverage, as well as support or referrals for fertility preservation, adoption, and third-party reproduction services, including gestational carrier services.

Answering the need for fertility treatment

Infertility remains a common problem in the United States. Among married women of reproductive age with no prior births, nearly one in five is unable to get pregnant after trying for a year, according to the Centers for Disease Control and Prevention (CDC).

A comprehensive fertility benefit frees patients from the financial limitations, clinical risks, and emotional stress that may come with limited coverage. Patients are more likely to base decisions on clinical recommendations rather than concerns about running out of funds.

With a comprehensive fertility benefit, patients may have access to a fertility advisor, a network of high-quality providers, and a fertility-focused pharmacy. With a limited fertility benefit, patients have fewer personalized resources, a limited provider network, and less support.

Patient fertility journeys: limited vs. comprehensive benefits

The experiences of Susan and Diana, two hypothetical patients trying to conceive, illustrate the differences between the types of benefits.

Although they both went on to deliver children, Susan, who had a limited fertility benefit, had a more difficult journey than Diana, who had a comprehensive fertility benefit. Here’s a glimpse into their respective experiences:

• Susan dealt with a 22-month process fraught with delays and uncertainty. By contrast, Diana’s experience lasted 15 months.
• As Susan explored treatment options online, she encountered conflicting information that left her confused. Meanwhile, Diana was in touch with a fertility advisor who directed her to reliable resources.
• Neither Susan’s doctor nor plan objected when she asked for the transfer of two embryos. She went on to deliver twins, while Diana delivered a single baby.
• Susan encountered greater costs than Diana – both in terms of what she paid out of pocket and what her plan paid.

As Susan and Diana’s experiences show, a comprehensive fertility benefit can improve outcomes and reduce costs for both the individual and the plan sponsor.

Expanding fertility coverage

Organizations that want to attract employees in a competitive hiring market should consider offering a comprehensive fertility benefit, along with family-building services.

They should also look for inclusive benefits that don’t limit treatment based on the need for an infertility diagnosis. Language in some traditional plans may hinder LGBTQ+ or elective single parents from getting treatment.

To meet the need for end-to-end coverage, Evernorth’s integrated family-building benefit FamilyPath^SM partnered with Progyny, a fertility benefits management company. FamilyPath now provides a comprehensive fertility benefit and family-building services plan.

“For plan sponsors, a comprehensive benefit means you’re offering your employees a full episode of family building care that provides coverage and support beginning at preconception and enables patients to follow their Board-Certified physician’s evidence-based treatment recommendations, the first time. This in turn, increases their likelihood of a healthy pregnancy and birth, and lowers stress levels” said Julie Stadlbauer, EVP of Strategic Sales and Partnerships.