Fertility Benefit Plan

Fertility Toolkit

There are a variety of fertility and family building benefit solutions on the market that may be offered through a health plan or by a vendor. Each solution varies in plan design, provider access, member experience, pregnancy outcomes, and cost.

  • Dollar lifetime maximum or financial benefit
    • Many companies have historically provided a dollar maximum coverage amount for medical and/or pharmacy. Individuals will be covered for treatment amounts up to their provided lifetime maximum. These can range anywhere from $5,000-$100,000+ and covered services/treatment options vary depending on the plan.
    • These plan designs have traditionally required precertification or a diagnosis of infertility, and the dollar limits typically fail to cover the cost of the treatment an individual may need.
    • Dollar limited plans leave individuals struggling to track fee-for-service claims and multiple explanation of benefits and may prompt them to make treatment decisions based on cost instead of outcomes.
    • While most carrier-based plans offer fertility benefits as a pre-tax benefit, some outside vendor plans are only able to to provide a post-tax benefit.
  • Cycle-based solutions
    • This may include bundling provider and laboratory services into a cycle that makes it easier to understand treatment and coverage options and ensure that coverage is not exhausted mid-treatment.
    • Plans vary widely in what a cycle includes so it is important for members to understand what is and isn’t included to adequately compare plans and ensure access to all necessary treatments and technologies.

In conjunction with these benefits, employers may also choose to provide reimbursement programs for adoption and/or surrogacy. Employers may choose to provide a specific amount of money for eligible expenses. Employers may administer these benefits on their own or may rely on a vendor for processing and administration.  

Employers may also consider other family friendly perks like telehealth or digital solutions. In an increasingly virtual world, these types of products provide patients with access to education and/or a variety of health care providers focused on fertility, maternity and parenting.

Evaluating Fertility and Family Building Vendors

Key Benefit Components

Case Studies