Key Benefit Components

Fertility Toolkit

Benefit Plan Designs: Key Benefit Components

Here are the key components of a managed fertility and family building benefit:

  • Accessible to all members: Employers should ensure that all members are able to access the benefit and that no populations within their workforce are excluded. It’s important to evaluate plan design and language to ensure there are no precertification or medical diagnosis requirements that would discriminate against individuals without a partner and LGBTQ+ members.
  • Dedicated support: For many, the path to parenthood is not easy and it can be a physically and emotionally taxing process. It’s important to offer dedicated and personalized support that provides clinical education and guidance, emotional support and directs members to high quality care.
  • Culturally competent care: Every path to parenthood is unique and there are many cultural factors that can influence a person’s fertility and family building experience. It’s important to ensure that members have access to fertility advocates who can provide culturally competent education, personalized guidance and emotional support.
  • High quality provider network: It is important that members have access to high quality care through a managed network of reproductive endocrinologists. Provider choice is critical to the member experience, and individuals should have access to providers of their choice with the specialties they need for their unique situation. Consider how your benefit provider is supporting best clinical practices and managing high-performing clinics.
  • Demonstrated clinical outcomes: Clinical outcomes are the biggest indicators of fertility and family building benefits success and the most critical driver of overall program savings and member satisfaction. Fertility clinics in the U.S. report data to the CDC on the assisted reproductive technology (ART) cycles started and completed in their clinics and the outcomes of these cycles, during each calendar year. It is important to review the program’s impact on the fertility benchmarks that will support greater pregnancy success and a healthy, singleton pregnancy, including:
    • Pregnancy rate per IVF transfer
    • Miscarriage rate
    • Live birth rate
    • Multiples rate
    • Single embryo transfer rate.
  • Reporting: Your fertility vendor should provide actual outcomes (not projections) specific to the member population that are compared to CDC data.