September 07, 2023

Employer-sponsored fertility and family-forming benefits are fast emerging as an integral component of a comprehensive employee health and well-being benefit offering. According to the International Foundation of Employee Benefit Plans, the number of U.S. organizations offering fertility benefits has increased swiftly, from 30% in 2020 to 40% in 2022.² Expanding employer support for employees seeking to build their families corresponds to a growing need for reproductive health support as shown by a 2023 report from the World Health Organization (WHO), which reveals that one in six people globally experience infertility.¹ With significant advancements being made in the fertility treatment field, employers have a tremendous opportunity to continue to address this growing need and offset prohibitive medical costs by offering access to inclusive, evidence-based fertility and family-forming treatments and services.

 

The impacts of fertility benefits extend far beyond physical health. Financial, social and mental health challenges associated with infertility and navigating family-forming plans are also significant. Individuals and couples grappling with infertility often encounter various emotional challenges, including stigma, anxiety, depression, guilt, shame and heightened psychological stress.^4,5 Globally, 36% of employees facing fertility issues are confronted with stigma.⁶ Notably, employees in India (50%) and Mexico (42%) experience the highest levels of stigma.⁶ What’s more, one study assessing the psychological well-being among couples dealing with fertility suggests that this associated distress may influence fertility treatment outcomes.⁷

While infertility is something that can affect anyone, regardless of gender, marital status, socioeconomic level or geographic location, individuals from marginalized populations and other groups face disproportionate barriers to accessing fertility and family-forming resources.^8,9,10 Business Group on Health members, however, offer these benefits, as shown by its 2021 Quick Survey Findings: Family Benefits. Eighty-seven percent of participants stated that they offer fertility benefits to employees, while 90% of respondents reported that they offer equitable coverage of fertility benefits for all employees regardless of sexual orientation, gender identity or marital status where legally applicable.¹¹ Moreover, 20% of survey respondents address stigma of infertility by providing educational materials, communications and/or specific campaigns.¹¹ According to the Business Group’s 2024 Large Employer Health Care Strategy Survey, 66% of employer respondents in 2023 have expanded fertility benefits for all types of families, an additional 9% will expand fertility benefits in 2024 and another 11% are considering doing so for 2025/2026.

Disparities in access and outcomes are driven primarily by barriers such as the following:

• High treatment costs;
• Differences in coverage criteria/state mandates;
• Societal stigma;
• Legal considerations; and
• Varying cultural norms globally.^12,13

One study focusing on decision-making challenges for gay male couples using in vitro fertilization (IVF) reported that almost a third of participating couples had not engaged in adequate financial planning for costs associated with their treatment, resulting in delays of more than 2 years for 25.8% of participants.¹⁴ Another study notes that the cost burden for single men as well as gay couples is likely to be high due to often having to compensate both an egg donor as well as a gestational carrier when building their families.¹⁵

Cost barriers restricting access to fertility and family-forming treatments differ widely around the world depending on many factors, including insurance coverage criteria and/or mandated coverage that can vary by each state, region or country. In France, for example, IVF laws make it easier for single women and same-sex couples to access care by covering the cost of fertility benefits under their national health care system for all women aged 43 and younger.¹⁶ In contrast, in the U.S., most states do not require private insurers to provide fertility benefits. Given the reality that out-of-pocket costs for fertility treatments can easily exceed $10,000, a path to parenthood without coverage may be difficult.¹⁷

In recognition of these disparities, employers can continue to enhance their fertility and family-forming benefits by assessing coverage criteria and creating targeted initiatives to address inequities for LGBTQ+ individuals as well as other marginalized populations where legally possible. Moreover, through such efforts, employers can showcase their comprehensive benefit offerings to serve as a powerful tool for employee recruitment and retention and to foster a more diverse and inclusive workplace.

Emerging Trends Amplifying the Importance of Fertility and Family-forming Benefits

As employers strive to attract and retain talent, they are adapting their fertility and family-forming benefits to better meet the needs of employees. This involves creating comprehensive, inclusive and evidence-based designs. Importantly, this approach isn't limited to just the U.S. market; it extends across their global enterprise through a consistent benefits strategy.

Emerging trends for employers to keep in mind in their efforts to plan and design fertility and family-forming benefits include:

Meeting the needs of a changing workforce

As the workforce continues to evolve, attracting and retaining top talent has become increasingly challenging. Employees, particularly millennials and Generation Z, are interested in working for companies that offer inclusive benefits, including fertility and family-forming support.¹⁸

Survey research indicates that approximately:

A 2020 WTW survey reveals that employers are increasingly offering other family-building benefits (e.g., 29% of employer respondents are adding or enhancing surrogacy reimbursement) in efforts to increase equity for LGBTQ+ employees seeking to build a family.¹⁹ Providing inclusive support for all employees, including those facing infertility challenges, can help cultivate a more diverse and equitable workplace culture.

Reducing health care costs and improving outcomes

Historically, IVF has been known to lead to multiple births because of multiple embryo transfers. According to one study, the cost of having twins ($105,000) or higher-order multiples (>$400,000) is much greater than a singleton birth ($21,000).²⁰ Companies can help mitigate potential costs associated with high-risk maternity claims, premature births/neonatal care unit costs and other complications resulting from a multiples birth by offering evidence-based fertility benefits.²¹ For example, triplet and higher-order multiple birthrates have declined in recent years due to changes in assisted reproductive technology (ART) procedures that limit the number of embryos transferred.²² In the U.K., the source of funding can play a substantial role in birth outcomes, with patients in the private sector having a higher prevalence of multiple births compared to those using the public system.²³ In addition to improvements in technology, fertility benefits have been linked to decreased employee absenteeism, leading to improved productivity and reduced health care expenses. In fact, a 2016 consumer survey reveals that employee satisfaction is higher among employees pursuing IVF who have coverage provided through their employer relative to those without employer-provided IVF benefits.²⁴ These statistics highlight just some of the many compelling reasons for employers to consider prioritizing fertility benefits in employee health and well-being plan design.

A growing focus on global consistency strategy

Another trend amplifying the importance of fertility and family-forming benefits is a heightened focus on the implementation of a global consistency strategy.²⁵ Each country/state may have different rules and regulations regarding fertility and family-forming benefits that employers will have to thoughtfully navigate. When developing the global core benefit standard, employers can consider if they want to provide coverage based on a certain number of treatments vs, a set dollar amount and then evaluate if including this benefit complements what is available through the public system. In many cases, differing cultural norms and values around the world impact the level of access to care—creating a challenging situation for global employers seeking to drive global consistency and parity in benefit programs.

Employer Spotlights: Fertility and Family-forming Strategy

Morgan Stanley: In an effort to provide benefits more consistently across the globe, Morgan Stanley has undertaken a comprehensive review of its policies in the 40 countries where it operates. This review included an assessment of the regulatory environments of all their markets and local practices. The result was the establishment of a global minimum standard to ensure greater consistency. Understanding the challenges of delivering health care and other benefits globally, Morgan Stanley acknowledges the need to navigate through a lot of unevenness. The company’s goal is to achieve equity across the board. As a result, Morgan Stanley has increased its $30,000 lifetime benefit to support fertility regardless of infertility diagnosis to $75,000, which supports family-building options such as adoption, surrogacy and fertility treatments.

Ford Motor Company: To prioritize diversity, equity and inclusion and alleviate the financial burden associated with fertility treatments, adoption and surrogacy, Ford launched an equitable and inclusive family-forming program for their U.S. salaried employees. The new benefits offer fertility treatment and surrogacy reimbursement, as well as an expansion of the current adoption reimbursement benefit. Additionally, the company offers its employees access to a personal patient care advocate who guides and supports them every step of the way through their family-forming journey.

This Guide is for Business Group on Health members only. It should not be reproduced, distributed or quoted without permission from Business Group on Health

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