Fertility Coverage: What to Expect

When you start a new job and HR hands over the large packet of benefits information, do you look in great detail at the medical benefits offered? Most people look at the deductible and out of pocket amounts when choosing between offered plans, but how often do you inquire about the fertility benefit and why you should start.

While some companies offer fertility benefit, there is often a lot of red tape, filled with dollar maximums, cycle maximums, complex pre-authorizations, and limitations to the benefit, leaving many patients financially and emotionally strained. Some plans require patients to meet specific conditions to be considered “infertile”, which can leave out an entire population of single females and same sex couples who will not fall under the traditional definition of infertility to access benefit.

Insurance Options

Other businesses and companies realize that the population is becoming more fertility aware, and promote the fertility benefit offered to attract and retain employees. Companies like Apple, Facebook, and Intel offer expansive fertility benefit and even include egg freezing for their female employees, realizing that they can retain these qualified employees, who might otherwise leave the workforce earlier to start their families. There are some companies, like Starbucks and Amazon, that even offer fertility benefit to their part-time employees.

Fertility Coverage 

Fertility coverage is growing among businesses and industries as fertility treatment becomes more prevalent among our population. There are a total of 17 states that have mandated fertility coverage of some kind. The American Society of Reproductive Medicine has an online database that keeps track of state infertility insurance laws (found here). If a business is self-insured, it may not have to follow the state mandates, but that does not preclude it from offering fertility benefit of some kind. Employers that are not self-insured have less control over the plan fertility benefit, but that may work in employees’ favor, depending on the size and location of the company.

The easiest way to find out what your insurance plan covers is to contact your insurance carrier. You can find a list of questions to ask here (link to the questions to ask your insurance PDF).

Research Insurance Plans 

If your plan does not have any fertility coverage or coverage is limited, sit down and talk to your HR department. See if there is anything that can be done in the next plan year for expanded coverage. If your company doesn’t offer any concessions or solutions, it may be time to look at other similar positions with other companies who may offer additional benefits. Though a difficult choice to make, sometimes this can be a better option than dealing with the stress of paying for fertility treatments out of pocket.

Whatever your insurance situation, you do not have to be alone in navigating this. Call your insurance company or your physician’s office and see if an insurance coordinator or patient representative can help you understand your benefit more clearly. If you are determined to go through fertility treatment with the hopes of starting or growing your family, there is always a way.