Compliance and communication best practices for fertility and family building benefits

Employee adding notices to a bulletin board

The prevalence of infertility is on the rise. The World Health Organization released data in 2023 citing that 17.5% of people – 1 in 6 – experience infertility. This is an issue that impacts everyone: 

  • 1/3 of fertility issues are male factor 
  • Black women are 2x likely to be diagnosed with fertility issues, but less likely to seek medical help compared to white women 
  • 2/3 of LGBTQ+ individuals report needing reproductive technology, surrogacy, or adoption support 
  • 68% of adults would switch jobs for better family building benefits 

No two fertility journeys are alike – the reason for pursuing treatment, the process involved, the logistics, the health impact, and the costs vary from person to person, place to place, and treatment to treatment. The journey of someone pursuing fertility preservation before undergoing cancer therapy will look different than that of a couple starting IVF, and it’s necessary to provide equal support for unequal paths.  

So, how does an organization get started on the path to offering a fertility and family benefit that works for everyone? It begins with legally compliant benefits and clear, easily accessible benefit communications.    

Compliance considerations and best practices to optimize the member experience

The first step is to understand how state and federal regulations establish compliance standards for fertility benefits. This ensures your benefit is adhering to regulations designed to maximize access from the outset. 

Once you’ve chosen a fertility and family building benefit to meet the needs of your organization, the critical next step is clearly explaining the benefits to your employee population.  

When a participant is ready to use a benefit, the responsibility shifts to them to activate it. During a time filled with life-changing decisions, juggling multiple doctor’s appointments, and potentially taking medications that impact health and mood – the last thing a person undergoing fertility care needs is confusion or frustration with the activation of benefits.  

Many companies distribute benefit communications via a corporate site or an app, and that’s incredibly helpful to employees. Providing appropriate, easy-to-find information can make a stressful journey much easier. A great place to start is by organizing information from your plan documents that need to be available in your Summary Plan Description.  

Summary Plan Description (SPD) 
Document that a plan participant uses to understand their coverage journey. This should be easy to understand and clearly summarize the key features and responsibilities of the plan participant.  

Let’s look at a real-world example: if someone is going through IVF, their doctor isn’t going to detail treatments or procedures covered under their patient’s medical plan. If this individual has access to Progyny, they will have a dedicated Patient Care Advocate to help them understand exactly what is and is not covered. But for individuals who don’t have PCA support, the plan participant will need to rely on their Summary Plan Document to understand their treatment coverage, coverage for required medication, co-pays, and the cost of co-insurance. 

If your Summary Plan Document isn’t up to date, participants may receive bills they weren’t anticipating or don’t understand. They may even be denied coverage in the worst-case scenario, which impacts their financial and emotional wellbeing and negatively impacts the HR function in your organization. It’s critical that your SPD provides comprehensive, up-to-date information to be compliant with ERISA, benefit the plan participant, and mitigate stress and roadblocks along their journey. 

Best-in class benefits will also offer strategic communications plans, toolkits for training your HR team, webinars, educational content, and other resources to drive awareness and keep your members informed about their benefit.  

Additional best practices for compliance and communication

  • Routinely review legal documents to make sure there’s no contradictory information or information that is out of date with current events (i.e. changing IRS policies or new medical definitions). There’s no “set it and forget it” with initiating a benefit – this information must be updated every year. 
  • Send out appropriate legal notices, which have different required cadences  
  • Communicate the process for initiating appeals in clear terms 
  • Incorporate financial literacy and education into messaging 
  • Educate on the importance of staying abreast of benefit details 
  • Rely on your vendor to alleviate sticking points and maximize efficiencies 
  • When in doubt, ask counsel about how laws impact you 

If there’s one thing to take away on communication best practices, it’s to meet employees where they are. Find the cadence for communication that works for your population, and keep track of what channels are being used most frequently by employees to optimize accordingly. Explore new opportunities to communicate: Can you leverage an employee resource group to spread the word about benefits? Are you making announcements and giving reminders in your all-hands meetings? Just because information is easily available doesn’t necessarily mean it’s being found, and testing multiple channels to reach people is a great strategy for success.

Want to learn more about compliance considerations and how they may impact your benefits strategy? Watch our webinar: The Compliance Puzzle – Legal Realities and Implications That Influence Family Building Benefits.

Ready to learn more about how Progyny helps employers and health plans create equitable benefit packages to support individuals throughout their health journeys?