When employers evaluate fertility benefits, it’s easy to compare covered services and costs. But coverage alone doesn’t determine outcomes. Benefit design shapes the care pathway that members follow, and ultimately influences their experience, clinical outcomes, and total cost of care.
Traditional fertility benefits often rely on rigid requirements, such as mandatory intrauterine insemination (IUI) cycles before in vitro fertilization (IVF), that don’t account for a member’s age, diagnosis, health history, or family building goals. While these requirements may appear to control expense, they can delay clinically appropriate treatment, affect outcomes, and ultimately increase downstream costs.
What does a “Right Care, Right Time” approach to benefit design look like?
Progyny’s “Right Care, Right Time” approach supports individualized, clinically guided care based on each member’s needs, their provider’s recommendations, and their goals.
Members are paired with a Progyny Care Advocate, who helps them clarify their goals, get answers to their questions, and access personalized education and support before treatment begins. Nearly 50% of Progyny members achieve their goals with this level of support alone—without fertility treatment.
For members who need additional care, treatment decisions are guided by clinical evidence and physician recommendations—not predetermined benefit requirements. Age, diagnosis, health history, and goals all help determine the most appropriate path, whether that’s continued preconception support, IUI, IVF, fertility preservation, or another option. This individualized approach helps members avoid unnecessary delays and reduces the emotional and financial costs of ineffective treatment plans.
The lowest-cost treatment isn’t always the lowest-cost path
A lower-cost treatment path can become a higher-cost journey when it leads to unsuccessful cycles, multiple births, NICU admissions, or other avoidable complications. When benefit design supports clinically appropriate care from the start, employers are better positioned to improve outcomes and support long-term cost management.
Employers also need visibility into how those care pathways translate into results. Transparent reporting helps them assess program performance and make more informed decisions about benefit design.
Download the Right Care, Right Time research brief to explore how fertility benefit requirements shape care pathways—and what employers should consider when evaluating outcomes and total cost of care.