5 Things to Ask Your Fertility Benefits Provider

Insight from Seth Garrison, Vice President, Client Solutions

Did you know your fertility benefits provider has info that can make your business better? In fact, they can help companies cut costs and improve the company culture.

If fertility benefits aren’t on your company’s radar, they should be.

Your fertility users may look like a small group, but the decisions they make around their treatment causes ripple effects across your organization.

Are You Doing Everything to Support Your Employees?

It’s important to realize your plan design directly influences what your members do. Before you finalize your benefit plan, you owe it to your company, your employees, and their families to ask, “are we doing everything that we can?”

No one person can be an expert on everything. Fertility is a unique part of the healthcare industry. Lean on your fertility benefits provider for industry-specific expertise.

Starting the Conversation

With this in mind, consult your fertility benefits provider to help push the conversation towards actionable results.

1.   How many families have we helped build this year?

It’s surprising how many Benefits Managers don’t know this number. It’s hard to know how effective your fertility program is unless you know the outcome – helping your employees start their families.

We have a responsibility to use corporate funds wisely and effectively. The following questions are helpful to frame the conversation.

How many people:

  • used your benefit this year?
  • were able to build their family within the limits of the program?
  • exhausted their benefit and had to go out-of-pocket?
  • exhausted their benefit and just gave up?

Check to see how your outcomes compare to the national averages.

Is your success rate low? Examine how you can update your program for the best outcomes for your business and employees.

2.   Are we excluding some people based on our policy design?

“Medical necessity” and “diagnosis of infertility” are common terms added to plan design documents (check the fine print).

On the surface, they may sound like reasonable conditions to place on the plan design. However, they also create barriers to care. They often require members to attempt “natural” pregnancy (i.e. heterosexual intercourse) for 10-12 months before their plan benefits kick in. Undeniably, this excludes single-parents and LGBTQ+ members.

If you have these conditions in your policy (or something similar), ask your fertility benefits provider how those terms are defined. How your members are affected?

Your fertility benefits provider should know who has been denied coverage and why. In any event, it’s time to reevaluate your plan if only some employees can access it. After all, they’re all paying the same premiums.

Contact leaders of your internal LGBTQ+ and single-parent communities to find out if your fertility program has a bad reputation.

Ask your fertility benefits provider to support you. They should provide materials and expertise to effectively communicate the benefit.

3.   How much are our members paying out-of-pocket?

Fertility treatment cycles can be expensive. In conventional plan designs, employers provide a dollar-based lifetime maximum to limit the plan’s financial risk.

These plan designs are short-sighted. Even with a generous dollar maximum, members often run out of benefits mid-treatment.

But people usually don’t give up. They find a way to get the family they’ve always wanted. For example, they may take on debt through personal loans, borrow from family, or max out a credit card.

The physical and financial strain has a direct impact on employee performance.

How much does a treatment cycle cost your members and your company? How likely is that treatment to result in a successful outcome?

Your fertility benefits provider should help you structure your program to reduce the stress on a member. The goal is to protect them from the unexpected costs that result from exhausting benefits.

4.   How many people are going through treatment right now?

This is a great way to gather existing data to find out how effective your fertility program is. First, start by finding how many people are currently undergoing treatment and follow their journey through your fertility benefit program.

How many people are:

  • receiving the education and levels of service that you expect?
  • getting the outcomes they want out of your program?
  • asking for support that you don’t currently provide?
  • sending in complaints about the benefit?

Second, listen to your employees. Direct member feedback is your line-of-sight to the most impactful ways to improve your members experience.

In addition, your fertility benefits provider should give comprehensive information on utilization and spend too.

5. What else can we do to help our members?

The fertility benefit landscape is always shifting. Treatment protocols change. Technologies improve. Resources develop. Expectations evolve.

Within the last five years, there have been significant developments around fertility treatments.

Does your fertility benefits provider use new technologies and resources?

Doctors and members are assured they are covered for treatment with a comprehensive fertility benefit. As a result, your members can make the best outcome-based decisions for their journey.

Furthermore, without unnecessary barriers to care, employers can provide an inclusive, supportive, and effective solution to all employees.

Above all, your members should have access to the best treatment options with top-of-the-line support along the way. Learn more about best practices in benefit design by downloading our whitepaper.