Episode 99: Fighting for Fertility Coverage: Benefits Consultants Taking the Lead
It’s National Infertility Awareness Week (NIAW), and Progyny is hosting a six-part series of back-to-back episodes featuring several experts who are fighting for fertility coverage. Our goal is to educate others on how they can advocate for themselves and ask for the support that’s needed from their employer or state to build the family of their dreams.
This episode will dive into how benefits consultants can help drive this change. Elaine-Marie Cannella, from Willis Towers Watson, recognizes that providing employees with the benefits they need to be fulfilled and to lead healthy lives is extremely important. All too often, fertility benefits are overlooked. It’s seen as expensive and unnecessary when in reality, people are silently struggling to make ends meet for treatment and medication, which ultimately can crossover into the workplace. So how do you get your employer to listen? In this episode and our special NIAW series, you’ll learn how to approach your employer with facts and research that can’t be ignored.
Guest: Elaine-Marie Cannella, RN, BSN, MSN, Willis Towers Watson
Host: Dan Bulger
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Here are some highlights from this episode:
The Four Pillars of Well-Being
16:34 – 18:30
Elaine-Marie Cannella: We have the physical, the social, the emotional, and the financial four pillars of well-being. In each pillar, it addresses different avenues, or different things that affect an employee. For example, the physical pillar will frequently look to a client’s offering of how they keep people fit. The social aspect of the well-being pillar is in the workplace, which is quite different today than it was a year ago. But in the workplace, what does the employer have that aligns commonalities to their employees? For example, do they have an LGBTQ+ organization that has a voice up through the people place, up through the HR place. In each one of those pillars there’s different facets of solutions that the employer puts in place to address that. And quite frequently, what we’re asked to do from a well-being perspective is a full inventory of the different things that an employer may have in place that fall within each one of those pillars. But here’s the really good stuff. The really good stuff is holistically, I am a clinician and I look at a person holistically. So how does it all connect? What’s the connectedness of all those pillars sort of coming together and bringing the employee to the center of those pillars? That’s the cool stuff.
Why don’t all Employers Offer Fertility Coverage?
20:40 – 22:30
Dan Bulger: You’ve just heard a lot of really great reasons on why an employer would choose to offer robust fertility coverage for their employees. As you see, when a benefit is well designed, it actually can solve a lot of problems for the employer. But then you may ask yourself, why don’t all employers just start offering this kind of fertility coverage right now? Why isn’t it just automatic for employers to go forward? At Progyny, we ask ourselves that question all the time. But there are some misconceptions that employers have about coverage that can keep them from pulling the trigger. The biggest such misconception in Elaine’s eyes is what we’ll refer to as the floodgate scenario. This idea that by offering the benefits, suddenly the entire workforce will start getting these treatments and the cost will balloon out of control.
Elaine-Marie Cannella: So, if I open up the floodgates, how much utilization is there going to be? And I think that’s the first sort of hurdle for employers to get past. So, we frequently look at the previous experience or utilization. And it really isn’t apples to apples, quite honestly, because the previous lifetime max design was typically accompanied by medical necessity. So, you had to actually have a diagnosis of infertility. And that really sort of stopped people right at the gate. And so the question is, if I open the gate, you know, how is this going to impact my cost? And that’s why I go back to a truly comprehensive solution that will accomplish both managing the cost, promoting the positive outcomes, and affording the utilization that’s necessary for all employees.
Dan has been in the healthcare industry for the last six years as a multimedia content producer. Better known as ‘Video Dan’ he as interviewed numerous doctors, patients and other experts in the world of fertility. He’s also the producer for this podcast, This is Infertility. On a personal note Dan’s parents started fostering kids when he was four years old, and he considers himself a proud older brother to over 100 foster children.
Elaine Cannellais a Directorinthe Metro NY Health Management (HM) Practice supporting the Health and Group Benefits (HGB) Practice. She is the East Division Business Development ClinicianLead aligned to both carrier and vendor relationships inthe northeast. Herareas of expertise include benefit strategy, design, alternative care delivery modelsand operational carrier performance inclusive of care, disease, utilization management and holistic wellbeing programs. She prides her practice onhealth careprogram performance, utilization trends and customized strategy alignment to the overall population health. Ms. Cannellahas more than 25years in the health benefits spaceand 10 years previous to that inthe clinician role.She is a Family Clinical Nurse Specialist and a former Army Nurse Corp Captain-Reserves. She served on the Tricare Utilization Management Advisory Committee at Health Affairs in Washington DCduringthe Region 1 contracting process. She continues to be an active participant in the managed care nursing arena. Before joining Willis Towers Watsonin 2018, Ms.Cannellawas a 13 year United HealthGroupveteran serving as National Vice President overseeing a team responsible for liaisingand supporting 26Medicaid/Medicare health plans in the US. Prior to that, she served as Sr. Director on the National Accounts team overseeing the delivery of Optum clinical services/products to United Healthcare’s largest national clients. Ms. Cannellahasa BSN.in nursing from Mt. St. Mary College, Newburgh, NY and a MSN in Family Healthfrom Mercy College, Dobbs Ferry, NY.