We know open enrollment is an important time of the year to learn more about your benefits and Progyny is here to help. We kicked off our special Open Enrollment Webinar Series with a focus on financial planning. Listen to the Financial Wellness and Your Progyny Benefit webinar, where we shed light on the financial aspects of fertility treatment and share what to expect when utilizing the Progyny benefit.
This webinar featured:
- Melissa Maldonado, VP of Client Operations at Progyny
- Emily Orlov, Patient Care Advocate (PCA) Supervisor at Progyny
- Edna Lorenzo, Care Team Expert at Wellthy
Understanding the Financial Aspect of Your Progyny Benefit
We understand that beginning or continuing any fertility journey can be overwhelming. It is important to understand the financial aspects and nuances of your specific coverage, whether that is through Progyny, or a separate benefit or health plan.
Through Progyny, eligible members have coverage through their employes as either a supplemental benefit integrated with certain medical plans, or as a separate benefit from their standard health insurance. Progyny members receive comprehensive coverage through their employers; however, they can still anticipate some financial responsibility, such as deductibles and coinsurance. Here are a few helpful definitions of the most commonly used financial terms to make it a little easier to understand:
- The cost of covered services is the amount billed by your doctor or healthcare facility.
- Your insured amount is the cost of covered services minus your deductible.
- Your premium is the amount deducted from your pay for your medical coverage. There is no additional premium through Progyny.
- At the start of each plan year, you will pay out-of-pocket for all medical services (including fertility services) until you reach your deductible.
- You and your medical plan both pay a percentage of your covered healthcare services once you’ve reached your deductible. This is called coinsurance.
- You may also be responsible for a copayment, which is a flat fee for certain services or prescriptions, determined by your medical plan.
- You and your medical plan continue to split the costs of your covered healthcare services until you reach your out-of-pocket maximum.
During open enrollment, we recommend reaching out to your employers’ benefits team to understand the financial responsibilities associated with each plan and confirm which of your plans may be eligible for the Progyny benefit. Keep an eye out for other resources available to support with finances. Some employers and health plans offer tax-favored benefits to help offset costs associated with care, such as HSA (Health Savings Account) and FSA (Flexible Spending Account) plans. HSA and FSA plans are sponsored by an employer and use pre-tax dollars. Reach out to your HR team to learn what may be available to you, and any considerations you should keep in mind when electing your benefits for the new year.
What to Expect with Progyny
When you contact Progyny for the first time, it is important to provide your Patient Care Advocate (PCA) with the insurance plan that you have elected for that year. Your PCA will review what your expected financial responsibility would be for specific services related to your treatment plan. At the end of that call, your PCA will walk you through an estimate of services that would contribute to your deductible, if applicable, and what costs you might be responsible for. As you move forward in your journey, you can expect to receive invoices from Progyny that explain the costs of services, and your PCA is always available to help with any questions you may have.
Additional Tools for Financial Planning
Your employer may offer additional benefits and tools to help you financially plan for a future family. For example, Wellthy is an employer-provided care concierge service designed to help tackle the logistical and administrative tasks, such as finances, associated with healthcare for both you and your family. Wellthy’s expert care professionals support families across all phases of life and can help you sort through various plans to prepare you for the family building journey. Reach out to your employer to see if you have access to Wellthy or another helpful financial service.
Questions from the Audience
I’ve called my PCA but haven’t taken the next step yet. How much will I have to pay if I just want to go to a doctor for an initial evaluation?
Call your PCA, who will break down the cost for an initial evaluation based on your plan’s deductible, co-insurance, and maximum out-of-pocket, and help answer any additional financial questions. Your PCA can help answer any question you might have about the benefit – at no cost.
Fertility treatments are expensive and the financial aspect is stressful. Are there resources or people who can help talk through it with me?
When you contact Progyny for the first time, your PCA will review financial responsibility. They will also send you an infographic that explains how you can enter in your plan’s information to learn your expected financial responsibility. Throughout your fertility journey, your PCA will be in contact with you to explain and answer any financial questions. If you have access to a tool such as Wellthy, they may be able to direct you to fertility-related grants that can help offset any out-of-pocket costs, as well as lead you to more resources about financial processes and savings.
If you are looking for more information around financial responsibility, check out our frequently asked questions page here. If you have any other questions related to this webinar, please don’t hesitate to reach out to education@progyny.com. If you are a Progyny member and have any questions about your fertility benefit or coverage, please call 888.597.5065.