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Why health plans should get ahead of mandated fertility coverage

By
Bill Friedman, Vice President of Health Plan Partnerships
umbrella icon representing health plans coverage
Mar 28, 2022
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Today, 19 states in the U.S. have mandates requiring large group insurers to provide fertility coverage. With more states considering legislation, it’s clear that this trend isn’t slowing down.

At the same time, current coverage isn’t necessarily meeting the needs of many members seeking care. Existing state mandates typically impose limits on access, such as requiring a diagnosis of infertility to qualify — a standard that is particularly onerous or impossible for same-sex couples and single-intending parents to meet. With 63% of LGBTQ+ couples and individuals planning to use assisted reproductive technology (ART) or adoption to grow their families, these rules create serious limits. Some states even require couples to have lived with infertility for five years before requiring coverage.

Health plans have an opportunity to both anticipate and exceed expectations by partnering with fertility solutions that provide comprehensive programs that support all fertility health journeys. Let’s look at some of the finer points of providing benefits that anticipate — rather than react to — growing demand for inclusive coverage.

1. The trend toward mandated fertility coverage isn’t slowing down

Since Maryland introduced the country’s first fertility mandate in 1984, 18 additional states have launched mandates, with more considering them. Several states that already had mandates in place have recently made changes that, in some cases, expand coverage and reduce restrictions.

Both self-insured employers and large groups have also accelerated fertility coverage in states with and without mandated coverage. For jumbo employers — those with 20,000 or more employees — coverage in 2021 almost reached the halfway point at 42%. Overall, employer coverage for IVF has increased almost 150% since 2018.

Whether through health plans or outside point solutions, groups are looking to meet specific goals by offering fertility benefits, including:

  • Ensuring employees have access to quality, cost-effective care (51%)
  • Staying competitive to recruit and retain top talent (51%)
  • Supporting diversity, equity, and inclusion efforts (40%)
  • Responding to employee requests (34%)

As groups continue to focus on recruitment and retention and expand their definition of comprehensive health coverage, fertility benefits will only become more common.

2. If health plan coverage doesn’t meet their needs, groups will look elsewhere

Employers want to provide fertility benefits to their employees — and if they don’t meet this need through their health plan, they will seek solutions elsewhere. According to a Mercer survey, 12% of employers that offer fertility benefits do so through a specialized vendor such as Carrot. For employers with 5,000 or more employees, that number rises to 50%.

Fertility coverage can be a powerful sales tool for health plans — if your solution meets the goals groups are setting. When you partner with the right solution, integrating fertility benefits into groups’ existing plans can create a straightforward experience for employers while providing the inclusive coverage they’re looking for. In addition, there is a tremendous benefit to the group and to the health plan in providing an integrated member experience instead of the disjointed process delivered by two non-integrated solutions.

3. Health plans can offer benefits beyond coverage — providing more inclusivity than mandates require.

Fertility mandates have slowly become more inclusive of same-sex couples, single-intending parents, and those with male-factor infertility. At the same time, most of the existing state mandates are written with an underlying assumption that the patient is part of a heterosexual relationship. Several mandates also preclude the coverage of donor gametes. Individuals are starting to push back against the restraints of these mandates and seeing results: in New York, insurers are now required to cover fertility treatments for those unable to get pregnant because of their sexual orientation or gender identity. Carriers have even faced legal and regulatory challenges by not providing equal and equitable access to care.

In order to meet the needs of all members, inclusive coverage should support fertility treatments without an infertility diagnosis, donor-assisted reproduction, gestational carrier journeys (commonly known as surrogacy), fertility preservation, and adoption. By partnering with a fertility solution designed to support diverse members, health plans can provide coverage that goes beyond mandates and helps groups reach diversity, equity, and inclusion (DEI) goals.

4. Fertility coverage with care navigation creates a better member experience.

Fertility and family-forming journeys can be complex and confusing. At Carrot, the most common question our care navigation team receives is, “where do I start?” Comprehensive care navigation improves the member experience and guides members toward appropriate care.

Fertility solutions are already experts in the clinical, legal, and emotional aspects of fertility and family forming. For example, a same-sex female couple may need support understanding the legal side of sperm donation and identifying an LGBTQ+-inclusive fertility clinic in their area. A fertility solution like Carrot that already has experience in this space can easily guide members to supportive resources and create a positive member experience or create a hand-off back to the health plan for utilization management and clinical oversight.

5. Adding fertility coverage doesn’t have to increase costs

Cost is one concern brought up by both employers and health plans, especially since many associate in vitro fertilization (IVF) with costly multiple births. However, the vast majority of survey respondents — 97% — say that adding infertility coverage did not result in a significant increase in medical plan cost. Care navigation, in particular, can help mitigate costs and guide members toward single embryo transfer, prenatal care, and other resources that contribute to healthier pregnancies and better outcomes with fewer complications.

Health plans that are late to the game miss out on a powerful sales tool and the opportunity to expand impactful, supportive coverage to members. By partnering with fertility solutions that are already inclusive and have robust care navigation teams ready to support members, health plans can meet — and exceed — the needs of today’s groups.

Read more about assessing fertility benefits in our Fertility buyer’s guide for health plans.

Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical advice, diagnosis, or treatment. Carrot Fertility makes no representations or warranties and expressly disclaims any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app.
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