Are fertility issues covered by insurance? What employers need to know

As employers tailor their benefits offerings to attract and retain millennial and Gen Z talent, inclusive health plans and fertility benefits have become increasingly important. With many people waiting longer to have children, the "reproductive age workforce" continues to expand to include employees into their 40s.

As these employees age, challenges with fertility become a more common obstacle. Defined as the inability to achieve pregnancy with or without a partner, infertility affects one in eight people in the United States each year, and roughly one in six worldwide.

Fertility treatment becomes even more important through a diversity, equity, and inclusion lens, since challenges with fertility impact employees of all races, genders, and sexual orientations. Black and Latine people are more likely to experience infertility and have worse outcomes than their white counterparts, and 60% of LGBTQIA+ people plan to build their families using assisted reproductive technology (ART), surrogacy, or adoption. Even though many LGBTQIA+ couples want to grow their families, 63% of them can't because the costly treatments are not covered by traditional insurance policies.

Given the high cost of fertility and infertility treatments, these benefits often play a significant role in employee recruitment and retention. While 70% of millennials would change jobs to ensure they have fertility coverage, 61% of employees receiving fertility benefits from their employer feel more loyal to them.

Understanding fertility treatments and insurance basics

What are common fertility treatments?

Infertility treatment options depend on various factors, including the cause and duration of infertility, age, and personal preferences. For example, in cases of iatrogenic infertility, or medically induced infertility, often caused by radiation cancer treatments, people may opt to freeze their eggs or sperm in advance of these procedures.

For people with uteruses, doctors might prescribe fertility drugs to trigger or regulate ovulation. In a form of artificial insemination called intrauterine insemination, or IUI, healthy sperm are inserted into the uterus at optimal ovulating times, determined by menstrual cycles or fertility medications. Sperm can be provided by partners or donors.

In certain cases with types of scar tissue, polyps, and fibroids, infertility might be treated with a hysteroscopy and surgery.

Assisted reproductive technology, or ART, is any fertility treatment that handles both sperm and eggs. The most well-known ART technique is in vitro fertilization, or IVF, in which mature eggs are removed from the ovaries and fertilized with sperm in a lab. The fertilized eggs, known as embryos, are then placed back in the uterus. IVF often uses a couple's eggs and/or sperm, but single people or same-sex couples may opt to use donor eggs and/or sperm.

While IVF is by far the most common, other ART procedures include intrafallopian transfer, frozen embryo transfer (FET), and intracytoplasmic sperm injection (ICSI).

Overview of health insurance coverage

The Affordable Care Act (ACA) guarantees that health insurance plans cover at least the following health benefits:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Mental health and substance use disorder services, including behavioral health treatment
• Pediatric services, including oral and vision care (adult dental and vision aren’t mandated)
• Pregnancy, maternity, and newborn care
• Prescription drugs
• Preventive and wellness services (including shots and screening services) and chronic disease management
• Laboratory services
• Rehabilitative services and devices
• Birth control
• Breastfeeding services

The ACA also requires employers with at least 50 full-time employees to provide health insurance to their full-time staff. These employer-sponsored health plans provide healthcare coverage for nearly half of the United States.

Are fertility issues covered by insurance?

State laws and mandates

You may have noticed that health insurance policies are not required to provide fertility treatment coverage, and as such, many of them do not. However, 21 states and the District of Columbia require at least some infertility coverage, and seven more states are considering mandating some degree of fertility preservation and treatment this year. As of 2024, Colorado, Utah, Illinois, Delaware, New Jersey, New York, Connecticut, Rhode Island, New Hampshire, Maryland, and D.C. are the only places to require both IVF and fertility preservation services at the state level.

Variability in insurance policies

In addition to variance by state, infertility coverage varies greatly between different insurance companies and policies. Many major insurance companies offer different fertility benefits as add-ons, so employers must purchase them in order to provide them to their employees.

Infertility services are a common insurance exclusion, as are IVF services. For LGBTQIA+ people looking for fertility treatment, there are often even more barriers. Some states still require using the couple's own eggs and sperm (rather than a donor), thus excluding same-sex couples. These same laws can also exclude single parents of any gender or sexuality who also need a donor.

Key considerations for HR professionals

Evaluating insurance plans

The best way to determine if your insurance plan covers fertility treatment is to get a copy of the terms and details of the plan by reaching out to your representative at the health plan.

If infertility services are included in your plan, there might still be stipulations for insurance coverage, like undergoing a less expensive treatment like IUI before becoming eligible for IVF coverage. Additionally, some insurance plans effectively exclude LGBTQIA+ couples and single parents from coverage by requiring a medical infertility diagnosis in order to cover IVF.

If your company does have fertility insurance, here are some questions you can ask your insurance carrier to ensure that the plan is able to meet the needs of all employees: 

• Does the insurance cover fertility treatment and medications, either oral or injectable?
• Is there a separate cap for medical bills and pharmacy bills? 
• Do co-pays or co-insurance differ if employees see an in-network or out-of-network fertility provider? 
• Is pre-authorization required at any point in an employee’s fertility treatment? 
• Does this insurance cover telehealth appointments?
• How is infertility defined in the policy, and do my employees meet that definition? 
• Is a diagnosis of infertility a requirement? Does insurance cover the process of diagnosing infertility? 
• What are employees’ copayments for fertility services at a clinic? Is there a different copayment for fertility charges at a hospital? 
• What is the annual or lifetime maximum benefit for infertility treatment?
• Is there a limit on the number of IVF cycles?
• Does the insurance require the use of a specific lab or pharmacy?

It's also good to know state laws around fertility insurance coverage to make sure there aren't discrepancies between the insurance provider and state mandates.

Expanding fertility benefits beyond health insurance

With all of these limitations, exclusions, and stipulations, it's easy to see how most health insurance options do not offer sufficient coverage for fertility. Many of these stipulations are inherently exclusionary, with various state laws and individual insurance plans denying fertility services to LGBTQIA+ people and single parents.

Furthermore, many of these insurance benefits are not comprehensive enough to support people throughout their whole fertility journeys. Key components of fertility benefits include a vetted network of clinics and specialists, preconception care, easy expense management, and mental health support, along with reproductive medicine and treatments.

As companies work to close the gender pay gap and recruit and retain diverse talent, it's imperative to offer better, more comprehensive coverage for fertility that supports all employees regardless of gender identity or sexual orientation.

Maven provides inclusive, comprehensive support for all employees throughout the family journey by eliminating care gaps and creating better experiences for all. Maven members receive personalized, timely support from preconception to parenting and beyond, assisting them when they need it most. Employees receive a curated team of  healthcare specialists based on their preferences and have 24/7 virtual access to expert practitioners from mental health providers to nutritionists.

Case study: Employers who offer comprehensive fertility benefits

International law firm Cozen O'Connor initially offered fertility services through their employer medical plan. However, employees were still left with questions and inadequate coverage, adding additional confusion to an already emotional and challenging process.

Since launching Maven Managed Benefit in January 2024, over half of Cozen O’Connor employees in the Fertility & Family Building program have signed up for financial support through Maven Managed Benefit, with 70% of reimbursements covering fertility services and 30% covering egg freezing services.

Maven care teams help employees understand the full scope of their available family-building benefits and provide access to the highest quality clinics. Employees receive holistic support throughout their fertility journey from reproductive endocrinologists, nutritionists, mental health specialists, and adoption or surrogacy coaches. Additionally, employees can see all upcoming costs and their benefit balance on demand in the Maven app.

How to advocate for better fertility coverage

Building a business case

With 31% of the workforce currently expecting a child or planning to grow their family, comprehensive fertility benefits are more important than ever to attract and retain top talent. In a recent survey, 57% of employees have taken, or might take, a new job because another job offered better reproductive and family benefits. Employees also feel more loyal to their employers when they cover fertility care.

Since assisted reproductive technology (ART) is crucial for many LGBTQIA+ and single people looking to grow their families, these comprehensive family-building benefits become imperative to attract and retain diverse talent. A growing body of research shows how diversity and inclusion benefit businesses at every level, from better employee retention to higher profitability.

Communicating with employees

Once an employer has selected a comprehensive benefits solution that minimizes the number of vendors to manage, like Maven, it's important to communicate those updated benefits to employees. Communicating across a variety of channels—including email, office hours, Slack/intranet, and information sessions—is key for widespread usage.

Be sure to keep the conversation going with employees after the family-building benefits are up and running. Employee surveys, focus groups, and engagement metrics will show employee satisfaction and usage, as well as track program results.

How Maven can help

Offering comprehensive family-building benefits can be daunting, but you don't have to do it alone. Maven, the leading women's and family healthcare company, can be a valuable partner for your employees' family needs at every step of their journey.

We offer an integrated platform that provides clinical, emotional, and financial support all in one place. Your employees deserve care that is compassionate, knowledgeable, and accessible during some of the most vulnerable times in their lives, and Maven is here to help.

Find out more about offering fertility benefits with Maven and request a demo today.