Fertility benefits have become a major weapon in the war for talent

Among those looking for fertility benefits, workers say coverage for adoption, fertility medications, and IVF treatments are the most important offerings, according to the Harris Poll survey. 

Employer-sponsored fertility benefits encompass a wide array of perks and health-care options — from covering an initial fertility consultation to providing reimbursement for IVF. But these programs are not all created equal, and that can mean a big difference in the out-of-pocket costs for employees. 

The average lifetime total cost of fertility benefits provided by employers is about $36,000, according to fertility education site FertilityIQ. While that might seem like a lot, a single IVF cycle can cost upwards of $16,000 — and that typically doesn't factor in the cost of medications, anesthesia, embryo biopsies and storage, or the frozen embryo transfer. Not to mention that most patients need two or three cycles to become pregnant. 

Chicago-based cloud software platform ActiveCampaign offers its employees unlimited fertility benefits covering artificial insemination and IVF, as well as modified versions of IVF including gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT). 

“What we're trying to do is proactively look for things that will help our employees,” Michael Rico, ActiveCampaign's chief people officer, tells Fortune.

But it’s a rare for workers to have access to the kind of comprehensive fertility benefits offered by ActiveCampaign. Only 6% of workers surveyed by Harris reported they currently have some type of fertility benefit. HR experts think that will change in the near future.

“Any large company that's not offering a fertility benefit, wants to. They're just trying to make the economics work,” says Jake Anderson-Bialis, co-founder and CEO of FertilityIQ. He expects that over the next 18 months, any big companies that currently don’t offer these benefits will get onboard. 

Still, with programs varying so dramatically from company to company, it's crucial for employees to really understand the benefits offered. 

Don’t just focus on fertility options

When comparing employer-sponsored fertility benefits, review the whole suite of family-building options being offered. “Many people who look at fertility treatment, also look at other forms of family building,” Anderson-Bialis says, including adoption and surrogacy.

And those options may not be covered at the same rates. For example, a company that offers $50,000 to cover fertility treatments will only pay $10,000 toward adoption costs. In many cases, surrogacy and donor eggs don’t qualify as a medical benefit, which means there may be coverage restrictions. 

Generally, the cost of fertility treatments and adoption expenses can be about the same, but many times the coverage varies dramatically, Anderson-Bialis says. 

Look beyond the total dollar coverage 

Unlike ActiveCampaign, some companies set a limit on the lifetime fertility benefits coverage they provide. While the cap might seem high, with limits sometimes topping $100,000, Anderson-Bialis says many workers are still paying a lot out-of-pocket. 

“When an employer says they offer fertility benefits, be sure to ask questions to clarify the scope of the coverage. Believe it or not, some policies only cover the diagnosis of infertility but stop coverage once there is a diagnosis of infertility," says Betsy Campbell, chief engagement officer for RESOLVE, the National Infertility Association.

Many programs still have co-pays and coinsurance. On some plans, workers may, for example, have to cover the first $5,000 or even $10,000 of any medical expenses before the policy kicks in. Some programs don’t cover the cost of medications or only offer co-insurance, which could leave employees paying a significant portion of their drug costs out of pocket, which can average between $2,000 and $5,000 per cycle.

Additionally, many fertility specialists and clinics recommend add-ons that aren’t covered by insurance or fertility-benefit programs, such as genetic testing. 

“When people think, ‘Oh, I've got $50,000 of coverage, so that first $50,000 of bills, I'm not going to be responsible for that.’ and then that's not the reality. I think that sneaks up on employees, and frankly, it drives them crazy,” Anderson-Bialis says. 

Accessibility is key

Another limitation is the accessibility of the plan. Job candidates who are interested in fertility benefits should be asking potential employers what they need to do to qualify for these programs. Do they need to work for the company for a certain period of time? Are there medical conditions they need to demonstrate they have before coverage applies?

And workers should ask about any plan restrictions. If there are age restrictions, for example, or caps on the number of cycles a patient can undergo or even which clinics are covered, Campbell says. Also important: Does the plan mandate patients undergo certain treatments before moving on to IVF? It can be standard for some programs to require patients try less invasive options first. For some aspiring parents, this is helpful — but not always.

“It frankly wastes a lot of time and money before you're deemed worthy to get treatments covered,” argues Anderson-Bialis. 

For employees who identify as LGBTQ+ or are single and trying to have a baby, there's a very good chance they will never be able to access fertility benefits, Anderson-Bialis says. “Traditionally, the way policies are written is you need to have six to 12 months of heterosexual intercourse to prove that you are not fertile,” he says. This makes for a higher bar of entry for an unpartnered heterosexual person, and an impossible task for someone in a same-sex relationship. 

"Many policies still use a heteronormative definition of infertility based on heterosexual intercourse, so it’s important that fertility policies are inclusive of the LGBTQ+ community and unpartnered individuals," Campbell adds.

This is a point of conflict between employers and insurance companies, Anderson-Bialis says. “It's something employers battle over because [they] are embarrassed that their policies don't cover these things equally.”

Don’t just chase the latest and greatest fertility benefit

Just because a fertility treatment exists and is covered by your employer doesn’t mean it's appropriate for everybody. Egg freezing benefits are a good example of this. “Most women who freeze their eggs never return to use those frozen eggs,” Anderson-Bialis says. 

In some cases, it’s because they don’t need them. But many times, it’s because it can be extremely complicated to manage those frozen eggs over a long period — especially if women change jobs. Often, the way the policies are written, the benefit covers the medication needed to produce excess eggs, the retrieval, and the storage for a year or so. 

If a woman changes jobs, it’s unlikely that her new fertility benefits will allow her to use any of her previously frozen eggs. Typically, fertility treatment coverage doesn't apply to a cycle that predates your employment. 

Moving to a different state also creates complications. Most clinics won't accept eggs from somewhere else. So women may have to travel back to their original clinic and continue the process there, even if it’s now across the country. 

Many clinics also don’t have a lot of experience working with using frozen eggs. “You've got to be very careful which clinic you go to because only few have a [proven] track record, and if you return to use your frozen eggs, you'll probably be the test pilot in a lot of clinics,” Anderson-Bialis says. 

With all these limitations, fertility benefits can be something like golden handcuffs. When employees find a plan that meets their needs, it can be in their best interest to stay with that employer until the baby arrives.

“Paying for fertility treatment is super expensive,” Anderson-Bialis says. But while employer-sponsored benefits can defray some of those costs; workers need to understand that it may not be a silver-bullet, cost-free solution they thought they were promised.