Supporting Families Optimizing Employee Fertility Benefits
Event Participants
Introduction
Companies are increasingly viewing fertility benefits as a strategic tool for increasing employee satisfaction and well-being. As organizations strive to offer more comprehensive support for employees’ personal and family goals, the inclusion of fertility benefits has emerged as a key differentiator, especially in competitive industries.
On September 5, 2024, the Pharmacy Benefit Management Institute® (PBMI) convened a panel of employers to discuss challenges and strategies regarding employee fertility benefits. The event was moderated by Jeffrey D. Dunn, Pharm.D., MBA, president and CEO of the Cooperative Benefits Group. This PBMI supplement recapitulates key findings from the roundtable.
The Role of Fertility Benefits in Employee Well-Being Initiatives
Panelists began the conversation by agreeing that fertility benefits align naturally with broader employee well-being initiatives. In particular, these benefits address the evolving needs of today’s workforce, which increasingly prioritizes work-life balance and family planning support when evaluating employers.
Panelist Lucy Avsharyan, the global vice president of benefits for a Beverly Hills-based media and entertainment company, raised the issue of how fertility services are often excluded from traditional medical coverage. “The insurance carriers consider [life-threatening conditions] medically necessary, but they don’t see fertility the same,” she stated, describing how it falls to the employer to support their employees with fertility benefit coverage. This comment sparked a broader conversation regarding the role of employers in filling the gap left by insurance providers, further underscoring the importance of corporate responsibility in employee health and well-being. Other panelists, including Karen van Caulil and Rosa Nova, emphasized that their payer perspective is self-funded, with the insurance company acting as a third-party administrator. Their experiences reflect the reality many organizations face–having to make strategic decisions to support employees in ways that go beyond the standard healthcare offerings.
Panelists conveyed that by providing fertility benefits, employers can demonstrate their commitment to the personal and family goals of their workforce, reinforcing their overall employee value proposition. Ms. Nova, who represents employees for Miami-Dade County Public Schools, the third-largest school district in the nation, highlighted that societal and legislative trends are signaling that fertility care may soon move from being a company-specific offering to a standard expectation. “This is an important topic, because today, it is not only an active conversation within the healthcare industry,” she noted, “but it seems to be in the news every day, and…next year [it] may be a requirement for employers to cover it.” This growing public awareness highlights the shift in how fertility care is perceived–not just as a medical benefit, but as part of a holistic approach to supporting employee wellness.
Assessing the Current State of Employee Fertility Benefits
As the conversation continued, panelists discussed whether their organizations incorporated fertility care into their benefit offerings. The panelists acknowledged that there are challenges with employee fertility benefits due to several key factors including differing organizational priorities, varying interpretations of what constitutes fertility healthcare and the complex nature of fertility treatments themselves. Their answers reflected a spectrum of practices and a nuanced view of how different companies view fertility benefits, emphasizing that there is no one-size-fits-all solution to approaching fertility benefit management.
Defining Fertility Benefits
The panelists agreed that there is significant misalignment on defining fertility benefits among employer groups, reflecting the diverse and evolving needs of today’s workforce. This lack of consistency complicates the conversation about what exactly should be included under the umbrella of fertility or family planning benefits.
For some organizations, fertility benefits may focus on traditional treatments like in vitro fertilization (IVF) or intrauterine insemination (IUI), while others expand their offerings to include adoption assistance or surrogacy support. One panelist, Mike Stancil, the president and CEO of the Pittsburgh Business Group on Health, captured the issue by explaining the shift in terminology that many organizations are beginning to adopt. “We started using the phrase ‘family-forming benefits,’ because that encapsulates what is actually happening,” he noted. “It’s any benefit that allows the benefit recipient to create the family that they envision.” This broader definition acknowledges that family formation goes beyond traditional fertility treatments and includes a range of services that are critical to addressing the diverse ways people build their families.
Tailoring Fertility Benefits to Reflect Organizational Values
Each organization approaches fertility benefits through the lens of its own distinct values and goals, which contributes to the significant variance in how these benefits are structured. Employers may choose to align fertility benefits with their organizational values due to moral or religious affiliations, and panelists regarded this as an essential, yet often overlooked, aspect of the broader conversation.
As Dr. van Caulil, the president and CEO of the Florida Alliance for Healthcare Value, noted during the discussion that this perspective is especially relevant for religious organizations, as these entities may feel ethically opposed to certain fertility treatments, such as IVF, that conflicts with their religious beliefs about conception and life. For these organizations, the challenge becomes finding a solution that adheres to their moral or religious frameworks while offering family planning support that still respects the diverse needs of their employees. In such cases, employers might choose to focus on benefits that align more closely with their values, such as offering adoption assistance, fertility diagnostics or even counseling services rather than covering treatments that involve more advanced reproductive technologies.
Other panelists agreed that the scope of fertility benefits offered often correlates directly with the employer’s perception of the broader cultural and social factors that influence an employee’s ability to build a family. Mr. Stancil emphasized this point, noting that the benefits offered “fit the personality of the employer.”
Complexities in Selecting a Vendor
Selecting a vendor for fertility benefits is a complex process that requires organizations to carefully balance a variety of factors including customizability and member experience. The roundtable panelists discussed the intricacies of this decision-making process, emphasizing how each organization must navigate unique challenges based on the needs of its workforce.
As Dr. van Caulil mentioned during the discussion, “Each company is attacking it differently depending on their plan’s members.” Vendors must be able to customize their offerings to meet the unique cultural and demographic needs of an employee population, making the selection process highly individualized and complex. Ms. Nova echoed this sentiment, noting that her employees’ needs are not met by off-the-shelf packages. She emphasized that her role involves “understanding the individual’s behavior journey so that I can design a plan and then try to find a vendor that can offer it.”
Customization is paramount to program success for Mr. Stancil, too. “When our [employer] members are looking [at] and approaching family-forming benefits, they typically end up going for one of these large, aggregated vendors that offer a full suite of services,” he explained. Such vendors often cater to large organizations with 20,000 or more employees, offering wide-ranging packages that allow employers to pick and choose services. Panelists raised concerns for smaller employer groups who may struggle to find vendors that provide flexible, scalable services suited to their size, forcing them to either opt for a limited set of services or to stretch resources thin so as to offer comprehensive benefits. This mismatch between vendor offerings and the needs of smaller employers creates a significant barrier in providing the same level of fertility benefits that larger companies can more easily implement.
In addition to being able to tailor fertility offerings, panelists agreed that quality of care and employee experience are critical in evaluating vendors. Fertility treatments can be physically, emotionally and financially demanding, and employees require access to compassionate care, guidance and resources throughout the process.
Panelist Tammy Fennessy, the director of benefits at Dick’s Sporting Goods, emphasized the importance of optimizing care, noting that employees should have access to essential services like embryonic testing to reduce the number of IVF cycles. Streamlining vendor services is also critical, Ms. Fennessy argued, noting that a disjointed experience—such as managing prescriptions through a separate pharmacy benefits manager (PBM)—can lead to confusion and frustration. Similarly, Ms. Avsharyan highlighted the need to eliminate obstacles for employees. “If we’re telling you we’re going to support you with something,” she stated, “I’m not going to add multiple steps and hoops you have to go through.”
Both Ms. Fennessy and Ms. Avsharyan underscored that a fertility vendor should offer a comprehensive, integrated experience that addresses all aspects of the journey–from consultations and treatments to postpartum care and support services like lactation coaching and sleep counseling. This holistic approach ensures that employees feel cared for throughout their fertility journey, enhancing satisfaction and engagement with the benefit.
Ensuring Accessibility and Inclusivity
The panelists discussed several key approaches that employers can take to ensure that their fertility benefits truly serve their entire workforce, breaking down barriers related to gender, sexual orientation and cultural background.
One major area of focus is expanding fertility benefits to support employees beyond traditional family models. As Ms. Fennessy pointed out, “Looking at plan designs and seeing how they were really geared just to benefit women, in particular, birthing women…really put folks…in the LGBTQ+ (lesbian, gay, bisexual, transsexual, queer, and other) community and males at a disadvantage.” Historically, fertility plans have often centered on women undergoing medical treatments like IVF, which can leave other groups—such as same-sex couples and men—without equitable access to benefits. Ms. Fennessy indicated how male infertility, for example, is often stigmatized and overlooked in benefit structures. However, she noted that some vendors are now offering at-home testing for men to help destigmatize and address male infertility.
Ms. Avsharyan reiterated the challenges that same-sex couples face when trying to access these services, stating, “It’s really hard to prove that you’re infertile if you’re a same-sex couple.” For employers, recognizing the unique needs of LGBTQ+ employees and offering benefits that reflect various paths to parenthood–such as surrogacy, adoption and egg or sperm donation–is essential for inclusivity.
Ensuring accessibility also means taking into account the cultural diversity of the workforce. Ms. Nova highlighted this challenge in Miami-Dade County, where the majority of employees speak Spanish, yet only 6.3% of physicians in the area are Spanish-speaking. It’s imperative that employers offer resources such as multilingual services and culturally competent care to ensure that employees from different backgrounds can engage with fertility services.
Strategies for Enhancing Awareness and Engagement
During the roundtable discussion, panelists addressed the critical need for effective communication strategies to enhance employee awareness of fertility benefits. They identified several common challenges in getting the message across to employees and shared best practices for improving engagement.
Challenges With Effective Messaging Campaigns
Panelists highlighted the difficulties in ensuring that fertility benefits information reaches the intended audience within employee households. Dr. van Caulil pointed out, “The challenge is that most communications from employers go only to the primary person in the family. Oftentimes, that could be the husband who may or may not share that information with his wife.” This lack of direct communication with all family members can prevent key decision-makers—such as spouses or partners—from receiving the information they need to take advantage of fertility benefits.
Dominic Vu, who serves as the senior vice president of pharmaceutical strategies for USI Insurance Services, expanded on this limitation by noting that dependents may be unable to access internal benefits information from home. “You can’t access the intranet at home. You need something that’s accessible that you can view on a phone that their partners can view together,” accessible, employers need to offer platforms and communication tools that allow employees and their families to access information conveniently, whether at work or from home, and across multiple devices.
Targeted Communication Strategies
Several panelists agreed that personalized communication strategies–targeting employees at different stages of family planning–can significantly increase engagement with fertility benefits. Ms. Avsharyan emphasized the importance of regular benefit education, stating “We do orientations every Tuesday if you’re a new hire. When you’re going on parental leave, we have a one-on-one conversation with you…then I follow up that call.” By offering tailored, direct conversations at key moments in an employee’s journey, Ms. Avsharyan’s organization ensures that employees are informed about their fertility options and feel supported throughout the process.
Ms. Fennessy echoed the effectiveness of face-to-face engagement and grassroots communication. “I’m a grassroots person,” she explained, “so I believe in face-to-face contact, being able to have [employees] on-site to talk about the program, meeting with people at benefit fairs, distributing materials, having webinars.”
The fertility vendor can play a role in effective messaging as well. Mr. Stancil noted, “[If the vendor feels] unapproachable from the start, that is a massive barrier to overcome.”
In addition to digital and personalized methods, some employers have found success using more traditional communication channels. Ms. Nova shared her organization’s multipronged approach to outreach, stating, “We do postcards. We do mailers. We do, believe it or not, payroll stuffers, [because] some of our employees still get a paycheck, [an] actual paycheck. We [also] put posters up.”
Measuring the Impact of Fertility Benefits
One of the key takeaways from the roundtable discussion was the importance of effectively measuring the impact of fertility benefits to ensure that these offerings are not only used but that they also contribute to employee satisfaction, retention and overall health outcomes. The panelists shared insights into the various metrics employers can use to evaluate the success of their fertility programs while also identifying gaps in the data that are currently available.
Metrics for Evaluating Fertility Benefits
Mr. Vu pointed out that many companies rely on employee benefit committees to gauge employee satisfaction with fertility benefits. These committees are often tasked with collecting employee feedback through surveys and focus groups, which can provide valuable insights into how well fertility benefits are meeting employee needs. By regularly soliciting feedback, employers can identify areas for improvement and ensure that the benefits remain relevant to their workforce.
Utilization is another critical metric for understanding the impact of fertility benefits. Mr. Stancil emphasized, “You want to use utilization [paired] with satisfaction to make sure that that’s actually driving the satisfaction.” High utilization rates, when paired with positive feedback, can be a strong indicator that the benefits are both accessible and valuable to employees. On the other hand, low utilization may signal barriers to access or a lack of awareness, which could prompt a reevaluation of communication strategies or vendor partnerships.
Ms. Fennessy highlighted the importance of tracking specific outcomes data related to fertility treatments to measure effectiveness and safety. She explained “I look at singleton rate versus multiples. Look at [the] decrease in NICU (neonatal intensive care unit) claims…over time and the reduced number of cycles for single birth compared to national norms.” These metrics can provide a deeper understanding of the health outcomes resulting from fertility treatments and can demonstrate whether the program is reducing the need for multiple treatment cycles or high-risk pregnancies that may lead to higher healthcare costs.
Mr. Vu also mentioned the importance of assessing the quality of the providers within the fertility benefit network: “How many of these vendors have centers of excellence and the pedigree...within the fertility benefits?” he posed to the group. This type of quality evaluation can ensure that employees are receiving care from top-tier providers, which can lead to better health outcomes and increased satisfaction.
Identifying Gaps in Data
Despite the range of metrics available, panelists agreed that there are still significant gaps in the data employers use to evaluate fertility benefits, particularly in terms of benchmarking and long-term impacts. Ms. Fennessy noted the absence of robust benchmarking data, which makes it difficult for employers to compare their fertility benefits to industry standards or to those of other organizations. Without these comparative data, it can be challenging for employers to determine whether their fertility offerings are competitive or there are areas where they are falling short.
Beyond immediate outcomes and satisfaction, panelists also raised questions about the long-term impacts of fertility benefits on company culture and employee loyalty. While many employers recognize the short-term benefits of offering fertility support, such as increased employee engagement and retention, there is a need for more data on how these benefits shape long-term organizational culture and employee loyalty. As fertility benefits become a more standard offering, understanding their influence on broader company dynamics will be crucial for employers looking to position themselves as supportive, family-friendly workplaces.
Positioning Fertility Benefits as a Competitive Advantage
In today’s highly competitive job market, companies are increasingly recognizing the power of comprehensive fertility benefits as a strategic tool for attracting and retaining top talent. The roundtable discussion underscored that these benefits go beyond standard healthcare offerings, positioning companies as champions of work-life balance and family support. Fertility benefits can help shape a company’s employer brand, making it stand out in an era in which employees value organizations that prioritize their personal and family well-being.
Mr. Stancil emphasized, “The current workforce is much more comfortable and confident in switching jobs more frequently.” This increased job mobility means that companies need to offer compelling, differentiated benefits to stand out from competitors. Fertility benefits, particularly when well-structured, can be a key selling point for companies looking to attract candidates.
Ms. Avsharyan shared that her organization uses fertility benefits as a tool to recruit and retain a highly skilled workforce, especially among younger, mid-career professionals who are more likely to prioritize family planning. She proudly stated, “We are known as the market leader for family support benefits,” reinforcing how strong fertility benefits can position a company as a top choice for talent.
Amid challenges such as wage constraints and rising living costs, nonmonetary benefits like fertility support can help companies maintain a competitive edge in retaining employees. Ms. Nova, sharing the reality faced in the public sector, noted, “We are experiencing, within the public-school board sector, a turnover that we hadn’t seen before because of the lack of our ability to pay employees the salaries they deserve [due to] of lack of funding.” For organizations that cannot compete on salary alone, fertility benefits offer a valuable way to enhance their employee value proposition.
Finally, organizations need to consider how fertility benefits will integrate with other wellness and healthcare programs offered by the company. Employers are increasingly seeking a holistic approach to employee well-being, and fertility benefits are often seen as a piece of a larger puzzle that includes maternity/paternity leave, mental health support and family planning services. The panelists concurred, emphasizing that the goal is to create a cohesive benefits strategy that supports employees at various stages of their lives and careers.
Consideration of Costs and Program Sustainability
Incorporating fertility benefits into an employee benefits package is not without financial challenges. The roundtable participants delved into the complexities of balancing the costs associated with fertility services while ensuring the long-term sustainability of such programs. Fertility benefits, though valuable to employees, represent one of many competing priorities in employee benefit management.
Ms. Fennessy highlighted the shifting priorities, noting, “Mental health is probably the…leading priority right now.” This suggests that while fertility benefits are important, they are only one component of a much larger benefits strategy. Mental health, chronic conditions and emerging therapies all vie for attention in the broader context of benefits strategy.
Employers must make difficult decisions about which benefits to prioritize while ensuring affordability for their employee populations. Dr. van Caulil shared an example of an employer grappling with unexpected healthcare costs. “One of our employers has two or three [employees with hemophilia], which is staggering for them,” she explained. “The exercise that the employers go through that I hear about is excruciating [regarding] affordability.” This example illustrates the unpredictable nature of healthcare costs, which can heavily influence decisions about offering or expanding fertility benefits.
The long-term sustainability of fertility benefits hinges on their affordability. Even though these benefits are increasingly in demand and can enhance employee satisfaction and retention, they also come with significant financial burden. Ms. Nova succinctly put the core issue in perspective: “If it’s not affordable, it’s unsustainable.”
As fertility benefits become more attractive, particularly to prospective employees, employers may see increased utilization, further driving up costs. This is compounded by the broader goals of promoting diversity, equity and inclusion and addressing social determinants of health. Mr. Vu posed the critical question, “As we try to become a more inclusive society, the question is, how do we pay for it?”
Closing Thoughts and Future Outlook of Fertility Benefits in Employee Wellness Programs
One of the key takeaways was that the future of fertility benefits will be shaped by each organization’s unique goals and financial constraints. Dr. van Caulil remarked, “It comes down to a decision that the employer has to make... [Is] this is a strategy that fits with their game plan for recruitment and retention?” This underscores the fact that employers must evaluate not just the cost but also how fertility benefits align with their broader objectives including talent acquisition and employee satisfaction. Panelists also discussed potential legislative considerations as a critical factor in the future of fertility benefits.
From an employee experience standpoint, the emotional impact of offering fertility benefits cannot be overstated. Ms. Avsharyan noted, “Knowing that they care about you growing your family...is a really big deal. The hope is that you’re helping their well-being and, in return, they will increase productivity.” This potential return on investment comes from fostering a sense of care and support for employees, which can lead to greater loyalty, satisfaction and productivity.
Panelists concluded with a consensus that the conversation about fertility benefits must continue to evolve with a focus on further refining and promoting these benefits across the workforce.
