How is fertility benefits coverage evolving?

Generally, Canadian women are now having children later in life, she says, so employees have been ramping up their feedback in asking for more support related to fertility issues. This prompted her team to examine the reality of the associated costs. “We know the cost of treating infertility can be quite difficult for [individuals] whereas, when we looked at it as a group plan, it’s a manageable cost, so we had to take that into consideration, because whenever we’re looking at adding anything, we have to consider, ‘OK, what’s the impact financially?’”

What’s on the menu?

Since it doesn’t apply to the entire workforce, the amount of coverage that employers offer for fertility benefits varies widely, says Moe Renaud, Cowan Insurance Group’s vice-president of operations and product development in group benefits. “Some employers honestly don’t think it’s a valuable benefit because of the low demand for it, a low claim rate. It will be a small lifetime maximum, which will range from $2,000 to, say, $10,000.”

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As well, it’s primarily a benefit offered by larger employers, says Joan Weir, director of health and disability policy at the Canadian Life and Health Insurance Association. Looking at the landscape of Canadian insurers, she says they primarily offer fertility coverage as an add-on benefit to administrative services-only plans. “For underwritten plans, I don’t think it has been offered at this point in time.”

Indeed, the findings of a 2019 survey by the International Foundation of Employee Benefit Plans reported relative low coverage rates. Just under a third (31 per cent) of U.S. employers with 500 or more employees have some sort of fertility benefit, up from 24 per cent in 2016. Also, it found smaller employers were far less likely to provide fertility benefits, with just 10 per cent of companies with 50 or fewer employees offering some coverage. However, that was up from four per cent in 2016.

The most common forms of coverage are for in-vitro fertilization procedures (23 per cent), fertility medications (18 per cent), genetic testing to help employees determine their infertility issues (15 per cent), non-IVF fertility treatments (13 per cent), visits with counsellors (nine per cent) and egg harvesting or freezing services (seven per cent).

A delicate balance

In addition to that inconsistency, employers often only offer coverage for one part of the process.

Jade Hamilton, a 30-year-old elementary school teacher with the Avon Maitland District School Board in southern Ontario, receives a $12,000 lifetime maximum for fertility drugs through her benefits plan. But for treatment, if her provincial government-funded IVF is unsuccessful, she’ll have to pay for future attempts out of pocket.

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Hamilton and her husband began working with a fertility specialist in 2017. They were eventually transferred to another specialist in London, Ont., who determined they wouldn’t qualify for intrauterine insemination. They moved onto the wait list for a government-funded round of IVF. In October 2019, Hamilton had surgery to retrieve her eggs, but developed ovarian hyperstimulation syndrome — an excessive response to taking hormone medications used to help eggs grow, which causes symptoms such as nausea, abdominal bloating and weight gain and, in extreme cases, can cause death — and she was unable to go forward with the embryo transfer. After being placed on a months-long hold, she was able to undergo the transfer before the clinic shut down due to the coronavirus pandemic in mid-March.

Fertility drugs are expensive and Hamilton has taken plenty over the last few years, with price tags ranging from $30 to $983. It’s a relief to have drug coverage through her employer, she says. “It saves me a lot of money. It takes that pressure off of [wondering] where I’m going to come up with $3,000 to $8,000, just depending on what I need for something that’s completely out of my control. It’s nice to know it’s not costing me a whole lot. It does cost me time and energy, but it doesn’t cost me financially.”

However, she adds, that might not be the case indefinitely. “I’m lucky that I get pretty good coverage, but once the money runs out, I’m on the hook for it.”

Time and money

As Hamilton notes, fertility treatments aren’t cheap. In Canada, the cost of IVF ranges between $10,000 and $15,000 per round for people paying out of pocket. Understandably, some employers balk at the potential price tag of offering coverage, especially as they’re trying to reduce their benefits plan spend.

“It is a large cost item,” says Weir. “And I think employers — especially smaller ones, these days — are definitely interested in maintaining their coverage. The insurers we talk to understand employers are looking at their coverage and trying to contain costs.”

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However, some companies are interested in providing solutions, she notes, including employers with multi-generational workforces and those in the information technology sector, where employees tend to skew younger. “There is interest by employers to provide [fertility] benefits to obtain and retain employees. It speaks to the younger employees in the workplace.”

As well, employers can provide more than just financial coverage, says Nora Spinks, chief executive officer of the Vanier Institute of the Family. An important element of the fertility journey is the hours it takes out of an employee’s day. “[Companies are providing] time off to go to treatment, time to deal with pregnancy-related doctor’s appointments, time off to deal with complications.”

Getting with the times

Companies that provide some fertility coverage can also see a reputational benefit, adds Spinks. “These boutique-type benefits offer high return for the cost. . . . [If] I tell two friends, you tell two friends, the reputation and corporate image about being a fair, compassionate and caring employer is going to increase.”

However, many women still prefer not to share their process of getting pregnant with their employer, says Yafa Sakkejha, chief executive officer of Beneplan Co-operative. For example, IVF involves very frequent doctor’s appointments, so regardless of whether a company offers coverage for fertility treatments, it’s important it impresses upon employees that they won’t be penalized simply for seeking health care, she notes.

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“The thing about the work week — you’ve got five days and every day you show up at the clinic at 7:00 AM, you see the doctor at 10:00 AM, you’re back at work by 11:00 AM every day and your employer says, ‘Hmmm, why are you late every day? Where are you? We don’t have a work-from-home policy. Is everything OK?’ Women anecdotally are telling me, ‘I can’t tell work because I’m worried that they’re going to restructure me out of a job.’”

As well, women are often nervous about asking for too many details about a benefits plan in a job interview, says Sakkejha, because they don’t want to be perceived as a more expensive,
and thereby less appealing, candidate.

Onward and upward

The employers paying the most attention to fertility benefits are those that are especially keen to be on the cutting edge of diversity and inclusion in the workplace, says Renaud.

“The employers that are really embracing this, they’re not just looking at fertility, they’re looking at gender affirmation, gender transition, maternity benefits. They’re looking at the full spectrum of, ‘As an employer, how can I help the employees that are going down this journey?’”

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In recent years, employers have started developing best practices for supporting plan members going through gender affirmation surgeries and related treatments. Services like egg and sperm freezing play a role in transgender individuals’ family planning, so employers looking to support them through the transition process should keep those needs in mind, he says.

“I think the progressive employers are really looking at the bigger picture.”

Martha Porado and Kelsey Rolfe are both associate editors at Benefits Canada.