I'm a benefits director at a large company, and we're adding a fertility benefit starting Jan 1. It looks a lot like Deloitte's program (just noticing Deloitte a lot in this bowl), though ours will be slightly more generous with lifetime maxes. I'd love your feedback about what your employers do especially well or poorly, just to ensure we don't have huge blindspots as we roll it out from scratch. Honest feedback from people who are on this journey is appreciated!!

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I was able to get only one cycle with Deloitte’s program. The lifetime max does not even fully cover two cycles so having that as a higher limit will be great. Along with that good unlimited coverage for medicines will be helpful that take huge amount of out of pocket expenses.

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Agreed allowing a certain number of rounds. I hit my lifetime max after my first cycle (which was unsuccessful) and ended up paying out of pocket for round 2.

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I second Progyny! My prescription medications weren’t covered but it counted towards my health insurance deductible/out of pocket max so depends on how your health insurance benefits already is. I have worked for two big companies now with Progyny fertility benefits and they’ve made it very easy.

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Agree that Progyny is a dream experience for the patient. EVERYONE is happy to have you, and I found that my Progyny rep was even more helpful and supportive than any of the clinic’s staff. I so enjoyed talking with her that she was often the first person I called when I had a question, even before my doctor.

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Be inclusive on LGBT+ families in what’s covered. These families are more likely to have some costs like donor sperm/eggs/embryos, surrogates, etc, and many plans don’t cover

Have decent parental leave (and ramp off/ramp on plans)

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We'll be doing a reimbursement, similar to what you've detailed. There's not a lot out there different than what you've mentioned, at least from our research. There are vendors that make the process easier by offering concierge services, but ultimately the cost is the challenge for most parents, so we saved those fees and put them into the reimbursement program. I know part of what dampens interest for employers is that the IRS taxes the benefit above a certain level, like $15k or so. Raising that ceiling might help employers justify a higher amount, as many peg their benefit to the IRS max.

Make it clear the dollar maxes are based on what clinics bill insurance companies which is often significantly more than they would bill out of pocket to the patient. Check what med coverage would be and make the process to get and submit medical necessity easy, make sure employees are aware what the review time line. I had a cycle delayed because I was waiting for authorization on a few diagnostic tests I needed. Find out what the requirements are to be eligible for IVF coverage, often it requires some number of failed IUIs or something. This can cause major delays (and therefore dramatic decrease in egg quality in older patients). Lastly, if possible, would be great to provide coverage for elective egg freezing for younger employees. I would love to see fewer women in my shoes because they were more proactive about their own reproductive options at a younger age.

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Personally I think any threshold is dumb but understand why they’re in place from the insurer’s perspective. The “official” definition of infertility is 1 year before 35 and 6 months after 35 so those thresholds make sense from a clinical perspective. But then what about people with conditions like PCOS or endometriosis? Do they have to try a year too? What if they’re young but AMH is low? What if they have male factor? There are a lot of scenarios where timed intercourse is a waste of time, and time is everything in fertility. If you’re 34 and have to wait a year to start IVF for your first child, you’ll be at best 37-38 when you start trying for a second. That year could make all the difference. A year is also a long time to fail at something and I think we can’t overlook the mental health burden of getting your hopes crushed month after month trying something with such low odds.

As for elective egg freezing, my firm offers full coverage for the procedure just like IVF, but with a 2 cycle max, no coverage for storage fees. When I talk to people about egg freezing, I do recommend doing 2 cycles if they can handle it physically and financially to bank more eggs, since as you said they’re not as stable. Would you cap the cycles or have a similar lifetime max? Personally I prefer the cycle limits so they don’t have to consider if they want to use those eggs in the future, how much coverage do they have left (if they’re still at the same firm).

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I highly advocate for removing the requirement of needing x amount of IUIs before starting IVF. We were very fortunate our plan (Deloitte United) did not require this but I've heard so many do. So happy for those that IUI does work for, but unfortunately the success rates are low and for us personally, did not want to risk wasted emotional stress, time, and money to even attempt IUI. Thanks for adding the benefits!

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Excellent suggestion. We have this decision in front of us as we're implementing, and I will definitely ensure this is considered.

Separate the lifetime max for medical and Rx. Offer coverage for PGTA testing of embryos and coverage for both freezing embryos and freezing eggs. I’m an advocate for having this as a benefit and believe that more companies should offer it. 

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Review BofA’s fertility benefit - no lifetime maximum and $20k towards adoption/surrogacy/certain infertility procedures (pgt testing, donor embryos). It’s been amazing for me and my family.

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We did a lot of benchmarking when developing our program, and BofA was far and away the leading one among big employers. There are only a handful of companies that come close to BofA's benefit.

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Awesome!! I work for a large tech company—and we have a fertility benefit that pays 100% with no lifetime max which I used for IVF. I’m so glad we have this benefit! My surprise came when it was time to order medication; even though my IVF was covered, our prescription coverage did not cover most of the medication I needed, which came to an unexpected $8k.
I’m still glad we have the benefit, but it would have been nice if our prescription coverage was better.

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We opted for unlimited pharmacy on this. Your comment is really validating that decision. Thank you!!!

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Also coverage for genetic testing on the embryos would be fantastic. This was an out of pocket cost for us

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Yes! Our insurance allows you to use FSA fees for it so that helped. But covered would be even better obviously 😁

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I had elective egg freezing covered (does count towards the lifetime max) which was great. The rx benefit was separate and did not count toward the max - this was extremely helpful. I had to use freedom pharmacy, but thought the overall service there was very easy to navigate. In order to unlock the benefit we use WINFertility. WF had fabulous nurses who were on call to guide me through everything. The only part I found stressful was that the egg freezing was no explicitly noted on our benefits coverage and there was a lot go back and forth between my company, Aetna (insurance) and Win - but it was ultimately covered. If that had been clear it would have made the process much smoother. I wish there was no lifetime max on the coverage.

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Check out Wellhatched- a support service team. I’m sad to hear Progeny was a no go- as a patient I couldn’t recommend them more highly.

https://wellhatched.co/wp-content/uploads/2021/08/Wellhatched_Corporate-Education-Series_Overview2_Web.pdf

I used Progyny in NYC. Very happy with them.

Cover elective embryo freezing as well not just egg freezing

My company doesn’t offer fertility benefits unless you have a specific plan. This blew my mind as I thought since it is company covered I should be covered.

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