Why and How I am Working to Extend Fertility Benefits at My Company and Across the Globe
‘Insurance is not just about postponing death but promoting well-being’ (1).
I love this quote. Even trained as a physician, I have often fallen into the trap of looking at healthcare as exclusively for treating someone’s poor health. In reality, healthcare and the insurance that provides it should emphasize and prioritize everyone’s continued good health. While this quote is very true for preventative medicine, I also believe it is true for reproductive medicine. For people who want to have children, reproductive medicine can promote continued health, as studies have shown that infertility can lead to depression and anxiety. Therefore, I believe it is imperative for insurance to cover reproductive care for all types of infertility.
Only a couple weeks ago, the American Society of Reproductive Medicine (ASRM) agreed with my assessment and broadened the official definition of infertility to include LGBTQ+ and single people:
‘Infertility involves “the need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner” (2).
This is an exciting change, as the ASRM can be a driving force for change with the insurance industry. However, what fertility services are currently offered is extremely fragmented in the United States and abroad. As an American working abroad for a U.S. company, I am in a unique position to observe and experience this fragmented system of fertility benefits. For example, my company offers fertility benefits in the form of IVF and gestational carrier supplementation, but this is only for employees based in the United States, regardless of their nationality. Therefore, as an American based abroad, I am not eligible for these benefits.
This made me interested to further research this area and explore the following:
What is the current state of fertility benefits in the U.S., both from a public and private perspective?
For global companies, how do they go about offering fertility benefits outside the U.S.?
What aspects of insurance and benefits are unique to LGBTQ+ intended parents?
This last point is critical for me as queer moms, queer dads, and rainbow families are the focus of the BabyMoon Family community.
Fertility Benefits in the United States
Fertility benefits are a fairly recent phenomenon. Insurance companies have historically shied away from them for several reasons (1):
Regulations around women’s bodies is a challenging area.
Perceived ‘experimental’ nature of fertility benefits given their recent history, despite the fact that over 8 million babies in the U.S. have been born through assisted reproductive technologies (ART).
High costs.
It was only in 2017 that the American Medical Association (AMA) declared infertility a ‘disease,’ paving the way for more coverage and reimbursement possibilities (3). However, the current coverage in the United States is extremely varied, and it differs by state and by size of company (4).
In terms of state regulations, the figure below shows requirements for companies to cover fertility issues.
(4)
These requirements are vague and mandate only partial coverage for some infertility services for some companies, and so the majority of coverage has been promoted by multi-state corporations as a way to promote recruitment and increase retention of employees. The data from a recent survey shows that company fertility benefits have increased from 2015 to 2020, with larger employers (e.g. those with 20,000 employees or more), offering more benefits.
(5)
There are now a plethora of websites that collate information on fertility benefits by company (6). There is - in a great way - competition among these companies to get the best employees, and offering egg and sperm freezing, IVF, gestational carrier supplementation, and adoption benefits is a great way to do this. Whether it's big tech companies such as Google, Meta, or Microsoft; pharmaceutical companies such as Johnson & Johnson; or consumer brands such as Starbucks, Walmart, and Lululemon, companies in the U.S. are broadening their approach to fertility coverage, but the benefits are not uniform and are variable on their applicability to LGBTQ+ persons.
Fertility Benefits Outside the United States
While it's great that companies are increasing their coverage of fertility benefits for U.S. based employees, what about employees in other countries such as myself? As I said before, I work for an American company that has great fertility benefits for its employees in the U.S., but there are over 100 countries where my company operates, and none of these international employees receive reproductive benefits.
I am now working through my employee resource group and with our human resources department in order to address these discrepancies. The first goal is to assess the interest from the employees for such a benefit. How many employees want fertility benefits in other countries? This survey will be not only for LGBTQ+ identified employees, but also for straight women and any other interested persons across the various employee resource groups.
This ‘grassroots’ movement and quantification of interest is important in order to facilitate a need for the company. The company wants to have a robust diversity, equity, and inclusion (DEI) policy, like all companies, and so by showing there are benefits that are not being offered that employees want, this can be very motivating for the human resources department.
In addition to internal momentum, I am also talking with external companies who specialize in helping global companies develop fertility benefits. One such company is Carrot Fertility (https://www.get-carrot.com/).
Carrot’s global reach has provided it with an abundance of information on fertility benefits in various countries and what matters to those employees. They recently published a first-of-its-kind ‘Global Fertility at Work Report,’ which published the following statistics from 5,000 people across the United States, United Kingdom, Canada, India, and Mexico (7):
65% of respondents have spent time at work researching fertility treatments, benefits, and family-forming.
55% report that fertility challenges have detrimentally impacted their work performance.
65% of respondents would change jobs to work for a company that offers fertility benefits.
65% would ask about fertility benefits before accepting a new job offer, and 62% would even consider taking a second, part-time job with fertility benefits.
For 42% of respondents, if fertility benefits aren’t offered for a new job, it’s a “deal breaker.”
Retention is also a significant draw, with 72% committing to stay at a company longer if they had access to fertility benefits.
75% consider fertility benefits at work to be an important part of an inclusive company culture.
For employees looking to start or grow their families, just 32% say they can afford fertility treatments if needed.
In addition to these external data on benefits for employees and companies, Carrot also offers expertise in implementing fertility benefits globally, ensuring to follow local regulations, cultural sensitivities, and utilizing public and private healthcare networks. In cases when services are not allowed or accessible domestically, Carrot can assist members with seeking cross-border care, provided that it is compliant with local regulations. It’s with the expertise of an external partner like Carrot that I intend to present this opportunity to my company’s human resources department, in order to ultimately extend fertility benefits from the United States to countries across the globe.
LGBTQ+ Fertility Benefits
Despite the ASRM recommendation mentioned above, in U.S. states with mandated fertility preservation coverage, it remains unclear if this benefit extends to transgender individuals, whose gender affirming care can result in infertility. Additionally, many state laws regarding mandates for infertility treatment contain stipulations that may exclude LGBTQ+ individuals. For example, in Arkansas, Hawaii, Texas, and for U.S. Veterans, IVF services must use the couple’s own eggs and sperm, effectively excluding same-sex couples. In other states, same-sex couples do not meet the definition of infertility, and thus may not qualify for these services (4). As mentioned above, the coverage offered even by large U.S. companies is not always comprehensive in terms of its offerings for queer-identified employees, but it is improving.
In the United Kingdom, there have been recent news reports claiming there are excessive and burdensome costs for queer people attempting to navigate the National Health Service (NHS) for reproductive care (8). In England, the NHS will fund IVF for heterosexual couples who have been trying unsuccessfully for a baby for at least two years. However, same-sex couples are expected to demonstrate their infertility before the NHS will fund IVF. In order to do this, same-sex couples have to pay more than £20,000 for up to twelve rounds of private artificial insemination. This excessive burden of proof for queer couples is what has been labeled ‘gay tax,’ and has led to some rainbow families making hard decisions, remortgaging and sacrificing ‘heating and eating’ for fertility treatment (9).
We are in the midst of an exciting but challenging time for rainbow families. We have a new and broadening definition of ‘family,’ and the definitions of ‘infertility’ from medical associations are evolving to be more inclusive.
However, the pace of our social change needs to be met with changes in healthcare and insurance policies. I believe that we should not have an excessive burden or ‘gay tax’ on same-sex couples for fertility, and I believe that working through my global American company is one way to address this for LGBTQ+ employees all over the world. Helping them navigate through public and private national and international healthcare opportunities is a way forward.
If I am successful, such a precedent could then be used by other employees to motivate their companies to stay competitive internationally, helping to promote diversity, equity, inclusion, queer parentage, and family health all over the world.
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