Fertility Benefit Terminology: 6 Phrases Every HR Person Should Know for Open Enrollment

Peter Nieves, Chief Commercial Officer WINFertility As open enrollment for employee benefits begins, fertility benefits are increasingly important to employees and companies.  Here are six terms every HR person should know when offering, or considering, family-building benefits.

Cycle Cost

In Vitro Fertilization cycle cost (cycle cost for short) is, as the name implies, the cost of an IVF cycle.  It includes all the embryology lab costs, tests and procedures needed for one cycle of IVF.  It does not, however, include the cost of fertility medications.  When medication is added in, IVF treatment can cost anywhere from $12,000 to $30,000, depending on the location of treatment, medications used, and testing required. There can be huge variation in this price, as some companies mark up the cost of a cycle. It is important for your organization to shop around and work with a benefit solution that not only ensures your employees have access to the best providers but one that is also able to negotiate the best deal on your behalf.

Integrated Solutions

Integrated fertility benefit solutions are integrated with the payer and the PBM.  These solutions are seamless to Administrative Service Only (ASO) employer clients and are also a seamless part of the payer’s solutions, from the employee’s perspective.  Carve-in solutions use the payer’s network of providers to provide fertility benefits, but the benefit can be managed by the fertility benefit manager, like WINFertility, the only 3rd party integrated option. Using an integrated managed fertility benefit solution provides improved outcomes for employees while helping employers manage costs, all while using the payer network to create a seamless experience for the patient.

Carve-Out Solutions

Carve-out solutions use a separate provider network, outside of the payer network. Carve-out solutions alone, run the risk of driving costs up. However, there are benefit management companies, like WINFertility, that offer a carve-out solution utilizing a highly credentialed network of reproductive endocrinologists paired with clinically qualified fertility nurse care managers and behavioral health specialists that guide patients through their family-building journey.  Managing the carve-out solution with clinical experts helps patients navigate their fertility treatments and family-building options, driving more successful outcomes through efficient spending.

Provider Quality

One of the advantages of a managed fertility benefit solution is offering a network of fertility specialists to your employees.  Fertility benefit management companies can rank, recruit and maintain a highly qualified physician network which strives to enhance patient outcomes while choosing the most effective treatments.  Using a benefit management solution with an established network of reproductive endocrinologists will help your employees find the right doctor that is best suited for their specific medical situation.

Improved Outcomes

Improved outcomes happen when employees go directly to the most effective treatment (bypassing lower-initial-cost but often ineffective procedures) and when they receive only medically appropriate treatments and medications.  Clinically optimized care results in better outcomes, from improved pregnancy rates to reduced embryo transfers, and a decreased number of twins and other high order multiple gestations.  During an emotional and stressful time, a managed fertility solution improves member experience by using nurse care managers to guide patients through their journey, answering all questions and concerns and navigating them to the most appropriate treatment options.   Elective single embryo transfer (eSET), for example, is a procedure which has been found to be as successful as multiple embryo transfer in many patients, and which dramatically reduces the incidence of multiple births, reducing the need for c-sections and decreasing the length of hospital stays. Multiple births of twins or more greatly increase the danger to both mother and baby, including premature birth and an increased risk of birth defects.

Inclusive Benefits

Infertility is often defined as not being able to get pregnant after 12 months (or 6 months depending on the age of the woman) of regular, unprotected sexual intercourse. This definition assumes a heterosexual relationship, and is used by many insurance companies to determine treatment coverage. Some use a broader, more inclusive definition of infertility, social infertility, a term that accommodates people who want to conceive but are not able to engage in sexual intercourse for a variety of reasons, including lack of an opposite-sex partner or being part of a same-sex partnership. Inclusive benefits, such as surrogacy, egg donation, donor sperm, and adoption help employers accommodate the new definition of family. These benefits meet the special needs of a number of different employees, from gay and lesbian couples to single parents of either gender or non-binary people.

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