Infertility impacts one-in-eight Americans, more than those affected by diabetes, breast cancer or Alzheimer’s disease. US annual IVF cycle volume has grown 70% from 2005 to 2015 (the last year reported) and in the last two years of CDC tracking, the rate of annual growth has accelerated to all-time highs. By FertilityIQ estimates, 2020 cycle volumes should eclipse 400,000 procedures, effectively tripling volumes since the 2008 economic downturn.
While IVF costs range by geography, in every major American city they are now comfortably above $20,000 per cycle, nearly twice the commonly-reported rates of $12,400. What’s more, FertilityIQ data (provided by over 10,000 verified, US, IVF patients) shows the average IVF patient will undergo over two cycles during her treatment. As a result, total IVF treatment costs equate to nearly one full year of US household income at $51,000.
In 2017, the state of IVF reimbursement continues to be a tale of “haves and have nots” with 63% of patients and employees receiving zero coverage and almost 20% receiving complete coverage. Invariably, this is a function of what a patient’s employer is prepared to cover. While the number of US companies offering an IVF benefit has grown by approximately 10% in 2017, as has the size of many employer’s benefits, this has not made a meaningful dent in the percentage of patients forced to pay for their care out of pocket.
Fertility Benefits By Industry
For the second consecutive year, the Technology sector placed highest amongst 14 fields when we measured and scored industries along three dimensions:
• Average dollar size of benefit: This accounts for the amount of IVF costs employers will cover over the duration of a worker’s employment.
• Accessibility of benefit: This is the ease with which employees can access the benefit, as dictated by pre-authorization requirements laid out by the employer. It is common for many plans to stipulate employees engage in 6 – 12 months of heterosexual intercourse before becoming eligible. We allocate point totals for high (50,000 points), moderate (25,000 points) and poor (0 points) accessibility.
• Prevalence of benefit: This represents the degree to which IVF benefits have been adopted by employers within the category. We allocate point totals for high (50,000 points), moderate (25,000 points) and low (0 points) penetration within each field.
Technology: Despite the technology field’s reputation for being “male dominated” and “family unfriendly” it was the field’s inclusive nature of its benefits packages, and the pervasiveness of such packages, that propelled the Technology field to its second-consecutive first-place ranking, by a comfortable margin.
While bellwethers like Facebook and Salesforce offer benefits worth over $100,000 per employee, we continue to see smaller, and on-the-road-to-profitable companies like Pinterest, Slack, Wayfair, Snapchat, Uber, Foursquare and others putting forth compelling offerings to remain competitive.
Consulting & Audit: This year the Consulting & Audit firms rank second, helped by both a high percentage of companies paying for IVF, and doing so at lofty dollar amounts ($50,000 average). Two players (Bain and BCG), in a very consolidated industry, have an unlimited amount of coverage, which abetted the industry’s competitive ranking.
Banking & Finance: Banking and Finance placed third this year, thanks to the sheer number of firms (25+) covering IVF. This was counterbalanced by the fact employees have trouble actually accessing the benefit, needing to demonstrate 6 – 12 months of heterosexual intercourse, which is problematic for LGBTQ and single employees.
Media and Publishing: Media and Publishing placed fifth. Most of these companies (e.g. The New York Times, Hachette, Disney) have announced significant headcount reductions, making their commitment to offering a fertility benefit all the more noteworthy.
City Government: Government, a new sector this year, placed a respectable sixth. While it’s atypical for local government employees to receive a fertility benefit, city workers, schoolteachers and police officers in cities like New York, Chicago and Baltimore are eligible and at generous rates (upwards of $60,000 per year). This year, NYPD’s benefit allowed the wife of an officer to deliver their child after the officer’s sperm was retrieved posthumously (died while on duty) and used for IVF purposes.
Legal: Legal, also a new field to this list, placed well behind its comparable service sector peers of banking and consulting. While the few law offices that cover IVF do so generously (firms like Ropes & Gray and Skadden, Arps benefits are among the best in the country), they are the exception. While the majority of consulting firms and investment banks cover IVF, less than half of the national law firms do so.
Non-profit employers: Charities have begun to institute plans with a sizeable barbell effect. Institutions like the Gates Foundation offer IVF benefits as generous as any US employer, and large charities like UNICEF and The Ford Foundation peg their benefits closer to the $10,000 range. Penetration of IVF benefits within the field remain de minimus for the moment.
This year over 250 US employers offer a fertility benefit and thus placed on our Family Builder Index, a 10% increase over last year’s tally. We assessed companies on the size, and the accessibility, of their benefit. Unlike last year, when the top 5% of companies in our index hailed from the technology sector, this year’s top 5% class is comprised of employers from eight of the 14 industries covered.
We characterized and ranked companies with the following factors calculated:
• Total coverage of IVF benefit up to $100,000: This accounts for the amount of IVF treatment costs employers will cover over the duration of a worker’s employment.
• “Unlimited Coverage Bonus”: We awarded an additional 25,000 points to companies that place no limitation on the amount an employee can spend on IVF during their employment.
• “Accessibility Bonus”: We awarded an additional 25,000 points to companies that waive pre-authorizations and make IVF benefits available to any employee, at any time.
While companies like Bain, Boston Consulting Group, Chanel, Bank of America, KKR, Spotify and Ropes and Gray benefit from their “unlimited” IVF offerings, others like Unilever, News Corporation, Gates Foundation and Facebook are helped by the fact their benefits are immensely easy for all employees to access, including lesbian, gay, and single employees. A complete list of all employers in the index, broken down by their respective sectors, is available at the end of this report.
A number of employers newly added, or significantly enhanced, their benefit. In the case of large businesses, this was likely a sign of a commitment to stay competitive and amongst the smaller, growing technology companies, a reflection that their employee bases are advancing out of their 20’s and early 30’s.
We’ve also begun to see unique approaches whereby some employers are prepared to go “at risk” and cover all the treatment an employee requires up until that employee reaches a certain milestone, namely a pregnancy or a live birth.
Finally, we continue to be impressed by Starbucks’ benefit, which must be appreciated in the context that it applies to the 85% of Starbucks employees who work in-store. While the $15,000 IVF benefit will not top any of our rankings, it’s equivalent to that offered by banks like Morgan Stanley and probably represents a crucial bonus to baristas and store managers trying to conceive. How large of a bonus? Baristas who work 20 hours a week are eligible, and if we presume they work 1,000 hours per year at $12 per hour, the Starbucks fertility benefit comfortably amounts to a 100% bonus.
We surveyed a subset of the 10,000 verified IVF patients in the FertilityIQ database who had complete IVF coverage in 2017. The vast majority of women we surveyed received the benefit through their own employer, not their partner’s. Those employees who had their IVF covered reported being more likely to remain in their job for a longer period (62%), were more willing to overlook shortcomings of their employer (53%) and were more likely to work harder (22%).
Reassuringly to employers, the vast majority (88%) of women who had their IVF fully paid by their own employer decided to return back to that employer after maternity leave.
However, most respondents reported that having their IVF covered did not influence their decision of how many embryos to transfer during their IVF treatment. Many employers cover IVF with the understanding that assuaging an employee’s cost concerns will prompt that employee to transfer fewer embryos simultaneously, thus mitigating the risk of costly, multiple-birth deliveries, which often run employers $120,000 - $400,000.
The FertilityIQ Family Builder Workplaces For 2017-2018
Information was provided by employers, employees of companies, and fertility clinics. Employer characterization included the amount of lifetime IVF treatment coverage employees could receive, up to $100,000. Each IVF cycle was valued at $20,000 and those cycles that include genetic testing at $25,000. Bonuses were added to company scores if there was no established capitation on treatment costs or cycle volume. Bonuses were also added to company scores if there were no major criteria (also known as pre-authorizations) to access the benefit. For companies that offer an annual (and not lifetime) limit, we ascribed a 3x multiplier.
Industry indices included the average amount of lifetime coverage across all employers within that field. Other factors included the share of employers in that category covering IVF, and the accessibility of those benefits to employees.
A sub-segment of 200 IVF patients with full-coverage was selected from the FertilityIQ database of 10,000 verified, US, IVF patients. Respondents live in over 28 states with no more than 10% from any US state, and work in over 13 fields, with no more than 18% from any single field. All respondents were treated in 2017. No compensation was provided.