BY: RON SHINKMAN
According to a recently released survey by the International Foundation of Employee Benefit Plans, 40% of U.S. employers offered some form of fertility coverage last year. That’s up dramatically from 2020, when only 30% offered fertility benefits – a 33% jump in just two years. More employers now offer fertility benefits than financial assistance or paid leave for an adoption.
“We’ve been seeing family-friendly benefits like fertility coverage continue to grow as part of the larger trend of expanding work-life integration policies to be more inclusive of all employees,” said IFEBP Vice President of Content Julie Stich. “Fertility benefits hold a high value by talent no matter their gender identity or relationship status. Providing these benefits helps nurture overall happiness and well-being.”
However, coverage can differ dramatically between employers. For example, among companies that offer fertility benefits, less than 35% cover egg harvesting or freezing services, and less than 45% cover fertility services that are not related to in vitro fertilization (IVF). There are numerous other variations along those lines.
Larger employers – those with more than a few hundred workers – often self-fund their employee medical costs and use a third-party administrator to handle claims (typically a subsidiary of a large health insurer). They may also outsource their benefits to major fertility platforms such as Progyny, Carrot or others in what are known as benefit “carveouts.” In those cases, the fertility firms usually act as a one-stop shop, offering benefits in line with the limits of coverage set by the employer, managing claims and collecting payments. Here is a breakdown of the four largest platforms:
Kindbody
Founded: 2018
Headquarters: New York City
Valuation: $1.8 billion
Locations: 27 Clinics in 21 cities in 15 states and the District of Columbia, Including New York City, Los Angeles, Atlanta and Houston
Senior Management: Gina Bartasi, Founder and Chairwoman; Angeline Beltsos, M.D., CEO, clinical operations; Annbeth Eschbach, CEO, corporate operations; Greg Poulos, President; Taryn Branca, Chief Revenue Officer
Major Employer Clients: Walmart, Lyft, Activision
Walmart, the nation’s largest company with more than 2.3 million employees, entered into a fertility benefits carveout with Kindbody last September.
“Our partnership with Walmart signals that fertility benefits have joined medical, dental, and vision as standard workplace benefits for leading employers,” said Bartasi when the deal was announced.
The pact with Walmart is an indication of how all-in-one fertility companies have grown in just a few years. Kindbody was founded only five years ago. That it was able to raise more than $281 million, according to Crunchbase, helped turbocharge its growth.
Although Kindbody does not post specifics regarding its benefits packages for employers, a recent webinar conducted by its senior management indicated that companies should curate a benefit that takes into account projected utilization by employees, medical and drug costs per cycle, and sources of direct and indirect savings.
Progyny
Founded: 2008
Headquarters: New York City
Enterprise Value: $2.7 billion
Coverage: It networks with 650 clinics and 950 physicians and clinicians
Leadership: David Schlanger, Executive Chairman; Peter Anevski, CEO; Michael Sturmer, President; Mark Livingston, Chief Financial Officer; Jennifer Bealer, General Counsel
Major Employer Clients: Detroit Pistons (NBA Team and its employees); Children’s Hospital Association
Progyny is the elder statesman of the group with its founding in 2008. Its 2022 revenue of nearly $787 million was 57% higher than 2021’s. It works with 370 corporate clients nationwide representing some 5.4 million employees, although the company has been mostly tight-lipped about its clientele. Unlike the other companies, it does not post the names and logos of its major corporate clients on its website. And the employer pacts it has announced – with an NBA team and a healthcare trade association – likely only cover a few hundred employees apiece.
Progyny and Maven were the only companies to respond to a request seeking comment for this article prior to publication. According to Progyny spokesperson Alexis Ford, the company assigns each patient an advocate “to better understand their Progyny benefit, their deductible, co-insurance, etc., since this is dependent on each employer’s health plan. The patient care advocate also provides unlimited education and is the patient’s go-to resource during the entire journey.”
Ford provided a single detail regarding Progyny’s carveouts: 90% of employers working with the company also offer their workers ProgynyRX, which includes medication coverage, next-day deliveries and access to support from pharmacists and other medication clinicians.
According to Holly Hutchison, co-owner of Reproductive Health Center in Tucson, Ariz, a carveout firm such as Progyny offers a “smart cycle.” That is specifically an egg retrieval and transfer along with anesthesia, laboratory and monitoring services. “Employers choose how many cycles they want to include in coverage, from one to five cycles,” she said.
According to Progyny’s website, an IVF procedure where one embryo is implanted and rest are tested and/or frozen represents three-quarters of a cycle. An intrauterine insemination represents one-quarter of a cycle. Egg freezing is half a cycle. A reciprocal IVF procedure involving a same-sex couple is 1.25 cycles, while a surrogacy IVF is 1.5 cycles.
Carrot Fertility
Founded: 2016
Headquarters: Menlo, Park, Calif.
Valuation: $500 million (estimated)
Locations: NA
Leadership: Tammy Sun, Founder and CEO; Ashima Ahmad, M.D., Co-Founder and Chief Medical Officer; Tim Kelly, Chief Commercial Officer; Brooke Quinn, Chief Customer Officer
Major Employer Clients: Zoom; Clif Bar; Lucid Motors (luxury electric automaker)
Carrot Fertility has raised more than $114 million since its founding, according to Crunchbase. Its $500 million valuation is an estimate made by Inside Reproductive Health based on available revenue data and multipliers for the healthcare industry.
Carrot Fertility did not respond to a request seeking comment about their company’s differentiation in the fertility space.
Maven Clinic
Headquarters: New York City
Founded: 2014
Valuation: $1.35 billion
Locations: NA
Leadership: Katherine Ryder, Founder and CEO; Kalliope White, Chief of Staff
Major Employer Clients: Snap, Bumble, Sanofi, Booz Allen Hamilton
A Maven spokesperson said the company offers “typical” carveouts, but did not provide specifics.
Maven has raised more than $292 million since its founding, according to Crunchbase.
Carveouts Provide More Guidance Than Traditional Insurance Companies
Despite the dramatic increase in fertility benefits from employers, there are still no standardized guidelines mandated by nationwide governmental bodies such as the U.S. Department of Health and Human Services. As a result, fertility benefits and carveout structures vary from company to company.
“The coverage will vary depending on the employer and which fertility benefit management group they choose,” said Hutchison. State mandates on fertility benefits also play a role, she added. Hutchison estimated that about 45% of its patients currently have some form of insurance coverage. “They all have co-payments and deductibles and out of pocket amounts that apply prior to the coverage kicking in,” she added.
David Stern, the chief executive officer of Boston IVF – which operates 18 fertility clinics in six states – observed that most employees receive minimal guidance regarding their fertility benefits.
“You might have fertility coverage and IVF coverage, but the employee is told by their insurer ‘you’ve got to figure out yourself,’” he said. That puts enrollees at risk of using up their benefits on unneeded testing and procedures before they even start IVF, Stern added.
By contrast, carveouts can provide direction to health plan enrollees. According to Stern, one of the most important parts of a carveout is that fertility platform companies can provide care managers “who will talk to you about what the process is and what it looks like.” Boston IVF is a network provider for several major fertility benefits companies , including Progyny, Maven, Carrot and Stork Club Fertility, according to Stern.
Controlling Unexpected Costs
Stern noted that many platforms also emphasize “centers of excellence” models where they only refer patients to clinics with the highest standards and outcomes. This not only helps with success rates, but can also protect the employer, which may rely on rigorous standards to avoid multiple births. A triplet birth, even if all are healthy, can cost a self-insured company more than seven times the cost of a single birth, Stern said. As a result, he observed that many carveout arrangements specify only one embryo transfer at a time may be attempted for an IVF or similar procedure. Currently, about 95% of Boston IVF’s procedures are comprised of only a single transfer, according to Stern.
Whether employers offer carveouts or not, most coverage Stern sees from companies is minimal.
“You can go to a doctor and you can be seen by a specialist, but they don’t pay for medication or treatment,” he said.
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