Apple recently made headlines — and caused some controversy — when it announced a new benefit: Up to US$20,000 for employees to freeze their eggs. The benefit drew praise from some and ire from others, who saw the move as encouraging women to postpone childbearing — and, by extension, maternity leaves.
But plenty of organizations both in Canada and the United States have been quietly offering other reproductive benefits, such as in-vitro fertilization (IVF), for years.
It’s not at all uncommon for Canadian companies to cover some form of reproductive benefits, such as lower-cost fertility drugs, says Lindy Forte, principal consultant at Patient Access Solutions (PAS) in Toronto, who has done research on the reimbursement of fertility services.
“About half of insurers provide some form of (reproductive) benefit, but what’s uncommon is for the benefit to be fully covered. So most have a maximum that might allow for women and couples to be covered for some of the lower-cost alternatives, like the oral chlomiphene citrate, but not the more costly injectible drugs,” she says.
But while about one-half of employers have some degree of coverage for some fertility drugs, not many pay for more expensive fertility drugs or IVF.
That leads to a lot of couples taking on the costs entirely by themselves, she says.
“And with that often goes the choice to implant multiple embryos, because you have to pay for every cycle (of IVF). So rather than do one at a time, you might opt to do more than one at a time, have an instant family, so to speak, and yet there’s risks associated with multiple pregnancies — risks to the mother, risks to the baby — and the risks are around premature birth which can lead to a lot of respiratory problems; there’s (also) a higher risk of cerebral palsy, learning disabilities, blindness.”
Many organizations don’t offer such coverage because of the associated costs, says Forte.
“A lot of people think, ‘It’s unaffordable, it’s a lifestyle condition, why should we pay for that?’ But, really, if you look at the needs and how many people in Canada would need the service and avail themselves of the service, the total cost would be quite low compared to what they’re paying for many other conditions.”
In 2012, PAS looked at what the costs would be if infertility treatments such as fertility drugs were to be fully covered, says Forte. The analysis found that to cover fertility drugs, it would cost a total of about $25 million for the entire country or about $1.39 per privately insured person in Canada.
“And insurers are spending over $330 million annually, or $18 per person, on oral contraceptives,” she says.
It’s also important to consider that infertility treatment is short-term, whereas oral contraceptives could require insurance coverage for 15, 20 years or longer.
Also, many employees with infertility issues may never actually use their organization’s reproductive benefits, says Forte.
“Many will not for ethical reasons or they may just decide that they don’t want to undergo (the process) because it can be invasive — the injectible hormones require that you go to the clinic on a daily basis for a period of time,” she says. “So some may just opt not to do it.”
And those who do undergo these treatments might start with the lower-cost options, be successful, and then not have to go on to the higher-cost options, says Forte.
There is a definite business case to be made for offering reproductive benefits, she says.
“Just the stress on the family, the depression that you can have is difficult to deal with, but knowing that you have a source, an outlet, so there’s a fund there that will take care of your expenses if you need to undergo treatment — just knowing that it’s there can reduce the stress and the depression.”
Offering reproductive benefits will likely be a growing trend in Canada as the taboo around talking about fertility issues is broken down, says Forte.
“It’s sort of a mystery to me as to why mental health services, diabetes, cardiac conditions… there’s no limits to the coverage there, yet for some reason infertility, which has been deemed a medical condition by the WHO... there’s this perception that infertility is a lifestyle condition. And that’s not the case,” she says.
“Infertility is a medical condition, and should be covered just as mental illness, diabetes, et cetera is covered.”
Case study: Sunnybrook Health Sciences Centre
Sunnybrook Health Sciences Centre in Toronto offers reproductive benefits to employees — the organization offers IVF coverage up to a maximum of $15,000.
Sunnybrook offers the IVF package for a number of reasons, says Marilyn Reddick, Toronto-based vice-president of human resources and organizational development.
“ We don’t believe that it should just be about the quality of your work life, but our program is (about) quality of work and life. So it’s more about the balance between the two. So our program is really about enabling our employees to come into work, leave all their personal things at the doorstep, and really do complicated jobs here in which they have to concentrate, or mistakes will be made. So our whole program is based on that philosophy,” she says.
The organization has a heavily female-dominated population, like many health-care organizations, says Reddick.
“We also have an average age which is around 40, so we have a very young workforce, especially in the nursing realm. We have about 3,000 nurses and I would say that the vast majority are between 25 and 40 years old. So when we’re looking at benefits, we try to look at what is important to them,” she says.
“We have to do our standards, our drug and our long-term disability and all those things, but what else would be important to the population that we serve in this organization?”
In-vitro fertilization coverage was one idea that came up — partly because Sunnybrook has a very large women and babies program, with about 4,000 births per year, says Reddick.
It also helps many women who are having difficulty conceiving or keeping a baby.
“We’re a little more in tune as to how difficult it is — how stressful it is on the person and how stressful it is on the family,” she says. “So it was just natural when we were putting together benefits packages to try and address some of these needs.”
The organization has a unique perspective on fertility issues through the work it does, says Reddick.
“We understand how precious it is to have what’s deemed the ‘normal birth.’ And we know a lot of our employees are struggling with not being able to conceive. So it wasn’t a huge decision here, it was just the right thing to do.”
The benefit has been very well-received among the organization’s more than 8,000 employees, says Reddick.
“It is one of the most emotionally difficult journeys, so just not having to worry about the money on top of everything else, I think people are really thankful for,” she says.
“They seem to be very grateful that we’re supportive.”
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