Infertility is a disease of the reproductive system, resulting in the inability to conceive after one year of trying (or six months if a person is 35 or older). Individuals who can get pregnant but are unable to stay pregnant have recurrent pregnancy loss and need to help build their family as well.
in 1998, the U.S. Supreme Court stated that reproduction is a "major life activity", and "conditions that interfere with reproduction should be regarded as disabilities," as per the Americans with Disabilities Act of 1991.
Infertility affects both women and men equally, and fertility decreases in both women and men with age.
Without coverage, fertility treatment costs can be considerable:
Medication: $200-$5,000 per cycle
Tubal surgery: $10,000 - $15,000
Assisted reproductive technologies (ART): $10,000 - $18,000 per cycle
Fertility Benefits Facts
Infertility treatment is an important aspect of reproductive health care, yet only 1/4 of all health plan sponsors with at least 10 employees provide some level of coverage for infertility treatment.
Offering a comprehensive infertility treatment benefit with appropriate utilization controls may actually reduce costs and improve outcomes by eliminating the inappropriate use of costly covered procedures and allowing specialists to use the most effective, efficient treatment for a specific type of infertility.
The cost of including a well managed infertility benefit is minimal. In vitro fertilization (IVF) and similar treatments account for approximately seven-hundredths of one percent (0.07%) of U.S. healthcare costs.
Of all individuals in the U.S. requiring fertility services, less than 3% require IVF.
Infertile patients with benefits:
base their healthcare decisions on appropriate medical advice, not financial concerns, and transfer fewer embryos.
experience fewer cases of depression and anxiety associated with untreated infertility
States that cover IVF benefits like Massachusetts, Connecticut, and Rhode Island, show that the increase costs is less than 1% of the total premium cost. Massachusetts, the state with the most comprehensive mandate for infertility coverage, found that the cost of coverage was one of the lowest among its mandated benefits at $2.49 per member per year.