Financial giant J.P. Morgan has announced it will soon offer expanded fertility benefits aimed at helping LGBTQ employees start or grow their families. Let’s take the opportunity, then, to look at what they and other companies are doing—or should be.
J.P. Morgan’s new benefits include an increased reimbursement for surrogacy costs of up to $30,000, and up to $30,000 of fertility treatments, including in vitro fertilization (IVF), without requiring a medical diagnosis of infertility, reports CNBC. That lack of medical diagnosis is a big deal—many employers require pre-authorization through a medical diagnosis before an employee can access fertility benefits. For otherwise fertile single people or couples who simply don’t have one of each gamete (egg and sperm) between them, that can be a real obstacle. Sometimes it can mean a ridiculous delay, such as when one queer woman who does not have sex with men was required to “try naturally” for a year before her employer would pay for her fertility treatments. I also know of many queer couples who have only been able to start their families through assisted reproduction because an understanding doctor was willing to write down an infertility diagnosis even when there wasn’t one. (None of that should imply that queer people don’t experience true infertility, though. We do, and that should be covered just as it is for any infertile employee.)
J.P. Morgan is not the only employer to be revising its benefits with an eye to queer familymaking. MassMutual did so earlier this year, as I wrote about in detail. Among many other thoughtful benefits for LGBTQ people, they also cover employees’ fertility treatments without requiring a medical diagnosis. In fact, coverage of fertility benefits without pre-authorization is a growing trend, according to FertilityIQ, which crowdsources information on fertility professionals and benefits. I refer you to their Family Builder Workplace Index: 2019-2020 for a fuller list of companies that now do not require pre-authorization—and those that still do. Because FertilityIQ is based on crowd-sourced data, however, its list of companies is not quite as comprehensive as I’d like. I have yet to find a better list, though, that shows which companies require pre-authorization for fertility and which do not. (There are some consulting companies that offer pricey reports on employee benefits, but those are not readily accessible and I do not know if they contain such data.) I would love for HRC to include this information, along with data on adoption and surrogacy benefits, in its next Corporate Equality Index.
IVF coverage, generally speaking, seems to be on the rise among large employers. The New York Times reported earlier this year that 44 percent of employers with more than 20,000 workers offered some sort of IVF benefit in 2018, compared with 37 percent in 2017, according to Mercer, a benefits consulting firm. Smaller companies showed less of an increase. That’s a problem, because not everyone works at a big corporation. Some states require insurers to cover IVF and other fertility treatments in some fashion—here’s a state-by-state list from RESOLVE of those that do—but many of these laws don’t take into account single people or same-gamete couples. Additionally, as Daniel Hemel at the Washington Post has noted, “Current state-level IVF mandates have loopholes. For one thing, the Supreme Court has ruled that states cannot regulate self-funded plans—that is, plans offered by large employers that bear coverage costs themselves. Nor do state mandates extend to Medicaid, federal employees or patients in the veterans health-care system.”
Yet there is a good case for universal IVF coverage, Hemel argues, noting, “A just society should strive to provide all of its members access to the resources that they need to lead healthy and fulfilled lives — at least where available resources allow it…. Most parents would say that being able to conceive and raise children brings them more meaning and joy than, say, being able to run or lift heavy objects. Yet health insurance plans routinely cover treatment of non-life-threatening orthopedic conditions while excluding coverage for IVF.” I’d extend his argument to other fertility treatments as well.
Fertility benefits may make the difference for many people between starting a family the way they want, having to go a different route, or not starting one at all. FertilityIQ estimates that 71 percent of those using IVF in 2018 paid for it themselves, shelling out over $22,000 per IVF “cycle,” a 7 percent increase over 2017 and nearly a 15 percent increase since 2015. That’s not always the total cost, however. More than half of patients, they found, must undergo a second cycle, and nearly a third undergo three or more. “As a result,” they say, “it’s common for patients to spend upwards of $50,000 out of pocket on treatment, which roughly equates to the annual US household income of $51,000.” Those doing simpler assisted insemination (not IVF) may still pay $500-4000 per cycle, depending on the specific procedures and drugs used. Even families that manage to scrape together enough money to pay for that may have trade-offs down the road, with less money to spend on raising their child, saving for the child’s college education, or for other family medical situations or emergencies. There are grants available for LGBTQ families (and others) to help with the costs of assisted reproduction and/or adoption—Family Equality’s list is invaluable here—but grant applications are always less certain than clear coverage.
It’s great that more and more companies are choosing to offer fertility benefits without pre-authorization, though, along with surrogacy and adoption benefits. I hope the LGBTQ community continues to work with companies to expand that number—and to work on legislative mandates for fertility coverage that takes into account single parents and same-gamete couples. (Not to mention broader health care reform—but that’s a whole other post or three.) The J.P. Morgan change happened “after an investment bank employee queried an internal LGBTQ council,” CNBC reports. We need to keep queery-ing.