Presentation (CTI)

OBJECTIVES: Infertility is one of the most common health conditions among reproductive‑aged individuals, affecting an estimated 17.5% of women globally. Assisted reproductive technology (ART)—including fertility medications, in vitro fertilization (IVF), intrauterine insemination (IUI), and other procedures involving egg or embryo handling—plays a central role in treatment. Fertility medications are often dispensed through specialty pharmacies due to storage requirements and complex administration. While some U.S. employers offer infertility benefits to support recruitment and retention, the structure, scope, and generosity of these benefits vary and are not well characterized. This study evaluated infertility‑related benefits among U.S. self‑insured employers, focusing on coverage levels, benefit limits, and the inclusion of ART services.
METHODS: Benefit plan data from >500 self‑insured employer plan years in Workpartners Research Reference Database (RRDb, 2010-2025) were analyzed. Plans were assessed for diagnostic‑only coverage, outsourced services, annual or lifetime maximums, exclusions, and coverage of fertility medications, IVF cycles, and other ART treatments.
RESULTS: Employer benefit designs showed substantial variability. Many plans provided diagnostic‑only coverage, some covered only underlying conditions, and others excluded infertility benefits entirely. Age restrictions were common, with some plans limiting coverage to females under 44 years. A portion of employers outsourced fertility services to external vendors. Among plans with financial limits, annual maximums ranged from $10,000 to $20,000, while lifetime maximums ranged from $2,500 to $50,000. Coverage for IVF also varied, with some plans allowing one lifetime cycle and others covering two. Fertility medications were sometimes included under pharmacy benefits, occasionally with lifetime caps of $2,500. Higher‑benefit plans were associated with greater utilization, including increased use of fertility medications and higher rates of IUI and IVF procedures.
CONCLUSIONS: Infertility benefits among U.S. self‑insured employers vary widely in scope, coverage, and financial limits. These differences may continue to evolve in response to policy changes and cost considerations.