Published data now document the advantages of a limited infertility diagnosis and treatment benefit. Share this information with insurance providers and self-insured employers so they can consider offering these same benefits to their subscribers/employees.

The study described below demonstrates the results of a large self-insured employer providing a $15,000 infertility diagnosis and treatment benefit to its employees. Prior to the limited benefit the employer had offered unlimited diagnostic infertility coverage and unlimited tubal surgery coverage. The study compiled infertility cost data after the benefit had been in effect for many years.

Only 11 (2.5%) of 433 infertility patients reached their lifetime maximum in a 3-year time period (Jan 1993-Dec 1995).

The cost of providing a limited infertility diagnosis and treatment benefit was 0.79% (less than one percent) of total healthcare costs in a 3-year time period (Jan 1993-Dec 1995).

Due to low utilization and low cost the employer increased its infertility benefit from $15,000 per member to a $25,000 per contract benefit.

A limited infertility diagnosis and treatment benefit serves the best interests of both the employer and employees. The employee, aware of the limit, will spend the benefit wisely while the overall limit protects the employer. The employer recognizes only a small portion of employees would use an infertility benefit. For example, older employees or employees who have no problems conceiving would not use this benefit. The majority of infertile employees who use the limited benefit do not reach their limit and become pregnant using less costly, less invasive procedures such as intrauterine insemination. In summary, the employer contains costs by providing a limited lifetime infertility benefit while the employees receive increased benefits.

Clear and concise contract language and a mutual coding agreement between the insurance carrier, the employer, and the medical providers make the system work