Methodology

Each year between November and March over 50,000 global FertilityIQ users provide copies of their employer's policy on family building coverage. FertilityIQ thereafter tallies, collates and scores employers based upon on multiple factors including broadness of benefit design, accessibility, flexbility for employee choice (e.g. nature of clinic networks), and ability to provide rigorous, non financially-conflicted education.

Key Findings

8% Growth Amongst Large Employers

The number of large companies and employers that newly-introduced or enhanced their family-building (fertility, adoption, or foster) benefit grew 8% year-over-year and is now approaching 800 large organizations globally. New entrants, or those who raised their benefit, continued to hail from multiple verticals including retail, consumer packaged goods, industrial production, and healthcare services.

"Rise of the Rest"

Industries traditionally known for generous benefits (like technology, banking, and consulting) mostly decided not to increase their benefit. This is the second year in a row we’ve noted that “white-shoe” and "knowledge economy" verticals have decided to sit out the broad-based trend of improving benefits. Meantime, others have caught up. In our minds, the days when these industries could be viewed as undisputed, progressive leaders are rapidly coming to a close.

For context, industrial giant BP now offers benefits comparable to the household-name technology companies. Starbucks offers benefits on par with Goldman Sachs and Dressbarn offers benefits that resemble global auditor PWC.

Reduction of Benefits - A First

For the first time since we’ve covered the subject, in 2021 we saw a number of companies reduce benefits. Historically, we’d only seen benefit reductions in the context of an acquisition (like Walmart acquiring Jet). In 2021, reductions tended to come from employers with the most generous benefits and seemed to represent a rotation into helping cover more costly approaches like gestational surrogacy. This likely helps to broaden the set of employees who can build their families under the aegis of fertility treatment.

Total Fertility Coverage Largely Flat

The average amount of U.S. fertility coverage held steady at roughly $36,000 lifetime. This reflected a shift in companies expanding their existing benefits, new entrants coming in with lower introductory coverage and again, for the first time in years, companies reducing their benefits.

Adoption Dramatically Trails Fertility; LGBTQ Employees Most Impacted

This is the first year we’ve closely tracked coverage on adoption. Only 1 in 5 companies that offer fertility coverage also offer coverage for adoption or foster assistance. What’s more, the average levels of coverage amounted to around $8,000 per employee versus the $36,000 level allocated for fertility. For context, while only a few companies (like Nike, Johnson and Johnson, IBM) offered a $20,000 adoption benefit, over 200 companies offered a fertility benefit of the same amount or more.

We believe this has negative implications for many employees but especially for cis-gender men in same sex relationships, or those pursuing single fatherhood. In both of these cases, alternatives tend to include gestational surrogacy ($100,000 or more) or foster care, where the goal is to reunify a child with their family. We expect employers to take a harder look at this disparity in 2021 and beyond.

Egg Freezing Measured, Utility Brisk

In 2021 a number of large, Fortune 500 organizations introduced an elective egg freezing benefit. The range tended to be wide from $2,000 on the low end to multiple cycles on the high end. Companies struggled with how to treat the tax implications of elective egg freezing as many believe it’s not a “covered medical expense.” There is (possibly well placed) concern that those who’ve been treating it as such will need to re-audit financials, face fines or (in rare cases) restate earnings. We expect CFOs and auditors to pay more attention to the issue this year.

Relatedly, we believe egg freezing utilization was brisk in 2H20 and a function of COVID pent-up demand (reflecting clinic closures in 1H20), COVID-related difficulties of dating or finding a partner, and relocations away from partners. We ourselves see the uptick in interest reflected in FertilityIQ search data.

Scrutiny Over How Egg Freezers Are Educated

In our opinion, those considering egg freezing remain startlingly undereducated. The reality is most every stakeholder makes money when women freeze their eggs and do not when they don’t. Few entities have the time, resources or inclination to thoroughly educate women on the strengths and limitations (of which there are plenty of both) of the procedure.

We foresee 2021 as being the year companies closely examine what their employees are being told about the procedure given:

1. Data tends to show that ~90% of egg freezers don't return to use their eggs
2. A non-insignificant number (1 in 6) of egg freezers may come to regret the decision with a strong correlation between regret and the low level of balanced education they're afforded
3. Tests (AMH and FSH) marketed on social media that tend to catalyze treatment do not predict whether a woman will have trouble conceiving naturally in the future

We foresee 2021 to be the first year CHROs, Benefit Managers (and their consultants) perform honest, unflinching reviews of (1) which organizations were hired to educate their people, (2) what precisely was (and was not) communicated and (3) what conflicts or motivations (financial or otherwise, conscious or otherwise) shaped how women were educated.

Extreme Difficulty Offering Benefits Overseas

For companies with a global footprint, and who want to offer benefits equitably to US and non-US employees alike, challenges remain. Regulation, legality, costs and access to care remain idiosyncratic within each country and this has stymied efforts amongst progressive employers to offer the same benefits across borders. For instance, multinationals offering egg freezing to US employees struggle to extend the same benefit to employees in China or Germany.