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2024 Fertility Benefits Commercial Reimbursement

Fertility benefits are no longer just limited to employees of big tech giants like Apple and Meta. A host of major employers now offer their employees tens of thousands of dollars of fertility benefits, including Boston Consulting Group, General Motors, Liberty Mutual, Morgan Stanley, PNC Financial Services Group, and many more.

Fertility benefits are features of employer-sponsored benefit plans. While insurance carriers like United Healthcare do not traditionally cover fertility treatment as a covered benefit, major health insurers may act as third-party administrators (TPAs) for employer-sponsored health plans that include fertility benefits from a fertility provider network like Progyny.

Fertility benefits vary from employer to employer with benefit limits ranging between $10,000 and $45,000 for most employers. A few employers offer lifetime benefits up to $75,000.

Under the new Transparency in Coverage regulations, the federal rule mandates that all covered items and services under commercial health plans, including self-insured employer-sponsored plans, must be disclosed in the new public price transparency data. By definition, fertility benefits are covered items and services under self-insured employer-sponsored health plans.

As a result, commercial reimbursement rates for fertility services are now public information for thousands of providers nationwide. The four bar charts below illustrate ranges of commercial reimbursement prices for a sample of about 50 fertility services for 1,343 providers in 47 states nationwide. This information was obtained from United Healthcare’s public disclosures as the TPA of the self-insured health plan of the employer Nielsen in New York. The largest samples of reproductive endocrinologists in the data include providers in California (n=175), New York (n=153), Texas (n=134), and Florida (n=75).

 

Every commercial reimbursement contract rate for every health plan, provider, market, and service is now in the public domain. Entrepreneurs, developers, financial planners, and consultants can access every commercial reimbursement rate they could ever need for specific markets. Learn more about DataRise™ Commercial Reimbursement Data.