What to Know About LGBTQ+ Family-Building Insurance Coverage & More

two moms to beWe know that the finances of fertility and biological family building can be confusing - there's no denying it. Here at Gay Parents To Be, we’ve been working with patients, parents, and insurance companies for years, so we’ve taken our experience with benefits, finances, and open enrollment to give you an in-depth rundown of your options, the best questions to ask HR and your insurance company, and how to make the most of your coverage.

The Good News: Things Are Changing

In recent years, companies like Starbucks have begun to offer expanded fertility coverage to all employees and boost reimbursement maximums. This is yet another step in the right direction when it comes to equal benefits and fertility coverage for those in the LGBTQ+ community who wish to grow their families. Here are some other companies that offer awesome fertility coverage - many with surrogacy, adoption and other benefits!

Still, many companies and their benefit providers do not reimburse family-building services like IUI and surrogacy equally for LGBTQ+ singles and couples. While we wish every company would see the headlines and copy a page from Starbucks’ playbook, you don’t have to wait for that to happen.

You can learn from the many employees at Starbucks who supported this change and work to advocate for similar policies and protections from your employer. There are various costs involved in biological family-building for the LGBTQ+ community, so it’s best to get clear on which costs are covered, or might be eligible for reimbursement with your benefits package.

How to Understand What Your Insurance Coverage Offers

If you have insurance coverage through an employer, it's important to ask the right questions in order to understand what your plan might cover when it comes to LGBTQ+ family building. The best place to start is your HR department or representative.

Here are four essential questions to ask HR:

  1. Is there a fertility benefit offered at this company? If the answer is yes, what treatments and testing are covered? Does this benefit apply to all employees equally, regardless of gender or sexual orientation?
  2. Are there many in-network fertility clinics to choose from? If yes, do any of those clinics tailor programs or services to the specific needs of the LGBTQ+ community?
  3. Are reimbursements offered to all employees for procedures that are typically not covered by insurance, such as IUI or surrogacy?
  4. Are there any exclusions to our fertility/family-building policies that I should be aware of?

What if I don't have any family-building coverage?  

We encourage you to be persistent with your employer, especially in regard to equal coverage for LGBTQ+ persons. However, in the event that your company does not offer a family-building benefit, check out our grant guide as well as this list of LGBTQ+ family-building grants compiled by Family Equality.

Additionally, if your primary policy is just not covering it, companies such as Progyny offer expanded coverage for LGBTQ+ singles and couples for pathways like surrogacy and adoption. This allows employers to offer those benefits that are not within the primary policy and can be a great option to raise to your HR department or representative.

Although it is important to advocate for yourself all year round, one of the times that you can make big changes in your personal plan is during open enrollment. 

Want to learn more about affording fertility treatment?

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What is Open Enrollment?

Open enrollment is the time each year when you are able to manage your benefits and healthcare costs by choosing the best plan for you. The enrollment window typically opens November 1 and closes December 15 each year. While you do have until January 15 to make changes, if you want your new coverage in effect come January 1, you'll need to meet the December 15 deadline.

  • If you are self-employed or work for a small business there may be plans available to you through the Health Insurance Marketplace or through independent insurance companies.
  • If you work for a larger company, this may be the time for you to evaluate the plan or plans offered by your employer, and choose the best fit for you.

The deadline for open enrollment may vary based on your employer, but if you haven’t heard anything about it yet, we recommend that you check in with your HR department! You don’t want to miss out on this opportunity to manage your costs for next year.

What are your family-building goals for the upcoming year?

Open enrollment is a chance for you to pick a plan that will allow you to meet your goals in the new year. Especially if you’re considering biological family building or fertility treatment, you may want to select a plan with a lower deductible, so the full breadth of your insurance coverage will kick in sooner in the year.

What should I look for in an insurance plan?

This is also a great time to ask your employer about the specific fertility or family-building benefits of each plan, including if there are any reimbursements for certain costs. Many employers are now also offering third-party policies (like we mentioned above) that include coverage for LGBTQ+ family building.

If your company does not offer coverage specifically for LGBTQ+ family building, you may be able to use other methods to finance your family building journey. With help from your employer or on your own, you may be able to save money with tax benefits through a variety of programs. Here are some options to consider:

  • A flexible savings account allows you to withhold money from your paycheck and then spend it on unreimbursed medical expenses.
  • A health reimbursement account is funded by employers for their workers to spend on medical costs.
  • A health savings account is designed for people with high-deductible health plans to pay for qualified medical procedures.

Important: Check with the benefits administrator at your employer or with the company that issues the account to ensure that fertility treatment is included in these expenses and help to personalize your financial plan.

What can I do before the new year to take control of my fertility?

As we get to the end of the year, you may be reaching or have already reached your deductible on your current insurance plan - which means that your insurance will cover more of the costs through the end of the year. 

If you’re wondering what steps you can take that will be covered by insurance, we do recommend that you speak to your specific provider to learn about your exact coverage. However, we can suggest some things that are often covered by insurance, that you could potentially schedule and complete before the end of the year.

See below for a list of appointments and tests that you may want to complete before December 31st.

For anyone who was born with ovaries/eggs:

For anyone who was born with testes/sperm:

  • Initial consultation with a fertility specialist (reproductive endocrinologist)
  • Physical exam
  • Semen analysis
  • Genetic screening

For anyone who does not fall into the categories above, or identifies as trans: 

  • Initial consultation with a fertility specialist (reproductive endocrinologist)
  • For trans persons, your journey would be personalized to the plan that you discuss with your reproductive endocrinologist, based on your medical history and that of your partner (if applicable).
  • As with all LGBTQ+ parents-to-be, your next steps and testing may be covered by insurance, but we recommend that you speak to your insurance provider as well as a financial advocate at your fertility clinic to learn more.

Why is planning ahead so important?

Well, many of the test results that you receive now will be "good" for up to six months or a year. Not only is this an opportunity to complete preliminary fertility and wellness assessments, but it is a great way to take a step toward your family building plan with your fertility specialist. Being prepared for the new year with a plan will help you start things off on the right foot and achieve your goals sooner!

If you’re already in the know about your fertility coverage, a great next step is to set up an initial consultation with a fertility specialist (also known as a reproductive endocrinologist).

At Gay Parents To Be, as at many centers, you’ll be connected with an insurance advocate after that consultation - and this person will be able to help you fully understand your benefits, advise you on how to handle the costs of family building and much more.

Ready to take the next step in your family-building journey?

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Sierra Dehmler

Sierra Dehmler

Sierra Dehmler is the Content Marketing Manager for Gay Parents To Be and its partner clinic, Illume Fertility. She is also a fertility patient herself. Combining empathy gained on her personal journey with her professional experience in marketing and content creation, she aims to empower and support other hopeful parents by providing family-building resources that educate, inspire and encourage.

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