BENEFITS DIGEST

Fertility-benefit buyers may be comparing prices and networks without examining differences in clinic outcomes. Shawn Redd, who works in the industry, argues that those differences deserve more attention. He cites CDC reporting across 454 clinics in which the median success rate for patients under 35 was 59.4%, with the middle half ranging from 50% to 67%. The figures aren’t adjusted for differences in patients, and his savings estimates are modeled. They support asking vendors how they evaluate clinics, not assuming that a raw success-rate ranking identifies the best provider for every employee.

An associate at AmeriBen, the company administering the plaintiffs’ employer health plan, emailed a spreadsheet of members’ claims data, names, providers, dates of service and amounts billed, to other plan members. The district court dismissed the resulting class action, finding no concrete injury. The Ninth Circuit reversed in a published opinion, holding that unauthorized disclosure of sensitive health information entrusted to a company is itself the injury. Congress’s judgment in HIPAA reinforced the point, since even mundane-looking line items can reveal a psychiatrist visit or a fertility clinic. The ruling allows the patients’ suit to proceed without requiring them to show that the disclosure caused financial loss, and it matters to sponsors because the defendant administers employer health plans across the country.

Judge Bryan sent Sam Lokensgard’s FMLA discrimination and Minnesota Parenting Leave Act claims to trial. Three weeks after telling his brand-new manager he’d need time off for his wife’s fertility appointments and eventually parental leave, the help desk engineer was fired for taking himself out of the call queue during team meetings, a practice the record shows the company tolerated for years without disciplining anyone. The court allowed the retaliation-related claims to proceed, finding that the timing and the company’s history of tolerating the same conduct could support a jury verdict for Lokensgard. The employer also argued the state parental-leave claim failed because no child had been born yet, and the court held the statute protects the request even before a child is conceived. The FMLA entitlement claim and the marital-status discrimination claims were dismissed.

HR Dive explains the Kulwicki fertility-benefits ruling in plain terms: under the Supreme Court's Bostock decision, the court flipped exactly one variable, the plaintiff's sex, and asked whether the benefit would treat a hypothetical male employee better. Because the plan covered no male infertility treatment at all, the comparison failed, and with it the claim that the plan's eligibility terms discriminated by sexual orientation. Both sides agreed that Bostock applied. They disagreed about how to make the comparison.

A closely watched challenge to fertility benefit design ends in dismissal. A lesbian employee of Wellstar Health System sued under Title VII because the medical plan makes women establish infertility either through months of procreative intercourse, which costs nothing, or through rounds of artificial insemination that she must pay for and that do not result in pregnancy, the only path open to her. A magistrate judge had recommended letting the claims proceed under Bostock, the Supreme Court decision holding that firing a worker for being gay or transgender is discrimination because of sex. Judge Brown rejected that recommendation and dismissed the case. In his reading, Bostock requires changing one thing only, the plaintiff's sex, and a similarly situated male employee would not receive the benefit either, because the plan covers only female infertility. The group actually disadvantaged, the judge reasoned, is everyone unable to conceive through intercourse, which includes men and women of all orientations and is not a protected class. The court declined to follow contrary decisions from federal courts in California and Illinois, so the split over fertility benefit design deepens. The class claims were dismissed without prejudice.

Tammy Sun, founder and chief executive of the fertility-benefits provider Carrot, argues that fertility plans lean too quickly on IVF, which she puts at upwards of $30,000 a cycle, and skip what she calls the “premester,” the window before conception when metabolic care can shape whether IVF is needed at all. She notes the pending federal proposal to classify fertility coverage as an excepted benefit with a $120,000 lifetime cap, and contends a benefit built around procedures rather than root causes would spend that cap faster with worse outcomes.

Milliman examines how employers are positioning fertility coverage amid cost pressures and new market dynamics, covering utilization trends, treatment costs, benefit design approaches, and emerging access pathways through retail and digital health partnerships, against a backdrop of state mandates and drug-pricing initiatives.

Bermuda has introduced a new right for employees to take 'parental leave' when they adopt or become the legal guardian of a young child who lives in their household. The new right broadly aligns with