Making sense of compliance in the fertility & family-building space.

Maddie Meyers: Hi, everyone, thank you for joining. We're gonna give people a few minutes to to jump in. But curious for folks who are already here would love to hear where you're where you're coming in from where you're located. My name is Maddie. I am based in New York, specifically, Brooklyn. It is a very dreary, rainy day here for a New York summer, but hopefully weather is better in some other locations.

Anthony Perez: Thankfully. Here in Socal. We don't have that problem right now. We actually have the opposite.

Maddie Meyers: It's quite hot now.

Anthony Perez: It's 87 today. No, sorry. 97. Yes, we're like 98. So it's definitely heating up.

Brian Bartels: I will. Yeah, I'm in Omaha, Nebraska, where the College World Series is going on, and you can set your clock that the weather is going to be very hot, very humid and potential thunderstorms every June Cws is happening this year's no exception.

Maddie Meyers: The humidity really, really gets you? Yeah. Arizona, 96.

Anthony Perez: Charge those solar panels.

Maddie Meyers: Seriously. It's the one of the many benefits I usually look forward to New York summer, which is rare, because many people are trying to get out of here, but I like to. I like to stay, but not when it's pouring rain, for like 7 weekends in a row.

Anthony Perez: Thank goodness.

Maddie Meyers: Nevada. Awesome. San Diego.

Anthony Perez: We'll we'll take your reign here in Socal.

Maddie Meyers: That you always grass is always greener unless you have no rain, in which case you need rain to make the grass greener.

Anthony Perez: We got New Mexico, Nevada, Utah.

Maddie Meyers: So fun to see the the span of how these webinars go. Alrighty well, we're 2 min past, so I will, we'll dive in and hopefully. We'll be able to hear whether people are calling in from as as we continue officially. Hello, everyone very happy to have you joining today. we are going to get into today's session. It's going to be a really important one. We'll be talking about the fast changing world of fertility and family benefits.

There's a lot going on right now in the landscape. And specifically, we're thinking about how Hr teams can really navigate this from a compliance, perspective, a coverage perspective and employee needs.

We've got a great group of speakers lined up, and our goal is really to make this feel like a conversation. So if folks do have questions, feel free to drop them in the chat, and we'll save some time for Q. And A at the end, in terms of today's agenda. We'll start by setting the stage for why fertility and family benefits are growing so quickly, and what that shift means for Hr. Teams like yours.

We'll then dig into the fun stuff the compliance landscape, both from a legal lens and a strategic lens. So we've got 2 great experts on the call to talk about how to navigate mandates. Look at the gray areas, how to do employee education, things like that.

We'll then move into how to build inclusive and effective programs for your teams. We really want to think about this as not just checking a box, but actually meeting the needs of your employee base, and finally, we'll wrap up with a few key takeaways, and, as I mentioned, have time for Q&A.

But first, a few introductions, I will go first.st My name is Maddie Myers. I'm the People Operations manager here at Nava, which really means I do everything in terms of employee experience from off boarding and onboarding. Everything in between. That, of course, involves building out our fertility, benefits as well, and really looking at the demographics of our company, and how we can build psychologically safe workspaces.

Anthony, I'll have you tell them a little bit about yourself as well.

Anthony Perez: Hello, everyone! My name is Anthony Perez. I'm 1 of our account executives at Carrot. I've been at Carrot for just over 4 years. Now, I'm based in Southern California. And my role is really, I work and partner with Hr leaders who are looking to explore different solutions to support their employees around family building. So thank you all so much for your time, and and joining today. pass it over to Brian.

Brian Bartels: Great thanks, Anthony, so good morning, or good afternoon, everyone depending on what part of the country you're joining us from. My name is Brian Bartels. I'm a partner at Kutak Rock.

Kutak Rock is a national law firm with over 550 attorneys in 19 offices across the country. I'm a member of our national employee benefits and executive Compensation Practice Group, and I focus my practice on advising employers on health and welfare benefit plans, including erisa hipaa, the affordable Care Act, the No surprises act, mental health parity, negotiating administrative services, agreements and business associate agreements and helping clients respond to participant or regulatory inquiries. and as noted on our slide, we have our our favorite disclaimer that this presentation is for general information purposes only. This is not legal advice and does not create an attorney client relationship.

Maddie Meyers: Thanks, Brian, a small but important disclaimer. Cool, let's dive in. So we 1st want to talk about really what's driving all this momentum. And all this change and energy around fertility and family building benefits.

I think. 1st and foremost, there are a ton of big life stage shifts going on. So more people are delaying their parenthood or preserving fertility earlier, which means the support and the need for workforces to differentiate. This looks really different from 10 years ago.

There's also a big push to expand inclusion in this category. Hr teams are really looking at expanding our benefits to cover all kinds of families. So that includes same sex couples, solo parenting. Really anyone navigating for a less traditional path into parenthood.

We also have pandemic aftershock, which maybe sounds a little scary, but potentially some of us have experienced this. I think Covid has delayed family planning for a lot of people, and it's played a big role in kind of how people are thinking about their lives. But now Covid is over, demand is picking back up and fast. And so I think employers are trying to catch up in some ways to kind of the decisions that folks have made in terms of their family planning. and add to that the fact that these benefits are also increasingly a recruitment and retention lover. So they're not really seen as just perks anymore. But more kind of fundamental to folks benefits package folks are asking about it in interviews. They're weighing it in terms of where whether they choose to join the company. I've definitely seen this in the recruiting practices at Nava firsthand as something that's really important to folks who are looking to to join Nava.

And then, of course, there's the compliance angle. A lot of new laws happening. Tax guidance is making it harder to know what's allowed, what's important, what's required and how to stay on the right side of it all.

So that's the bigger picture of of what's changing and why. But I think to ground this in some demographic data. And just how many people are actually impacted. I'm going to pass it over to Anthony.

Anthony Perez: Alright. Thank you, Maddie. So who are we talking about here?

You know, when most people think about fertility and family forming benefits, they picture a small group of employees, maybe just a few people trying to get pregnant. And yes, those people matter a lot. But oftentimes there's a belief that these fertility benefits won't really reach a broad population within your organization to really justify the investment. But once we take a closer look, you know, the picture becomes much bigger.

Yes, there are employees struggling with infertility, but they're also people who are single and want to start families. Lgbtq plus employees exploring various paths to parenthood like adoption and surrogacy. others planning to have kids, or, you know, later on in life.

And then, of course, many of your employees are already parents. They're balancing work with caregiving, or they need real support. And for those beyond their family building phase, hormonal health becomes a major issue, including menopause, low testosterone and other age-related needs. These challenges affect women.

They affect men, gender, diverse employees alike. And when you stack all these different people together who need support. It's not just the one in 6 people who are struggling with infertility.

It's it's meaningful portion of your population, your workforce across life stages, identities, family structures who could benefit from this kind of care. So that's the real opportunity here, that is, who we're looking to support.

And that is what we're here to dig into today. So what does this mean for your employees and your organization now?

So so you know why. Now you know why? Why are we looking at these these solutions today. And you know, why not look at this later? So when we talk about the cost of inaction. because doing nothing can often be far more expensive than we realize on the surface. It may seem easier to delay or deprioritize investment in comprehensive fertility or maternity support, but the reality is without the right infrastructure in place, both your employees and your business face significant risk.

And so from the employee perspective, they're up against high treatment cost limited coverage and restricted access to specialty providers. They're trying to understand the new California to state mandate and what that means to them. Many face real discrepancies in care and without proper guidance. There is no steerage to top performing clinics or fertility experts. And now, when you zoom out to the broader system, level impact.

Mismanaged care, especially across fertility and maternity journeys often leads to unnecessary interventions, high-risk pregnancies, and costly complicated deliveries. and the implications don't stop at delivery you know, poor outcomes can lead to long-term health implications, or even complications for downstream costs for both families and for employers.

So whether someone is planning for pregnancy. actively pursuing it already parenting or transitioning care between an obgyn. Every step in that journey matters and getting it wrong is expensive. So the business case here isn't just about adding a benefit. It's proactively managing risk and improving outcome outcomes across the board.

So why? So now we're going to talk a little bit about kind of what this means, and when we think about supporting employees through family building and hormonal health, it's clear that there's not a 1 size fit. All approach right. You know. That's why solutions like this. We've built modular or flexible programs that you can implement across various journeys from family planning through parenting and beyond. And so a lot of Hr leaders that I hear from are looking for something that supports everyone, regardless of age, gender, sex, marital status, whether they are struggling with infertility or not. You know a 1 solution to support all.

And that's really what we've structured and what we're looking at here, you know something that's very intentional. It's designed to support the full arc of someone's experience, you know, starting with family planning through fertility, care, pregnancy, parenting, and lifelong hormonal health.

So while the majority of our customers do choose to offer support across all these different touch points all these journeys that you see here. it's also flexible to meet any employers, needs or goals based on their preference, their demographics. and most importantly, what we really want to do here is meet members where they're at in their journey.

So let's look at your employees in their family planning phase. You know many of our members come to us in the early stages.

They're just starting to think about family. They may be wondering about timing, fertility, testing or feeling anxious about what's ahead here. We want to provide 1st line and education. pre-pregnancy, counseling at home, testing options, giving people clarity and confidence right from the start.

Then you have those employees. You know. They're actively pursuing family building. Whether that's through Ivf. Iui. Fertility, preservation, adoption, surrogacy. We want to guide members every step of the way because these are very complicated, very emotionally charged journeys, making sure that everyone understands their options and are connected to culturally competent and high quality providers near them.

That navigational support is huge during this very emotional process.

And then someone that is pregnant, you know our support shifts to birthing plan. you know. Emotional support, miscarriage support, high risk pregnancies, access to Doulas, and even practical services like milk, breast milk, shipping for business travel. It's about making sure people feel safe supported all the way through that delivery. and then, after delivery, we continue to support folks through postpartum care, pediatric navigation, parenting resources, and even training for managers. So they know how to support employees transitioning back from from leave into the workplace. And this is where you know, culturally, really, you know, your culture really shows. And we really want to help reinforce that, ensuring that people have the right level of care at the right time.

And then, finally, we support lifelong hormonal health, including menopause care, testosterone support as well as gender affirming care. In fact, we're now offering telemedicine support for menopause, making it easy for people to get the help that they need without disrupting their day to day.

And so again, while this end to end model is what most customers offer their employees. It's not all or nothing. You have the flexibility to decide what's most important for your population. Our goal is to meet your people where they're at and help you build a program that fits your wellness. Strategy, because fertility is not a nice to have. It's a need to have.

So now we're going to shift gears and talk a little bit about.

You know what this actually looks like in practice, what Hr teams are navigating day to day, and where some of the biggest gaps and opportunities exist right now.

Maddie Meyers: Thanks, Anthony. What Hr teams are navigating today. Lots of things. So I want to talk through kind of the reality of of what we're seeing. I think the 1st thing is really coverage gaps. A lot of companies think that they're offering fertility benefits, but when you look closer they might only cover Ivf. or they're leaving things out like preservation or support to same-sex couples.

This creates a lot of confusion for employees and frustration for Hr. When questions start rolling in.

There's also a big Admin lift. I think, as many folks on the call know, Hr. Teams can often be caught in the middle. You're Fielding, really sensitive questions from employees, and you want to give them as much clarity and show them as much empathy as possible, while also trying to explain what's taxable and what's not, while on the other side of things, managing vendors that might not be doing enough of the heavy lifting and kind of putting you in the middle. and there's also tension between roles. Hr wants to support employees, but they're not tax experts, and we're not attorneys. So I think that's where leaning on your resources can be really helpful. Leaning on partners like your broker, like your vendors and legal teams, becomes really essential in this category which brings us to a lot the big question a lot of folks are asking, what's actually required from a compliance standpoint. What's changing?

And how do you know, if your plan, your current plan, is at risk and any adjustments you need to make.

So with that, I'm going to hand things over to Brian to walk us through what the legal landscape is, and what you need to be watching for.

Brian Bartels: Great thanks, Maddie. so we're gonna 1st dive in talk about a California law that was recently enacted and actually is set to go into effect quite soon.

In 2024, California. Governor Gavin Newsom, who's been in the news quite a bit. The last couple weeks, has signed into law, Sb. 729, and the intent of Sb. 729 was to increase access to in vitro fertilization and other fertility and infertility services.

This law applies to fully insured health policies that are issued, amended, or renewed on or after July 1st of 2025 for calendar year plans. That means changes will take effect for the 2026 plan year. When the Governor signed that law, he kind of indicated that he wanted the the State legislature to delay the implementation a little bit. But to our knowledge nothing has happened on the legislative front yet that would delay or extend that implementation deadline.

But there's still, I suppose, a little bit of time where they could try to make that happen.

So the requirements is noted on the slide are going to vary, depending on whether or not the insurance policy is issued to a large group or a small group.

If you have a large group health insurance policy. Starting with that effective date that we just mentioned, large group policies are going to be required to cover fertility and infertility services while small group policies are required to offer the option to add such coverage. So if you're a large group policy, you know, it's mandatory that certain benefits be included in the health insurance policy, whereas, with a small group health insurance policy, the group has the option of whether or not to add certain coverages to address, fertility and infertility related services.

So in general, among the other things, a large group contract must include a maximum of 3 completed egg retrievals with unlimited embryo transfers in accordance with guidelines by the American Society for Reproductive Medicine.

The insurance contract also cannot contain certain provisions, such as an exclusion, limitation, or the restriction on coverage of fertility, medications that are different from those that are imposed on other prescription medications.

Importantly, Sb. 729 does not apply to self-insured group health plans that are subject to Erisa. So if you are sponsoring a self-insured group health plan because this is a State insurance law, the Erisa says, the State insurance laws are preempted by Erisa, and so a self-insured group health plan is not required to offer the coverage that's under California, Sb. 729.

So let's go to the next slide, please. So as you can imagine, California, although California tends to be a leader on a lot of things. California is not the only state that is expanding state insurance laws and other laws to mandate that health insurance policies include infertility or fertility coverage so noted on slide states like New York, Utah, Colorado, Illinois, Arkansas, New Jersey, and several other States have laws that address, infertility, coverage, such as Ivf and fertility, preservation.

So if you're in one of the States that has started to address this through legislative action, and regulating what health insurers must do in those States. Your broker consultant should be able to provide you that information as well as any renewal information that the insurance company would provide you.

So when we think of family formation benefits. There's not just the healthcare side. There's a lot of other things that employers can do to help with family formation. And then what I call family supporting benefits, you know, once, you know, a child might be adopted or or brought into the family. There's there's lots of other ways. Employers can help their employees support the the family formation, the whole family journey.

So one of the popular on the side, we just list a couple of the popular benefits. There's probably others that we could list. But these are kind of the ones that you typically see employers offering. And each of these, as we'll talk about a little bit has very unique and specific legal requirements. And obviously I could spend literally all day talking about each one of these. I'm not going to do that. I don't think you want to hear me speak for 8 h on these topics today. So we're just going to do a general high level summary of some of the key aspects of each of these benefits. We're not going to go into all the details that apply to them.

So in the 1st popular benefits, for family information is what's called a health reimbursement arrangement which is commonly referred to as an hra.

An Hra is a self-insured group. Health plan, and only employers may fund an hra. There's no employee money, so employees do not elect to put money on a pre-tax basis to an hra. The hra is only funded with employer money and an hra may be used to pay or reimburse employees on a tax advantage basis for qualified medical expenses that the employees incur.

And this you know, as we've kind of alluded to in a couple of times throughout the presentation, what constitutes medical care and a medical expense is a really technical definition under federal law. So for an Hra to reimburse an expense on a tax advantage basis, that expense has to be what's called a medical care or medical care. Expense generally is applicable here.

A medical care generally means amounts that are paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.

So an hra can be designed to reimburse employees on a tax advantage, basis for infertility, treatments that constitute medical care. As long as those expenses are not paid or reimbursed from other sources, such as health insurance. So some employers, if they see a gap in what their group health plan is providing, might decide to structure an hra to provide additional reimbursements for medical care, expenses that are for fertility or infertility, treatments that might not be covered by health insurance, and so employers can design an Hra to work in connection with their health insurance to kind of help supplement gaps in coverage that the health policy might not be providing another popular family formation benefit is a qualified adoption assistance program under an adoption assistance program. Eligible employees may be reimbursed again on a tax advantage basis for expenses that qualify as adoption expenses. And there's a long list of what does and does not qualify as an adoption expense. Typically things like the adoption fees court costs to effectuate the adoption and attorney fees that are incurred throughout the adoption process are typical examples of what could qualify as an adoption expense.

The federal law limits the maximum amount that may be excluded from an employee's income under an adoption assistance program, and there's some nuances to be the amounts that may be excluded. But for 2025, talking in very general terms. The maximum amount that may be excluded from an employee's income from an employer provided adoption assistance program is $17,280 per eligible child.

Now, some employers don't want to give that full amount. There's no requirement that says if you're offering this adoption assistance program. You have to provide that full amount. Some employers might want to say we're going to make, you know, $5,000 available, and that's perfectly fine to offer an adoption assistance program that does not reimburse that full statutory amount.

It's important to note that the adoption amount can be reduced or eliminated, based on the employees gross income. So if an employee makes too much money, they might not qualify for this benefit. then finally, another popular benefit. For the you know, family supporting realm is what a call is called a dependent care assistance program or a Dcap under the typical Dcap arrangement employees elect during open enrollment, to participate in the Dcap and reduce their compensation for the upcoming year by contributing to the dcap.

So let's say, for example, my employer offers a dependent care assistance program. I'm going through open enrollment, and I know I'm going to pay daycare expenses next year. So I might say I want to put $2,000 away on a pre-tax basis into the Decaf. So I have that $2,000 available to me in 2026 that I can use to pay for childcare.

So when an employer is offering a dcap, the Decap may reimburse the employees on a tax advantage basis for dependent care expenses that the employee incurs to be gainfully employed, you know, such as in my example, daycare the decap again, just like all the other benefits, has maximum amounts that can be allowed to be put on a pre-tax basis. So the general starting point is $5,000 a year can be contributed to dependent care assistance program. If you're married and filing a joint return, or if you're a single parent generally, the limit is $2,500 per year for employees who are married, but filing separately. Then for some employees, they don't, depending on what income they make. The limit may be the amount of their earned income. So that there's special rules about how much you can contribute, based on how much money you earn. one of the common issues that come up with dcaps are the nondiscrimination rules. So under a dcap, a dcap can't discriminate in favor of highly compensated employees. Want to make sure that all the employees of an employer are benefiting from being able to pay for childcare, for example, on a tax advantage basis. So we want to make sure, under the nondiscrimination rules that highly compensated employees are getting more of a benefit than our lower compensated employees. And so the the dependent Care assistance program rules are designed to make sure that if you have really highly compensated employees, that they're not putting too much money away compared to the lower employees, and so sometimes depending on what the demographics of an employer look like. You might have. All the highly compensated employees are having children and incurring all these expenses, whereas the non highly compensated employees might not, and so adjustments that have to be made to the amount of contribution that the highly compensated employees are able to make to the decap so they can pass on discrimination testing the decaps are a really good benefit both from an employee perspective and an employer. Perspective, you know from an employee perspective. The employee knows that they're going to be paying these dependent care expenses the next year. So by having the decap, the employer is able to provide a way that these expenses can be paid on a pre-tax basis. So we're lowering the employees taxable income a little bit, which means they're paying a little bit less money in Federal income tax. They're paying a little bit less money in employment taxes, and on the employer side the employer can save a little bit of money, too, on the employment tax front, because again, the employers or the employees, compensation has been reduced a little bit. So it's kind of a great situation for everyone involved.

So, as previously noted, Hras adoption assistance programs and Decafs have very detailed and specific legal requirements. Among those there must be written plan documents, and there's very detailed nondiscrimination rules. So if you're thinking about offering one or more of these benefits to your employees, it's really important to understand what those rules are. Make sure they're going to work with your existing structure. and that they're properly designed and developed to meet all the different legal requirements that apply to each of these benefits.

Maddie Meyers: Before we move on to the next side, Brian, a question about these formation benefits. What's the difference between a dependent care assistant program and just a regular dependent care. Fsa.

Brian Bartels: They mean the same thing is the same thing.

Maddie Meyers: Great and in terms of the administration of these benefits. Is it similar to administering? And an Fsa or a dependent Fsa.

Brian Bartels: Yep, yep. So typically an employer will hire a 3rd party to administer the dependent care assistance program or the dependent care. Fsa, just because it's a lot easier to have someone else who's in the field and doing this all the time, you know. Take the receipts to demonstrate. Yes, I've improved this expense and keep track of how much has been contributed every month, and how much it's been deducted. Things like that. So it's very similar to like a health, flexible spending arrangement, having a vendor do it, and typically most dependent care. Fsa vendors will also do a decap. You know, they kind of all do the same kind of reimbursements.

Maddie Meyers: Right. Thank you.

Brian Bartels: Yep. So we've alluded to this like I said before, that one of the major issues both with Hras and then just a group health plan, and generally is making sure that the health plan or the Hra is only reimbursing expenses that are for quote unquote medical care, because the tax code says that you can only reimburse on a tax advantage basis specific items that qualifies medical care.

There's a number of court cases and then specific Irs. Guidance that addresses whether or not a particular expense qualifies as medical care.

As I previously noted, medical care for purposes of this discussion generally means amounts that are paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.

So in one of the pieces of guidance that the Irs put out a few years ago. The Irs determined that it was for a heterosexual married couple, and the Irs determined that fertility, medication and treatment and egg and sperm retrieval procedures qualified as medical expenses in connection with that couple's Ivf treatments.

But in another case that involved a same-sex couple. The Irs determined that medical costs and fees directly related to sperm donation and sperm freezing were expenses for medical care. but costs and fees related to egg donation, Ivf. Procedures and gestational surrogacy did not qualify as medical care expenses, because those expenses were not incurred for the purpose of treating disease, or for the purpose of affecting any structure or function of the taxpayers, bodies. And this is where things get a little challenging, especially for same sex couples is because they might not technically not be able to have children biologically. And so that makes it really difficult to say that they're, you know, infertile or have a fertility problem. It's not that they're infertile or have a fertility problem. It's that, you know, biologically, you know, 2 same sex individuals can't reproduce on their own. And so it's really those examples. And there's lots of tax court cases that kind of due to the same issues. Those cases really illustrate that it's important to when you're administering both your health plan and health reimbursement arrangement. That's providing fertility infertility surrogacy type benefits that whoever's running that program really understands what is and is not a medical expense and what will qualify for favorable tax treatment, because it's there. There's a lot of kind of flying, slicing, and dicing, depending on the individuals involved. What their medical condition is. Who's being reimbursed? Who's incurring the expenses? Things like that? So it's really important to have usually a 3rd party vendor who's administering your hra and your health plan. who really is knowledgeable about these different expenses, knowledgeable about the irs guidance, and you're working with your broker, your legal team, and your outside vendors to make sure that the expenses are being properly reimbursed.

With that I'll pass it over to Maddie. Who's going to talk about key lessons and next steps for us to consider.

Maddie Meyers: Thank you, Brian. Super helpful. So let's talk about designing these benefits for for your workforce. This slide breaks down through a few of the most common assumptions we see in benefits design, and why they don't go far enough.

Starting with Ivf. I think Brian touched on this a little ivf a lot of folks assume. This is the only thing that matters. So if you've got Ivf as your fertility benefit, you're good to go. But as we've seen throughout this day's conversation. People are pursuing all kinds of paths to parenthood. They need to support things like preservation, surrogacy, adoption, and hormonal health.

The second one is mandated coverage. Assuming that that's enough, just because your state requires something. It doesn't mean that's going to cover all of the things your people actually need. So an inclusive plan means that you're filling those gaps with education, wraparound support design. That's tax aware things like that.

And then you've got the assumptions of who's really using these benefits. Not everyone's path looks the same same sex couples, solo parenting, gender, diverse employees. All of those folks need to be considered when you're building these plans, equity needs to be really intentional here. and on top of that, employees can't navigate this stuff on their own. It's incredibly confusing and a landscape that is very stressful and overwhelming. They're often working with limited information. So plans should really think about how to build guidance and education directly into the experience. It's not just a tack on later. It really needs to be fundamental to how you're building these plans.

And finally, we know that a 1. Size fits. All plan doesn't cover it anymore. As Anthony mentioned, flexibility is key. In building these formulations, the most effective plans are able to adapt to different needs and evolving life stages.

So I think holistically, these assumptions are, our mindset really needs to be around, not just checking the box for these benefits. But you want your benefits to be usable and practical. So making sure that what you're offering is really going to work and make an impact for your team is super important.

Brian Bartels: And Maddie. One thing I would note, especially on the helping employees navigate their benefits. one benefit we haven't talked about is an employee assistance program and eap depending on who the Apa vendor is, and and what benefits that the employer has selected. Many Eaps have either a component that has, like a childcare helping, you know, find a childcare or an adult daycare, for example, or helping employees find which partner in their health plan can provide, you know, specifically reproductive health care, for example. And so that might be another area when employers are thinking about, how can I help my employees navigate this whole journey, navigate their health care. Think about eap because a lot of Eaps are kind of like offer, but forgotten. It's kind of the unsung kind of starting point for a lot of benefits. And and so I would really encourage you if you have any Ap. Take advantage of it, and see if these type of benefits or this type of navigation is included. And then, when we're speaking of navigation, a lot of probably over the past 4 or 5 years there's been a lot of new services that have popped up where either the insurance company or the 3rd party administrator itself will offer navigation. But if it's kind of like a higher level, like concierge type guiding for employees or plan participants, or there's 3rd party companies that can tack on to your health plan, who really then provide more of a handholding experience for employees, and so depending again on you know your benefit budget and your employee population, things like that. That's another way thing to consider exploring is, does your current vendor offer those services, or is it something to think about? Maybe adding on, if if you're having trouble, having employees navigate their benefit, space.

Maddie Meyers: Yeah, I think, plus one to both of those points. Eaps are something I very frequently see are underutilized. And I think there's like a lot of myth around what they actually do. But a lot of them are baked into pretty standard benefits, packages so definitely worth looking into and agree to kind of the concierge approach of one. It's about building the package. But 2. It's really just about having people who can help you learn about the package that is in front of you and reminding you of the resources that you know individuals, employees are dealing with a lot of different stuff. It's hard to pay attention to all these benefits, presentations. So having folks who are just experts in the field to remind folks of what's already there is at least half the battle, if not more.

Brian Bartels: And you know a lot of employees. They only think about benefits, you know, maybe twice a year, once when they're enrolling, and then number 2 when something really bad happens and they have to use their benefits. And so some employers consider a strategy where? Okay, we're going to send out like a monthly, you know. Benefit newsletter or monthly reminder like, Hey, these are the benefits. And you know it's summertime. So think about, you know. XY. And Z, before you go out in the sun, or think about, you know. back to school, you know. Did you get your immunizations and your shots here? Things like that. So we can, instead of just thinking about benefits. You know, once a year, during an open enrollment, we really can think about it as how do we have a conversation throughout the year to really remind employees of what benefits are provided? And that also shows, you know, offering benefits is expensive. Right? It's it's part of employees compensation package. So the more we can do to show employees. Hey, we spent a lot of money on putting this really nice package together for you. It's really part of your compensation that helps show the value of not just, you know, the take home salary, but the overall experience you're providing.

Maddie Meyers: Absolutely. That's something that Nava, as as a broker and as a partner like, really tries to help with, is just that thinking about benefits as an annual commitment. And how can we help build out those communications and have them be kind of consistent reminders versus, you know we helped you with renewals. Open enrollment is done, and so we'll see you in a year. It just makes such a difference for utilization cool. Let's go to the next slide. I just want to talk through how you can think about just how important it is to ask the right questions when you're evaluating or refining your family building benefits, so that you leave this with kind of things to think about that are more tactical. I think even well-intentioned programs can fall short if they're not designed with compliance and inclusion in mind. so things that you might want to ask. Leaving this conversation, do our partners support all paths to parenthood, including surrogacy, adoption, same sex couples. If not, there's a real equity issue that could create friction with employees. And you want to make sure you're aware of those before getting into risky territory with your team?

Are you thinking about tax implications? How do your partners handle what's taxable and what's not taxable? Are they helping your team navigate that? Or are they leaving that up to the Hr. Team?

And finally, as I mentioned as Brian and I were just talking about. What are your partners doing in terms of education? If you're as an Hr. Leader, stuck Fielding every question or explaining every nuance, that's a sign that your vendor isn't doing enough. They should really be supporting you in that. And they're the experts in the field. So you want to be utilizing them, and they should be offering that as part of their package we also included some some operational questions in here. Things like compliance support across states would be really helpful admin lift? Are they supporting you in that? Would they support you in contract negotiation? These can really make or break your experience as an Hr leader. I speak from personal experience. So I would definitely lean on these questions to really make sure that you're getting the most out of whatever partnerships. You look into Anthony and Brian. Do you have anything to add?

Brian Bartels: Yeah, I I would say, the you know, contracting is really important. Obviously, like, I'm attorney. I don't want that sound like, you know, self serving but a big part of my practice is helping clients all across the country, you know, review and negotiate contracts, and you know, if a vendor, and, Anthony, no offense to you. This is directed to you, but you want a vendor gives you their contract the contract is written from the point of view of the vendor, what what's best for the vendor? And so it's really important that you know you you review and really understand what you're signing, and to the extent you're able to negotiate the contract. There might be provisions in there, you know, like payment terms, for example, the payment terms might not work with your your accounts. Payable department, you know. It's a really, you know, basic, simple thing. But you know you, you don't want to agree that you're going to pay on X date when your your accounts payable team needs, you know, 30 or 45 or 90 days to process payments like, that's a really easy, simple example. Example.

Then we think about in a contract like data, privacy and security, making sure those pieces are appropriately addressed thinking about indemnification. If something bad happens, we want the vendor to make it right and making sure the the contract has the appropriate language to accomplish that objective. So it's really important that you! You work with qualified counsel to really understand what what the contract says, what you're being obligated to do, and then address things that might be deficient in the contract.

Oh, and also, Anthony, I think we'll say this, too. Don't wait until the last minute, you know, if you're trying to do a benefit on January first.st You're not going to get a contract done if you give it to anyone on December first.st That's just it's not gonna happen. So it's really important to plan ahead. So you can build out all the time necessary for implementation. And at the end of you have quite a bit to say on that as well.

Anthony Perez: I was literally going to say that I think what's important, because, you know, I've been at careful for 4 years, and I see this every year is is kind of look at your timeline, you know. When do you make decisions? When does your medical renewal come in? When is your open enrollment. When do you want to start providing support because busy season for employee benefits happens right after 4th of July, and oftentimes what we see is companies will like wanna look at these solutions in August or September or October. So take advantage of the of the Nice. You know time that you have in terms of the evaluation process. because, like Brian mentioned, just to make the decision just to implement to to meet a target 1, 1 launch date becomes very you know, closes very quickly. That gap, you know, trying to get a contract signed during the holidays is probably not ideal for everyone. So we wanna, you know, arm and equip you with education, upfront and begin those conversations sooner rather than later, so that your team has time to make those decisions and implement.

Maddie Meyers: Yeah, I think you know, as a benefits brokerage plus one. We're always like, you know, the timeline starts. Now, if you're looking at a 1, 1 renewal, and also in terms of these partners and vendors, being able to call fertility benefits something that you thought about at the beginning, when you were building out your benefits. Package not an add on later of oh, we forgot to do this. We want to add it in, but when you're baking in your budget. You're thinking about all of these things from the get go. So you're making all of the decisions and conversations with another so that you can really build something that's like holistically the best it's going to be for your employees for that year.

Let's go to the next slide and talk about what Hr. Can walk away with. So you know, you don't need to be a compliance expert or a tax attorney to take action. But I think we thought about kind of 3 clear things that you can walk away with from this conversation.

Think first, st look at your current plan. Do an audit. Take stock of what's actually covered already. And more importantly, what's not? Look at where your employees might be facing barriers, especially on those less traditional paths to parenthood. Are you only supporting Ivf right now? Are you accounting for things like surrogacy, solo parenting, preservation, gender diverse needs? You can think about doing a benefit survey as well to really get feedback from your employees on. Are there big gaps that you want to be thinking about?

Next? Let's look at the tax implications. This one's huge. I think there's a ton of confusion around what's taxable and what's not, and it can make a really big difference, but get tricky very fast. So you just want to make sure your internal team and your vendors and your employees are all aligned on what's taxable and what's not, so that no one is caught off guard. This is where Navar or any broker that you work with, and your legal partner can be really helpful.

And last, but not least, we already got to this with Anthony and Brian. But start planning now. If you're thinking about a 1, win renewal or any sort of roll out for the holidays. Now is absolutely time to start the conversation. Ask your broker the hard questions. Get your legal partners involved. Start getting those contracts in for review so that, you know, when Q. 4 comes, I guarantee your plates gonna be full with other stuff, but you'll at least have thought this through in the summer. So that you can really approach it thoughtfully, and and feel really confident in your decision. At the end of the day.

Brian Bartels: And I would add, you know, for we're starting now. That really helps you also build out that communication piece that we were talking about a little bit little bit ago, you know, if you you've made decisions now, in the summer or late summer, you've chosen your vendor. Your contracts are underway. You know what the benefit design looks at. That, then gives you time and breathing room to say, Okay, what kind of open enrollment campaign do we want. How are we gonna communicate it? What really cool things kind of vendors come on site, maybe review through a webinar or something like that.

So giving yourself the gift of time to really think through. Okay, we're offering this great new benefit. How are we gonna communicate it? So our employees know about it. They appreciate it, you know. We can use it for recruiting purposes. All those things that the more kind of pre planning you could do that, then tease you up for success for all the other things to to launch this new benefit.

Maddie Meyers: Yeah, absolutely. And also give your team a heads up. So for folks who are planning to do who are family planning in in Q. 4, or in 2026. They know that this will be part of of their package, and something that they can utilize upfront versus finding out about it too late.

Anthony. Anything else you wanted to add. I saw you unmuted.

Anthony Perez: No, I was. Gonna say, that's like one of the biggest ones I get like towards the end of summer, early fall is like. can you share collateral material or resources for our open enrollment coming up in, you know, October, November timeframe? So to Brian's point? You know, getting ahead of that. To provide those communication campaigns is critical for promoting engagement.

Maddie Meyers: Yeah, I would say, like as an Hr leader, it's such a bummer when you hear from employees like, I wish I knew about that. And it's like, Oh, okay, I want you to know about these things, because, you know, we want to bake them in so that you do know about them, and you utilize them. So communication is just like fundamental. There.

Brian Bartels: I think the auditing and plan is really important, too. We've been to situations where. we've been representing buyers and like merger and acquisition transactions and looking at the the business, who's selling, and, you know, doing the due diligence to say, well, you know what benefit plans do you have, or you comply, Yada Yada, and we'll we'll discover that you know. The the seller thinks that they've had a cafeteria plan or dependent care assistance program for the last 10 years. But there's no plan document, you know. There's nothing memorializing that they're following the law, that they are doing all the things that's required to do to actually. correctly off of that benefit. So it's a really good idea. Maybe just you, you kind of keep a running list of. Okay, these are our plans. These are the things we've done to make sure that they're compliant.

Excuse me that also. Then, you know, helps the the plan. Fiduciary, satisfy their risk of fiduciary duties as well is is just, you know, periodically making sure that you know you have the right plan documents. They're up to date. They've been modified for changes in law. You know that they reflect your current eligibility requirements. You know all the the type of things that are are an employee benefit document, you know, things change. And so it's really good idea every year to look at that, just to make sure you're up to date, and and nothing's changed or things have changed. Hey? Let's submit our plan to make sure we're up to date.

Maddie Meyers: Right? Right? Let's go to the next slide before we wanted to open up for Q. And A. I did want to mention that Nava is going to be at the Shrm Conference this year in San Diego. So if you want to talk more about this, we would love to. We're benefits. Nerds so kind of can't stop talking about this stuff. So if you're attending, we're going to be at Booth 441, we're also putting on like a bunch of other really fun events throughout the conference. We're doing social hangouts and wellness activities. So you can see the full lineup. I think we'll drop it in the chat to Rsvp. If that's something you're interested in. I did hear that Josh Groban is performing. So that's not a plug for Nava. That's just a plug for Josh Groban, but could be pretty fun.

We have exactly 10 min for Q. And A. So please submit anything that you're curious about in the chat.

One question that came in is for Anthony. Maybe you can speak to this. How does carrot work with the new California mandate coming in for 7, 1.

Anthony Perez: Wonderful. so California is just the what is it? 14th State to mandate infertility coverage? And so Carrot has been working with States across the Us. For many years now. with Sb. 729, you know. It is an important step forward, however, with any mandate there's going to be gaps in coverage and care.

So carrot really layers on top of that existing coverage navigates members who could take advantage of the mandated coverage if they do qualify, and then for folks who are not able to take advantage of that mandated coverage, we would support them, and they would go through carrot. So 1st off with the mandate. It caps Ivf retrieval to 3 cycles. while that might be enough for some. You know, we know that with from some clinical experience that we have, that some folks might need more than just 3 cycles, and so through carrot employers have the option to offer more than 1 3 3 cycles. So it's customizable in that sense. And then the scope of services under Sp. 729 is quite narrow. So sometimes it doesn't include things like Pgta testing or genetic testing or Icsi, which is a type, a fertilization method which would not be covered as well as the mandate doesn't support paths like donor assisted reproduction or surrogacy or adoption. And so through carrot. We're not meant to replace the mandate, especially if you're a fully insured company who can't rip that out. The goal here is to maximize the coverage, fill in the gaps, provide education, navigation, and provider steerage.

So that's the way you can think about the mandated coverage, especially if you're a fully insured company for self-insured groups, as Brian mentioned, that doesn't apply to you. But we do see from a competitive standpoint. A lot of self-insured groups are following suit to stay competitive with fully insured groups that are required to cover the 3 rounds of Ivf through insurance.

Maddie Meyers: Yeah, that makes sense. One other question. For Brian. What do I do? If I messed up my compliance.

Brian Bartels: This. This is a really popular question. We, we get this on a very regular basis and it depends on what what the the mess up is you know, I know we're talking about, you know, medical benefits today on the retirement plan side of employee benefits there, depending on what the issue is. There's very detailed guidance from both the Department of Labor and the Irs on how you correct like a 4. 1 plan mistake, for example, unfortunately, that detail wonderful guidance that is available to retirement plans doesn't necessarily exist for health welfare plans just that. That piece of the compliance puzzle isn't really there. And so, you know, our starting point would be to say, you know what? What exactly, is the error, or usually it's not just one error. It's a cascading set set of errors, because doing. not doing one thing that affects all these other things the kind of one of the general big overarching principles for correcting errors is to place the participant in the position they would have been in had the error not occurred. So let's say, for example. that the error was charging someone too much money for their benefit. You know that there's a a fairly easy way we could go about addressing that type of error. Because we say, okay, they would charge X, we charge them. Y, we can figure out that and and fix the difference. Other errors are much more systemic and difficult, like, if you don't have a plan document, for example, and you're required of a plan document. Well, that's multiple legal problems right there. But again. we would want to make sure we understand what the areas identify. The error, identify kind of all the ancillary errors that step off from that area. So you know, not doing one thing, kind of affects other things down the road, depending on what the error is. And then looking at, Okay, who's affected? And then putting in place, going forward. How are we going to correct it? Going forward to make sure we're not repeating the error going forward and then depending on what the problem is, we look back and say, Is this something we can fix? Were participants harmed. If they were harmed.

Can we find a way to to put them in the position like I said, where they would have been had this error not occurred, and I know I'm talking very generally, but there's so many different ways that problems can come up in different errors that arise, that the question really depends on what the specific problem is.

You know, one thing, it doesn't happen as much anymore. But a fairly common error for a while was with domestic partner coverage, not treating the domestic partner coverage correctly from a tax perspective. So there's some ways that can be corrected, depending on how big the error is so it's a a fairly common error. Other areas, we see, is, you know, not having a plan document, not filing a form 5,500 for a health plan that you're required to. you know, not sending October notices, you know. There's all sorts of different errors in. Usually there's ways to fix them, especially going forward. I think that's the primary like. As soon as finding error. We want to make sure we've corrected it. So we're not keeping repeating the mistakes. And then we look and say, Okay, what's the error? Who's effectively going backward? And what do we need to do to correct it going backward. So there, there are ways we can correct it. But unfortunately, every error is unique. Every little problem has its own fun, little nuances. And so there's not just a, you know, a recipe book on the Health and Welfare plan side to correct errors like there is on the retirement plan side.

Maddie Meyers: Yeah. yeah. And I think I mean alongside that I just in my own experience, I think, leaning on your partnerships as much as possible. So that you're not making assumptions, you know. I think Hr leaders can sometimes be wearing a lot of different hats and expected to know everything about a lot of different things that we may not. So having folks who are really specialized, has been super helpful when I feel a little bit like a fish out of water. Yeah.

Brian Bartels: I think that's a good point to, you know. Reach out. You're you're paying them sometimes a very significant amount of money.

You should always feel free to, you know, reach out to your account executive, for example, say, Hey, this is going on. Can you help me?

But I recommend clients do that all the time.

Maddie Meyers: Yeah, absolutely. Anthony, maybe you know the answer to this question. It's around cryopreservation. Do you know typically how employers are taxing cryopreservation reimbursement for their employees. Would that be through an Hra? Is the benefit based on an infertility diagnosis? I don't know if you have any context. There.

Anthony Perez: Yeah, so this is one of the main things that we support with is taxation and compliance. So when it comes to taxation, we provide and share recommendations and our best practices. And so. as Brian mentioned earlier for an Hra, you know, care is structured as a post-deductible Hra for qualified medical expenses. Things like cryopreservation are going to be seen more. As on elective services, so those can be, those would be typically subject to taxation in things that are a Qme. So if someone has an infertility diagnosis, for example, from a doctor, which means they've been trying 6 months to a year to conceive, but haven't been successful, and they're submitting reimbursement through care. They're submitting claims, and we handle the claims, processing and reimbursement to the member. You know, they would have to have that advantage of on a pre-tax basis.

So for cryopreservation, because in its elective services it still falls in the same category as like adoption and surrogacy where where taxation would apply.

But we do have some of our customers. Roughly, 30, about 36% of our customers will gross up and cover taxes, and they'll do that from an equity standpoint, you know. Hey? We don't want some employees to have to pay taxes and some don't. We want to provide a very, you know, inclusive and equitable program. And so in that sense, we would be able to provide calculations if they wanted to gross up and cover the taxes if they choose. However, most of our customers will pass on taxation to the member. but we provide the payroll and finance team tax reporting so that they know what employees are responsible for taxation and which don't. And then we provide the upfront education to the members, you know. Hey? Your employer is offering you a $20,000 lifetime benefit. You know, taxation is a thing. This is how it applies to you or not. So we provide that upfront support, so that there are no surprises when they're going through their their family farming journey.

Maddie Meyers: Awesome. Thanks, Anthony. Well, we have a hard stop at one. So really appreciate everyone attending, and thank you so much to Anthony and Brian for participating. This now is very grateful, and thanks everyone for joining. We'll be sharing the recording after this, and I hope everyone has a great rest of your day.

Anthony Perez: Thanks. Everyone.

Brian Bartels: You.

Maddie Meyers: Bye.

‍