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Health

An illustration of reporter Courtney Vinopal's headshot.

Courtney Vinopal

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Having a baby in the US is significantly riskier than in other comparable countries. As of 2022 the US had 

 than any other high-income country, according to the Centers for Disease Control and Prevention, at 22 deaths for every 100,000 live births.

In recent years midwifery care has emerged as one potential way to address this crisis. Gaps in education and access, however, prevent many patients from working with midwives. A new 

 from Morgan Health, a business arm of JPMorgan Chase focused on healthcare benefits, sheds light on how these trends play out in populations with employer-sponsored insurance.

Just one in five patients on employer-sponsored insurance had a midwife as part of their care team during their last pregnancy, according to the survey held in March. A higher share of respondents (66%), though, said they would be interested in midwifery care for a future pregnancy.

“Lack of knowledge” and “insurance coverage” were cited as the main barriers to midwifery care among those who were interested in it, but didn’t use it.

“People want access to midwifery care,” said Bea Capistrant, VP of healthcare innovation at Morgan Health. “But there are some gaps that we can fill there.” Patients may struggle to understand the scope of a midwife’s practice, how they work with other providers, and how they manage existing health conditions, for example, she said.

A certified nurse midwife is a type of registered nurse that provides a range of reproductive health services, including prenatal care, childbirth, and postpartum care. They can work in hospitals and private practices, as well as birthing centers. Research indicates midwifery is generally associated with more positive clinical outcomes for pregnant people, including fewer cesarean sections and lower preterm birth rates, but a dearth of providers makes it difficult to secure such care in the US.

Available data shows insurance coverage for certified nurse midwives isn’t currently widespread, with just 25% of employers with 500 or more workers covering it, according to Mercer’s 2025 health and benefit strategies survey.

Should employers want to help their employees access midwifery care through a medical plan, they wouldn’t necessarily need to invest in a separate point solution, as some companies have done for doula or fertility services 

. Oftentimes employees can work with midwives just as they would any other provider, such as an OBGYN, on their health plan. Employers may work with their insurance carriers, then, to help connect workers with midwife “providers that are already in-network, on existing health plans,” Capistrant said.

When working with carrier partners, employers can focus on the delta between “educating patients” and “clarifying access,” Capistrant added.

The access piece may be trickier to address, particularly if employees are based in states where midwives aren’t sufficiently integrated into the maternal healthcare system. Midwives are less prevalent than OBGYNs in the US for a variety of reasons, including regulatory requirements that make it difficult to work in certain states, and lower reimbursement rates that translate to lower wages compared to other physicians.

If these broader systemic issues are addressed, though, Capistrant and others expressed optimism that employers would see a positive return-on-investment from directing their workers to midwifery care when it makes sense. One reason is that deliveries that incorporate midwifery care tend to see lower rates of costly procedures like C-sections and NICU visits.

“What our employers want from us is the best possible outcomes, and also they want to be able to manage costs across the board,” said Neel Shah, chief medical officer with Maven Clinic, a reproductive healthcare benefits firm that includes midwives in its network. “They can get more efficiency out of their spending, and they can produce better health by having solutions that incorporate midwives.”

A black pregnant woman with a medical cross logo glowing behind her

The case for midwifery in employer health benefits 

 Many patients are interested in working with midwives, but confront barriers tied in part to insurance coverage.

Midwifery care represents an untapped opportunity for benefits leaders

The White House recently rolled out several policies that seek to deliver on President Donald Trump’s campaign promise to expand access to in-vitro fertilization (IVF).

EMD Serono, a fertility medication manufacturer, will offer certain drugs at a reduced cost exclusively through TrumpRx, the White House said in a 

Additionally, the administration clarified that employers can offer fertility services as a standalone benefit, akin to how dental or vision insurance is often offered. The Department of Labor (DOL) 

 that details how businesses may go about this, but it’s unclear whether the policy will spur more companies to cover fertility treatment.

The policies recently rolled out by the White House follow an 

 seeking to protect and reduce the cost of IVF, but fall short of the president's campaign trail promises. Employers won’t be required to cover IVF, nor does the administration plan to offer any financial incentives for them to do so, at least for the moment.

Instead, several federal agencies announced that “employers can now offer standalone benefit packages to employees interested in coverage for treatment of infertility, including IVF,” the White House said. The DOL guidance clarified that employers can cover fertility treatments through an “excepted benefit,” which is a type of benefit that isn’t subject to certain requirements under laws like the Affordable Care Act and the Health Insurance Portability and Accountability Act.

The agency also said it planned to propose a rule “aimed at providing additional ways that certain fertility benefits may be offered as a limited excepted benefit.”

While the excepted benefit recommendation was framed as a “new benefit option” for employers, the guidance doesn’t actually create any new pathways for companies to cover IVF, sources told HR Brew.

“I read this much more as maybe an affirmation of what was already possible, as opposed to new policy,” said Katie Keith, director of Georgetown Law’s Center for Health Policy and the Law. The types of excepted benefits the DOL points to—such as reimbursing an employee’s out-of-pocket costs through a Health Reimbursement Account, or offering fertility treatments through a specified illness policy—are currently possible, but may not make sense from a design perspective.

Nearly one-half (47%) of large employers cover IVF services in their largest medical plan, according to Mercer’s 

 on employer-sponsored health plans. And there’s a reason many employers choose to incorporate IVF into their group health plans, rather than offer it as a standalone benefit, Keith said. IVF patients have to undergo many different types of care, from taking prescription drugs to undergoing lab testing to ultimately seeking out providers for their pregnancy journeys, if the procedures are successful.

“I understand why employers would sort of treat it as part and parcel of their entire benefits package, because the care is so cross-cutting,” she said. While the Trump administration’s proposals may work for a “very narrow” benefit, “I just don’t think this gets you to the kind of comprehensive coverage that is being talked about,” Keith added.

Companies that provide fertility benefits were already offering the White House-endorsed options to their customers, but executives in the sector expressed optimism that these recent policies would move the needle even further on employer-sponsored coverage.

Carrot, a workplace fertility benefit provider, launched a “flex program” allowing employers to purchase its pharmaceutical benefit as a standalone option 

 the White House rolled out its policies. The company’s CEO, Tammy Sun, 

 she believed the moves marked “a really important moment” for the category of benefits Carrot sells.

Employers have increasingly designed fertility benefits as a “carve-out” from their health plans in recent years, Neel Shah, chief medical officer with Maven Clinic, another fertility benefit provider, told HR Brew via email. The excepted benefit approach that the White House supports “​​enables the shortest pathway to a healthy pregnancy, at the lowest possible cost, for most people,” he added.

Shah also pointed to the administration’s efforts to lower the cost of fertility medications, which represent “approximately one-third of the total costs of IVF,” he estimated. A full IVF treatment cycle can cost from $15,000 to $20,000 on average, and the potential for incurring increased health costs has historically been a top reason employers don’t cover it.

The deal to lower prices of some commonly used fertility drugs may help address this concern, but doesn’t tackle other types of treatment that contribute to the high cost of IVF, such as lab visits and embryo storage, 

President Donald Trump speaks at a podium while making an announcement about IVF access.

Trump policies unlikely to boost workplace IVF benefits

The Trump administration clarified that employers can offer IVF coverage as a standalone benefit, but it’s not clear whether the guidance will spur more companies to invest.

White House actions seem unlikely to move the needle on workplace fertility benefits

Democratic lawmakers reintroduced a bill on Sept. 16 that would provide up to 12 weeks of paid family and medical leave to US workers.

The bill, known as Family and Medical Insurance Leave (FAMILY) Act, was first introduced by Sen. Kirsten Gillibrand and Rep. Rosa DeLauro in 2013, but never gained enough traction to see passage, regardless of the parties controlling Congress.

 comes at a time when mothers of young children are leaving the workforce at the highest level in four decades, according to a 

 from the University of Kansas of federal data. Guaranteeing paid leave to workers who need time off for a major life event could end the “devastating choices” Americans face “between their livelihood and the health of themselves or their families,” Sen. Gillibrand said 

Though the bill is unlikely to be passed in the current Republican-majority Congress, state-level paid family and medical leave programs have 

 some employers to enhance their benefits.

Most US workers would be eligible to take paid leave under this latest version of the bill, which would grant benefits on a sliding scale basis. This means a minimum-wage worker would see 85% of their average monthly earnings replaced, while those earning the median weekly US wage would receive 67% of their earnings while on leave.

Unlike previous versions of the legislation, the 2025 bill would create a dedicated trust fund to pay out benefits, rather than funding the program through payroll contributions.

Workers would be eligible to take leave for reasons covered by the 

, including caring for a new child following its birth, adoption, or placement from a foster agency, as well as caring for a serious health condition for oneself or a loved one.

The authors of the bill take an expansive view of caregiving, as workers would be able to take leave to care for a child of any age, a step-parent, a parent-in-law, and “any other individual who is related by blood or affinity whose association is the equivalent of a family relationship.” This latest bill also includes a provision that would cover “safe leave” for workers experiencing events such as domestic violence or sexual assault.

More than a dozen states now have their own paid family and medical leave programs in place, creating complexities for HR teams overseeing benefits for workers across multiple jurisdictions.

Enacting a federal program “would certainly make things a lot easier” for these employers, Ashley Brightwell, a partner in the labor and employment practice of Atlanta-based law firm Alston + Bird, told HR Brew. It’s unlikely the FAMILY Act will move past the introduction stage this time around, though, as it lacks support from Republicans who control both chambers of Congress.

In the meantime, “you’re going to see more and more states start filling in those gaps,” Brightwell predicted.

A number of employers, including Levi Strauss & Co., Patagonia, and Etsy, 

 to members of Congress in support of the FAMILY Act. In a 

, Levi Strauss & Co.’s chief human resources officer, Bernard Bedon, spoke to the link between paid leave and productivity.

“We have seen firsthand that providing access to paid leave is critical for supporting healthy and successful employees and their families, which in turn allows them to perform better at work,” he said of the company, which provides 20 weeks of paid leave to workers who give birth to a new child.

Sen. Kirsten Gillibrand speaks at a 2021 event outside the US CApitol.

Democratic lawmakers reintroduce paid family leave legislation

Though the bill is unlikely to be passed in the current Congress, state-level paid family and medical leave programs have already spurred some employers to enhance their benefits. 

Lawmakers push for paid family leave, again, with Levi’s and Patagonia on board

If you’re a total rewards leader who’s just hearing about an 

individual coverage health reimbursement arrangement (ICHRA)

, it’s likely because the option has only been around for the last five years.

It may also be because this type of benefit—which allows employers to offer pre-tax dollars so employees can purchase their own individual health plan, rather than elect coverage through a group plan—is not currently the predominant form of employer-sponsored healthcare. Just 4% of firms offering health benefits gave workers funds to purchase non-group health insurance in 2024, according to a 

Still, this option may be of interest to small employers that wouldn’t otherwise be able to offer health coverage to their workers, or businesses with specific employee populations. Here are three questions for HR teams considering offering an ICHRA, according to industry experts.

The answer to this question depends on the size of the employer and how they view their role as a benefits provider, said Josh Miley, ICHRA solution leader with consulting firm WTW.

“If you’re a small employer or a startup, the reason why you would do an ICHRA is because it gives you a manageable entry point into offering benefits,” he said. Employers with fewer than 50 workers aren’t required to offer health insurance, but ICHRAs generally have a lower barrier to entry, as they don’t have requirements such as minimum participation rates.

Larger employers that are thinking about switching from a group health plan to an ICHRA will need to consider “cost and complexity,” Miley said. As health costs 

 and HR teams are tasked with “the administrative burden” of managing a complex ecosystem of brokers, vendors, compliance, and regulatory professionals for their healthcare, they may want to evaluate whether these efforts are commensurate with the value employees get out of the benefits, he said.

When doing an analysis to determine whether an ICHRA makes financial sense for the organization, HR leaders should look at not only how the cost of group-sponsored plans compares to the cost of similar plans on the individual market, but also whether workers would have “meaningful choice” if offered an ICHRA, said Miley. The price and quality of individual plans can vary greatly in different states, so employers should consider factors like how many carriers are located in the regions where their workers are based, or whether they offer lower-deductible plans, such as a gold plan.

HR leaders should also try to get a sense of employees’ appetite for ICHRAs when considering who would benefit, said Julia Zuckerman, VP and senior consultant in Segal’s compliance practice. Many companies take a “paternalistic” approach to healthcare coverage, and employees are typically happy to let them lead. But she noted “there are definitely some people interested in more choice, and who are more sophisticated and motivated to think about the best coverage options for them.”

Should your executive leadership team decide they want to offer an ICHRA plan to the workforce, there’s a fair amount of change management that has to happen ahead of the rollout, particularly for larger employers switching from group coverage.

HR teams should anticipate questions from employees about what the process looks like for buying a health plan themselves, as well as communicate about issues that may come up when the employer isn’t managing the plan for them, Miley said. Workers should know that they may lose coverage if they miss a premium payment, for example, or see a dependent lose coverage when they turn 26.

Successfully transitioning from an ICHRA requires “educating your employee population,” said Ben Light, VP of partnerships with Zorro, an ICHRA platform. Leadership can help employees understand that this is a new way to elect healthcare coverage, and make sure they know what information to secure ahead of time—such as potential doctors, facilities, and medications—in order to choose the right plan.

Illustration of an open hand with a coin on the left and an open hand in a doctor's white coat with a heart that has a cross in the middle

How to decide if an ICHRA is right for your company

Giving workers money to purchase their own health plan isn’t yet a widespread practice, but it may be the right call for certain types of organizations.

3 questions to ask when considering an ICHRA 

GLP-1 drugs like Ozempic gained traction in the press for helping many, 

, lose significant amounts of weight quickly.

But today, Ozempic and other semaglutide drugs, first approved for treating diabetes in 2017 and for obesity in 2021, are no longer just the favored (off label) weight loss method of Hollywood stars. Spending on GLP-1s rose to 

 in 2023, up 500% from five years earlier. Employers are also 

 GLP-1 drugs for weight loss, though the high price tag has prompted some to pull back on the benefit.

Aflac is one such employer. Last year the insurance company stopped covering GLP-1 drugs for weight loss over cost concerns, Tricia Griggs, Aflac’s manager of wellness and safety, told HR Brew. Around the same time, it expanded access to gym memberships through Wellhub for its 6,000-person US workforce.

Why Aflac says it no longer covers GLP-1s. 

In the summer of 2023, Griggs says she started having conversations with her team about ending coverage of GLP-1 drugs for employees seeking weight loss treatments. Aflac had covered the drugs for as long as they’d been on the market (the FDA first approved a GLP-1 precursor to semaglutides for obesity in 2014), and in 2022 they started seeing a major increase in workers seeking them out, Griggs said.

The decision was “strictly financial,” Griggs said, and had nothing to do with the efficacy of the drugs. Some studies have shown GLP-1 users 

 of 10% to 15% of their body weight in the course of a year, with more effective GLP-1 medications even leading to a 20% reduction. The drugs have a hefty price tag, though, as out-of-pocket costs 

 to be around $1,000 a month. More than one-quarter of employers reported GLP-1 drugs for weight loss represented more than 15% of their total annual claims in 2024, 

 from the International Foundation of Employee Benefits Plans.

“Unfortunately, the spend was outrageous,” Griggs said, estimating Aflac was spending “millions of dollars a year” on GLP-1s. She expressed concern about GLP-1 spending potentially affecting Aflac’s ability to pay for other medical coverage, such as a cancer claim. Aflac still covers GLP-1s for diabetes.

Around the time Aflac discussed dropping GLP-1 coverage in 2023, Griggs and her team realized they were already paying for about 300 people to be on a starter gym plan through Wellhub, the corporate wellness platform that was formerly Gympass.

“What would it look like if we just paid for all Aflac employees to have access to the starter plan for free?” she recalled asking. “It wasn’t bad. So that’s what we did.”

About 44% of Aflac employees use Wellhub, according to Griggs, which offers access not only to gyms and fitness studios, but also apps geared toward financial health, meditation and sleep, as well as therapy.

Since Aflac began covering starter plans for gym memberships through Wellhub in 2023, about 1,300 employees have signed up for it, Griggs estimated. She said not all employees see the fitness offerings as a substitute for GLP-1 coverage, and some even email her to inquire about when Aflac might start covering the medications for weight loss again.

“We have that small group who are just determined that [a GLP-1 is] the only answer, and they’re not going to attempt anything else,” she said. A larger share of employees, though, are open to pursuing other methods for weight loss, like a gym membership, she added. (Medical experts say the drugs are most effective 

 with dietary changes and exercise, and as such some employers are incorporating these offerings into their benefits plans alongside GLP-1s.)

, they’re also experiencing “pressure around pharmaceutical interventions,” said Carolee Gearhart, Wellhub’s chief revenue officer. Platforms like Wellhub may appeal to employers who want to promote exercise and healthy lifestyles.

Some research suggests employers may eventually see a return from investing in GLP-1s for their workers, despite the high costs. An 

 of US commercial health claims conducted by Aon found that while costs jumped during the first year GLP-1 medications were prescribed, cost growth rates for GLP-1 patients trended downward the second year, averaging half of the growth rate for patients who weren’t taking the drugs.

“We thought that was encouraging, because what it tells us is that there is a bending of the cost inflation,” said Anthony Scattone, deputy chief people officer with Aon. He noted that GLP-1 users saw their risk of hospitalization from “major adverse cardiovascular events,” such as strokes or heart attacks, drop by 44%.

Griggs said she’ll be keeping a close eye on research related to GLP-1s and how they might affect Aflac’s spending on other conditions, like high blood pressure or chronic diseases. “It is a topic that is not completely off the table,” she said.

A photo composite of two hands hold a semaglutide pen next to a woman exercising with a kettleball.

Inside Aflac’s decision to drop GLP-1 coverage 

The insurance company stopped covering GLP-1 medications for weight loss due to cost concerns, and now offers all US employees free gym memberships. 

Why Aflac dropped GLP-1 coverage and expanded its wellness offerings 

CVS Health recently earned a “menopause-friendly” accreditation from an organization seeking to help companies integrate menopause into their workplace culture. The efforts show how some employers are making deeper investments in benefits tied to the condition.

The healthcare company is the first US firm to earn the accreditation, according to a Mar. 13 

. MiDOViA, the organization that grants the accreditation, has already awarded it to a number of UK-based employers, including Unilever and Boots.

More employers now see a return-on-investment from menopause programming, April Haberman, MiDOViA’s CEO and co-founder, told HR Brew. She said she expects these investments to continue to grow even as benefits with a DEI lens face some scrutiny in the US.

How CVS Health became “menopause friendly.” 

MiDOViA looks at five different areas when evaluating employers applying for an accreditation, said Haberman: policies and practices, training and education, working environment, employee engagement, and culture.

While a panel of third-party experts evaluate applicants, MiDOViA works with organizations to identify gaps in their menopause offerings and prepare them for the accreditation process.

“We obviously have the same goal,” Haberman said of MiDOViA members seeking to become “menopause-friendly” employers. “We’re not just working towards accreditation, but we want to make sure that they really are changing corporate culture and integrating menopause into the workplace.”

MiDOViA advised CVS Health, for example, on menopause training and education for its retail managers, she said. The company already had a menopause learning hub with training and resources, but MiDOViA provided an additional e-learning module that focused on issues pertinent to managers, such as handling menopause-related accommodation requests or sign-posting resources available to employees experiencing menopause.

The investment in education and resources was a response to feedback from CVS Health colleagues who wanted support during “this critical time in their health journey,” Joanne Armstrong, the company’s VP and chief medical officer of women’s health and genomics, told HR Brew via email.

“We’re creating open forums for leaders to share their experiences and provide opportunities for all colleagues to attend menopause peer support groups,” she said. “We’re also offering tailored resources to support midlife health.”

CVS Health is also investing in menopause training for its clinicians and care managers, and has brought specialized providers into its Aetna insurance network, she added.

Recent research has demonstrated the financial impact of menopause on the workplace, and more employers have started to see a return-on-investment 

, Haberman said. “The US loses $1.8 billion annually based on workdays lost due to menopause symptoms, Mayo Clinic estimates,” HR Brew previously reported.

Still, it can be hard for HR leaders to find the budget for menopause offerings. Haberman said MiDOViA tries to emphasize the potential cost of turnover in discussions with employers.

“What we try to help organizations understand is that it costs two and a half times an annual salary to replace just one employee,” she said. “Menopause programming more than pays for itself if you can just retain one employee.”

Considering the possible effects of menopause on workers’ performance or productivity, CVS Health sees a clear return-on-investment, Armstrong suggested. “When employees receive the resources and support they need to live as healthy as possible, everyone benefits,” she said.

CVS Health earns “menopause-friendly” accreditation 

More employers now see a return-on-investment from menopause programming, the CEO of the organization granting accreditations told HR Brew. 

How CVS Health became a “menopause-friendly” workplace

Theresa Agovino

The severe shortage of healthcare workers is one reason that Jason Naidich is happy that the Northwell School of Health Sciences will open in September.

Naidich is the chief learning and innovation officer at Northwell Health, the healthcare system that helped develop the brand-new high school’s curriculum. The hope is that it will prepare and train students for healthcare careers, and that some students will one day work at Northwell, which employs 89,000 people at its 21 hospitals and roughly 900 outpatient facilities. Yet, the school’s mission goes beyond creating an employee pipeline to create a path to good-paying jobs for New York City residents.

“We do a lot of work in underserved communities. And when you talk to the high school students there, most don't know these opportunities even exist,” Naidich said, adding that part of Northwell’s mission is to improve the health of the people it serves, and that good-paying jobs help people take better care of themselves.

“We see this as education being a key pillar of health by providing the right education that can lead to meaningful jobs to pay a good wage,” Naidich said. “We’re also improving the health of our communities at the same time as we’re creating [jobs].”

The new school is an extension of Northwell’s partnership with the New York City Board of Education, through which it already provides various services, such as mentoring and internships, to four city high schools, and the opportunity to earn college credit and professional certifications. With a $25 million grant from Bloomberg Philanthropies, the new school is even more focused on healthcare, giving students special training in one of four medical specialties: nursing, medical assistant, mental/behavioral health, and management. They can also receive college credits, certifications, and preparation for licensing exams. For example, a student could graduate with enough classes to take the test to become a licensed practical nurse. That could lead to a job at Northwell, and access to its education funding that could help the individual become a registered nurse.

“This is truly a transformative experience for the students that are going to attend Northwell school,” said Melanie Mac, interim-acting chief of the office of student pathways at New York City Public Schools. “And it’s, I think, also going to be helping us as educators, solve some system-wide challenges, and we’re hoping that it’s going to help spur improvements that could reach students across the city and our other healthcare pathways.”

Northwell’s efforts to develop its workforce go beyond partnerships with high schools. In 2023, it opened a School of Diagnostic Medical Sonography with SUNY Empire State University as its academic partner. It also opened a second campus of its Peconic Bay School Of Radiologic Technology.

Maxine Carrington, Northwell’s SVP and chief people officer, said the institution tries to understand why shortages exist in certain areas and then tries to create programs to fill them.

“We watch it really, really closely to try to understand is this a school problem where the schools aren’t producing enough?” Carrington said. “Is it that enough people don’t have the ability to access the training? What are the barriers to them being unencumbered to participate in training they would need to go to these professions? Is it a retention issue? Do we have leadership issues? We look at it from all angles.”

Medical professionals dressed in scrubs are pictured from the waist down.