Navigating Health Insurance Selection for in Vitro Fertilization (IVF) Benefits: A Study Protocol.

Introduction: A large public university added health insurance coverage of 50% co-insurance for up to two cycles of in vitro fertilization (IVF) to eligible faculty and staff. Methods: We describe the design and conduct of a randomized controlled trial to evaluate the effectiveness of a health insurance educational intervention on health insurance literacy and IVF benefit utilization. The intervention materials included 1) Key insurance terms; 2) Examples of premiums and deductibles across the insurance plan options; 3) Examples of how premiums and deductibles affect out-of-pocket costs; and 4) A guide to find in-network providers/facilities. The primary outcome is health insurance literacy. Secondary outcomes are IVF services and insurance benefit utilization, out-of-pocket costs, and financial hardship related to fertility care. We collected validated patient-reported outcomes at three timepoints over 1 year. We will integrate mixed methods data to explore whether the intervention was effective, feasible, acceptable, and appropriate. Results: Among 394 faculty and staff screened, 217 (55%) reproductive-aged (18 to 50 years) employees consented, completed the baseline survey and were randomized in a 2:1 fashion. Participants were female (81%), married (63%), and worked as a staff employee (72%). Approximately 39% reported an infertility diagnosis, and 28% had undergone prior IVF treatment. Participants reported feeling slightly confident when using their health insurance plans and moderately confident being proactive when using their health insurance plans. Discussion: Our goal is to improve health insurance literacy and utilization of health insurance benefits for IVF care, thereby expanding family-building options for reproductive-aged individuals.