It’s the beginning of a new year, which means new laws are officially taking effect, carrying implications for HR and benefits teams—and for your employees. Navigating complex federal, state, and local laws will help you set the stage for success in the year ahead. As conversations around paid family leave policies continue at the federal level, more employers are implementing inclusive and innovative family benefits that augment legally-mandated policies like the Family and Medical Leave Act (FMLA), to meet the demands of millennials in the workforce and keep a competitive edge in attracting and retaining top talent. Still, compliance with legal requirements remains a major focus, and having a finger on the pulse of updated state laws around the country helps give you a glimpse of what the future could hold.

Here’s a roundup of the new laws focused on women and families that you need to know about going into 2020.

IVF coverage now mandated in New York state

As of January 1, 2020, health plans in New York are required to cover up to three rounds of in vitro fertilization (IVF). In April 2019, lawmakers in Albany passed the budget measure that requires insurance plans for employers with 100 or more workers, cover IVF and associated medications, as well as testing for infertility. While plans may not place annual dollar limits on IVF coverage, families will have a lifetime limit of three IVF cycles and services will be subject to an individual’s cost-sharing requirements, like deductibles or co-pays. Under the new law, large-group plans are also required to cover medically necessary egg and sperm freezing or embryo storage, such as for individuals who are undergoing chemotherapy. The new law will cover an estimated 2.4 million New Yorkers, helping to lift the financial burden of fertility treatments for many women and families. While this is an important step, New York state’s definition of infertility is embedded within the law, which means that coverage will exclude many individuals, including LGBTQIA+ couples, as it requires an individual be diagnosed with infertility in order to be eligible for this coverage from their insurer.

Oregon implements expanded pregnancy employee protections

Oregon has a new law taking effect that ensures employees have strong protections related to pregnancy, childbirth, or related medical conditions, which includes lactation, effectively expanding upon existing federal and state law. The new law, which was signed in May 2019 by Oregon governor Kate Brown, intends to prevent workplace discrimination for women who are pregnant or have recently returned to work after having a baby. Under the new law, Oregon employers with 6 or more employees may not discriminate against an employee or applicant on the basis of an employee’s need for reasonable accommodations due to pregnancy, childbirth, or related medical conditions, listed as things like “modification of work schedules or job assignments” or longer or more frequent break periods. This builds upon another new law that took effect in Oregon in September 2019 requiring employers of all sizes to provide more flexible lactation breaks for employees who are breastfeeding. The new law requires employers to provide “a reasonable rest period to express milk” each time an employee needs it. Under the new pregnancy accommodation law in effect as of January 1st, employers must provide written notice on new protections to all current employees and new hires including through posters and notices in the office.

Paid leave for any reason takes effect in Nevada

Nevada now requires that private employers with 50 or more employees provide up to 40 hours of paid leave for any reason per benefit year, making it only the second state to pass this type of legislation (with Maine, which also passed paid leave for any reason last year to go into effect in 2021). Under the new law, the paid leave benefit extends to any employee who works 40 hours a week. Employees may use the leave without telling their employer the reason for its use, but in situations where the employee is on FMLA leave, employers can ask if an absence is being used as FMLA leave and the provisions of the FMLA will continue to apply. While this amount of paid leave is not substantial for a new parent, this is the first time Nevadans will be able to access any paid leave after welcoming a new baby as FMLA leave remains unpaid in the state.

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Ten years ago, we were reeling from a recession in the U.S., the Affordable Care Act was a complex healthcare reform plan making its way through Capitol Hill, and the ‘octomom’ propelled IVF into global headlines. Only 37% of companies offered healthcare coverage for a same-sex domestic partner, and in terms of women’s health, the most commonly offered benefit was contraceptive coverage, with just 68% of companies covering the cost. From her office in London, our founder and CEO Kate Ryder was working in venture capital wondering why more healthcare technology companies weren’t focused on the needs of women and families.

Join us as we reflect on all that has changed and where we still need to push for progress since the last time we turned the page on a new decade.

A decade of highs and lows

Employer maternity costs rose by 50 percent in the last decade, fueled by the rising C-section rate in the U.S.

Maternity spend is typically one of the top three healthcare costs for employers, based on our experience, and the latest research reveals that these costs have climbed by 50 percent since 2008. This is part of overall growth in annual premiums for employer-provided healthcare benefits, which hit a record high in 2019 at $20,576 with employers bearing 71% of that cost, on average—compared with $13,770 ten years ago. But the reason that maternity spend is on the rise is in large part due to the growing number of C-sections. In the U.S., approximately one-third of babies are born via C-section, while the World Health Organization recommends a rate closer to 10-15 percent. Of the C-sections in the U.S., research suggests that nearly half of these are not medically necessary. Layer on top of this the reality that C-sections are not linked to better health outcomes for women or babies. So, what does this mean? Aside from driving up costs for employers and individuals, the increase in unnecessary C-sections points to the need to equip women with better access to information and holistic care during pregnancy to help them manage any risks, create their own birth plans, guide them to physicians and hospitals with lower C-section rates, and empower them with the right questions to raise as they consider the best delivery option for them.

Egg freezing is no longer considered experimental, and egg freezing benefits have gone from controversial to in-demand

Two years after the American Society of Reproductive Medicine declared egg freezing safe and legal in 2012, lifting the ‘experimental’ label, Facebook and Apple stirred controversy when they rolled out a new reimbursement benefit covering the procedure. "Surely what they meant to say was, 'We want women at Apple to spend more of their lives working for us without a family to distract them,'" Jessica Cussins of the Center for Genetics and Society wrote in a Huffington Post editorial. But since then, egg freezing has become more widely understood and embraced by employers as a key offering within a broader fertility benefit to empower women. Today, egg freezing benefits are in high demand by employees as it grows in popularity. According to the Society for Assisted Reproductive Technology, in 2009, 475 women froze their eggs, compared with nearly 11,000 women in 2017.

Companies are leading the way with progressive parental leave policies, despite continued debates at the federal level

Employers are filling gaps left by the lack of a paid federal leave policy and the patchwork of local and state laws. Over the last decade, global employers have taken steps to demonstrate their commitment to families: increasing paid parental leave policies, improving lactation rooms, and offering adoption, egg freezing, and fertility benefits. We’re also seeing a marked shift away from implementing policies or benefits that are limited to a mom or from defining policies for a designated “primary caregiver”. In fact, 40% of U.S. employers now offer gender-neutral paid parental leave, up from about 25% in 2015. As the new Great Place to Work 2019 Best Workplaces for Parents reveals, the top companies for working parents are doing more than just offering paid parental leave—they’re taking a holistic view of supporting new parents including through adoption, flexible schedule, childcare, and dependent healthcare benefits.

Gay marriage is legal in the U.S. as of 2015 and while discrimination against LGBTQIA+ individuals and parents remains, we have made some impressive advancements for inclusion

It’s hard to believe that same-sex marriage was not legal in the U.S. a decade ago—it was just passed in the landmark Supreme Court decision in 2015. In a separate decision two years later, the Supreme Court clarified that same-sex parents deserved equal treatment, specifically through state-issued parent birth certificates for children born to same-sex spouses. Yet, there are state laws that embed discrimination against LGBTQIA+ couples and individuals when it comes to adoption and foster care, as well as for diverse paths to parenthood like surrogacy, which is illegal in New York but legal in California. While these limitations in parental rights have gained attention in recent years, employers are implementing benefits that are far more inclusive for all paths to parenthood than any federal or state policies, and the top companies are creating cultures that empower everyone to be their full selves at work.

Maternal mortality rates have worsened in the U.S., reaching crisis levels for black women, directing much-needed attention on improving access to postpartum care

The maternal mortality rate in the U.S. has been climbing over the past 30 years. More than half of these deaths and near-deaths are from preventable causes, highlighting the need for better access to comprehensive postpartum care focused on mothers. What is most alarming is that African American women are four times more likely to die during or after delivery compared with white women. In recent years, the experiences of prominent black women (including Serena Williams who nearly died after the birth of her daughter, Olympia) have helped to shine a light on the real stories behind these dire statistics, the significant gaps in postpartum care, and the role that unconscious bias plays in screening, treating, and even listening to women following delivery.

Digital health startups exploded onto the scene

2014 was deemed “The Year Digital Health Broke Out” by Startup Health, after a record year for venture funding to startups. Indeed, for us, 2014 was a big year: Kate Ryder founded Maven to transform women’s health by creating a digital solution with women and families at the center. “There aren’t many women’s healthcare companies in the market (yet), so we have the competitive advantage of being an early mover in the space,” Kate Ryder said in 2017 in an interview. Now, as we enter 2020, just as Maven has grown exponentially over the last five years to cover every path to parenthood with holistic care, the market for women’s health startups has expanded in amazing ways as well, covering everything from smart tampons that help to diagnose endometriosis to at-home fertility tests and so much more. Alongside this, venture funding for women-led businesses is continuing to grow as well: it’s up 15x compared with 2010.

There’s been a shift in understanding mental health as a critical part of overall physical health and well-being

As a society, we’re talking openly about mental health—with celebrities and athletes like Olympian Michael Phelps opening up about struggles with depression or anxiety and advocating for awareness. The healthcare industry has also made strides in acknowledging the importance of mental health as a key driver of overall health, and in improving access to mental health care through telemedicine and digital health solutions like Maven. Importantly, over the last few years, employers have also stepped up to improve access by covering mental health costs for their employees to improve employee satisfaction, drive outcomes, and reduce absenteeism. Recent studies dedicated to mental health in the workplace have supported this approach, including a global study led by the World Health Organization that shows a return of $4 for every $1 invested by employers in mental health treatment.

The fight for reproductive rights continues to rage on

The last decade has seen a multitude of federal and state policy battles over reproductive rights, leading to a growing gap in access, services, and support for basic women’s health needs, including preventive care and birth control, which hits low-income and rural women hardest. As federal funding restrictions under Title X have tightened, women are being left without access to essential services like breast and pelvic exams, STD screenings, pregnancy testing, and prenatal and postpartum care. In rural areas, where hospitals are shuttering at an alarming rate, access is especially dire: fewer than half of all rural counties have a practicing obstetrician or gynecologist. As these issues play out through legal battles and in the courts, we’ll continue to see women facing longer wait times, increased costs, and reduced access to reproductive health services.

Looking ahead to 2020

We’re experiencing some déjà vu from a decade ago as healthcare reform and reproductive rights are once again a hot topic for the 2020 U.S. presidential election. One of our main predictions for the year ahead? We expect conversations around paid parental leave to reach a breaking point. Momentum is already building after the U.S. federal government—the country’s largest employer with 2.1 million employees—is poised to enact 12 weeks paid parental leave after passing in the House and Senate. We’ll also see more employers invest in supporting parents through the critical return-to-work transition and beyond as they navigate the realities of working parenthood, and spearhead efforts to train managers and workforces to be more supportive and inclusive for all families.

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“During a pregnancy, there are so many reasons a woman puts out her arm for a blood draw that it’s hard to know if that particular test is considered a genetic test or not.”

By 2021, 100 million people will have taken an at-home genetic test, according to the MIT Technology Review. Family history and genetics have a huge role to play in understanding one’s health and analyzing any predispositions for certain conditions like breast cancer or heart disease.

When it comes to becoming a parent or considering parenthood—during preconception or fertility, pregnancy, or surrogacy journeys—there are many considerations for genetic screenings and diagnostic tests that can be hard to navigate. It’s challenging to understand why genetic testing may be valuable for an individual, evaluate any risks, and interpret the results.

“For the most part, everyone wants to do what they can to ensure that their baby is going to be healthy, and some individuals want to have as much information as possible before the baby is born where others are ok with limited information,” explains Ushta Davar Canteenwalla, MS, LCGC, Maven Genetic Counselor. “That’s where genetic counselors can really be helpful. We work really closely with a parent or couple to understand what their concerns are and help them navigate the best testing options, if any, for them.”

Genetic counselors—who have specialized training in medical genetics as well as counseling—partner with individuals to provide personalized guidance that helps them understand their options, family history, and tests, and empowers them with the information they need to make the best decisions for their own health and future.

There are only 5,000 certified genetic counselors in the U.S. And we’ve now added the first genetic counselor to Maven’s virtual clinic: Ushta Davar Canteenwalla, a board-certified, licensed genetic counselor with over 15 years experience in clinical genetics.

For many individuals on Maven, a genetic counselor can play a critical role as part of their care team as they navigate diverse paths to parenthood. For instance, speaking with a genetic counselor is helpful to learn about the various testing options and review family health history for individuals who are planning or are in the early stages of their pregnancy. Consultation with a genetic counselor is also often sought out by individuals who are having difficulty getting pregnant or who have experienced a miscarriage. For couples who are navigating surrogacy, a genetic counselor can help to review donor egg or sperm genetic testing options and results, discuss family history concerns, and advise on other specific considerations.

“We work really closely with a parent or couple to understand what their concerns are and help them navigate the best testing options, if any, for them.”

“Pregnancy is such an exciting time but can be overwhelming as well when we think about all the different tests that are thrown our way,” explains Ushta Davar Canteenwalla, who is also the founder of FiND Genetics. “Learning in advance about what information genetic tests give you really allows you the opportunity to vocalize and be empowered with information so you can have more meaningful discussions with your provider.”

At Maven, the leading women’s and family healthcare company providing end-to-end coverage for all paths to parenthood, we’re in a unique position to drive healthier outcomes, reduce costs, and deliver a better patient experience. Improving access to key specialists for women and families—like genetic counselors—is a major part of this. Maven operates the largest provider network in women’s and family health with on-demand virtual access to more than 1600 providers across over 20 specialties like OB-GYNs, Mental Health Providers, Lactation Consultants, and Reproductive Endocrinologists.

With a Genetic Counselor as our newest specialty, we can ensure that our members have better continuity of care as they navigate their path to parenthood all on Maven’s virtual clinic.

Interested in learning more about why Maven has added genetic counseling to our virtual clinic? Read on for a brief Q&A with Ushta, an excerpt from our recent webinar on demystifying genetic counseling.

Q&A with Maven Genetic Counselor Ushta Davar Canteenwalla, MS, LCGC

Maven: What does genetic testing mean during pregnancy and why does it matter?

Ushta Davar Canteenwalla: When we think about genetic testing that’s specific to pregnancy, what we’re referring to is typically any testing that is offered in pregnancy that gives us information about the baby’s genetic makeup, or the risk for the baby to have a genetic condition. There are many reasons why someone may consider a genetic test during pregnancy. People who are interested in learning more about the chance for their baby to have an increased risk of a genetic condition that could potentially impact physical or intellectual ability are typically the ones that end up choosing genetic testing most often.

Q: What kinds of genetic tests would be helpful for someone who wants to become a parent?

A: When someone asks me if there is a test they can do in the preconception phase before getting pregnant, genetic carrier screening is typically the test I recommend. Carrier screening is a blood test that’s done on the parents that can give meaningful information about potential increased risk for inherited genetic conditions. Knowing this information in advance can really be helpful in regards to creating more testing options and understanding overall risks.

Q: How do you know what type of genetic testing is right for you?

A: There’s no right or wrong way to approach genetic testing but it is important to figure out what options would be best for the types of information that matter most to you. Chatting with a Genetic Counselor can be informative in learning more about what tests may be optimal for you and helping make a decision. I recommend patients ask themselves what information they want to know, what they will do with that information or if that information will be meaningful to them and whether the timing is right for them to get the testing now. There are many factors to consider and the information provided can be stressful, overwhelming, and present a new set of challenges—so it can be a hard decision and shouldn’t be one that is taken lightly or alone necessarily.

Q: Let’s dive in to one specific type of genetic test for chromosome risks, which increases with age—a key driver of high-risk pregnancies. What is a type of test that can assess the risks for chromosome conditions?

A: You may have heard about the risk for chromosome changes as a woman gets older. And this is because, as women get older, so do our eggs, and the theory is that, as the eggs get older, the chromosomes just don’t separate the way we’d like them to. The key takeaway is that there’s always a risk for someone to have a chromosome abnormality, but this risk increases as a woman’s age increases.

There are a few tests that are offered in pregnancy to better understand risks for chromosome changes, which I’ll dive into specifics on here.  

• Maternal Serum Screening is a blood test that’s done on mom between 11 and 13 weeks into a pregnancy, and is often combined with an ultrasound around 12 weeks. It looks at the proteins made by the baby circulating in mom’s blood, and combines it with information like mom’s age and how far along the pregnancy is. It gives you a risk estimate for a couple of the more common chromosome conditions that may occur. So when you get the results from this test, you’ll get a ratio—something like a 1 out of 710 chance for baby to have Down Syndrome.  
• Another blood test that is now commonly offered is referred to as NIPT/S or Non Invasive Prenatal Testing/Screening which can be done any time after 9 weeks gestation. The biggest difference between this test and a Maternal Serum Screening is that it is much more accurate and has a lower false-positive rate. Why? Because the NIPT/S looks at cells from the placenta that have crossed over into mom’s bloodstream--and the cells that make up the placenta go on to develop into the baby, meaning they generally have the same genetic makeup as the baby. So you’re looking at fetal DNA with the NIPT/S versus just a pattern of proteins as in a Maternal Serum Screening. The results for NIPT/S will come back as either high-risk or low-risk for various conditions screened.
• Other tests that can look at the risk for chromosome abnormalities are referred to as diagnostic tests. These tests, such as the Amniocentesis or CVS (Chorionic Villus Sampling), give you information about the number and structure of all the chromosomes, and instead of giving you results as a risk estimate, they are giving you more concrete, yes-or-no information. Both tests are invasive in that they are taking a sample of either the chorionic villi from the placenta (in CVS) or the amniotic fluid surrounding baby (in amnio). While both are safe procedures, they do come with a risk of complications that could lead to miscarriage. That risk will vary per center that performs the procedure, but in general it’s anywhere from 1 out of 500 through a 1 in 1000 chance of complications that could lead to miscarriage.  

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