‘We, the collective, need to ensure that everyone's aware of what's available to them,’ says Sofia Colaiacovo
When it comes to women’s benefits, fertility coverage in Canada remains one of the most glaring gaps in employer benefits plans. It also stands out as the single biggest unmet need in benefits, according to Equitable’s Sofia Colaiacovo.
The VP of group sales in Eastern Canada at Equitable argues that it’s often treated as an afterthought; a specialty add-on that has to be requested, negotiated, and paid for by the plan sponsor on top of everything else. And for the small to mid-size employers that make up the bulk of the Canadian market, that cost conversation often ends before it starts.
“It's typically a separate category of drugs that's not standardly included that an employer needs to mindfully ask to be included and that’s also dependant on the group and the size or the carrier they're with,” she explained. “There's not a one size fits all maximum from a drugs perspective. There’s also the fact of considering what you're able to get as a smaller employer versus a mid-size employer and what you're able to afford. There’s one bucket under the fertility benefits, but then there's the fertility treatments themselves. There's only so much that’s covered by the province, depending on where you live or your age and it doesn’t always work the first time.”
Additionally, Colaiacovo emphasized how fertility benefits are often positioned as a women's health benefit when it is not specific to women only.
"Granted a lot of the drugs and treatments are specific and claimed by a woman, it is good to highlight that infertility impacts all people. While fertility isn't a woman specific health concern, most often the cost of treatment is the women's to bare," she noted.
With drugs and treatments starting at $20,000, a single claim can hit a small plan hard, noted Colaiacovo, adding menopause and perimenopause supports are in better shape by comparison. Hormone replacement therapy (HRT) drugs are included in most standard plans, and mental health practitioners are a standard paramedical inclusion. But the annual maximums tell a different story. From $350 to $500, plan members can't get far with a therapist, and finding one is another obstacle.
"I don't think that most Canadian employer benefits plans are set up to really absorb the cost of that treatment," added Colaiacovo.
According to recent data by StatsCan, the country slipped into “ultra‑low fertility” in 2024, with a total fertility rate of 1.25 children per woman. Additionally, the average age at first birth has climbed for decades and hit 31.8 in 2024. Consequently, the share of women who never have children has also climbed.
Moreover, Colaiacovo believes the rising cost of women's health claims is driven by the demographic reality of more women being in the workforce, and many are at the age where fertility or menopause becomes a factor. Even those who aren't plan members themselves are often covered as spouses.
Pinpointing the exact cost pressures is difficult, she argues, because the industry hasn't been tracking women's health data with enough precision. The bigger issue is a double gap that consists of what plans actually cover, and what employees know is available to them. Most Canadian plans fall short on fertility and menopause supports, and even where coverage exists, plan members “don’t know what they don’t know,” she said. “And half of the battle is knowing what you're about to face, what supports are out there, and how to navigate them,” adding the current cost increases are just the surface, she suggests, because too few people have the awareness to access the services and treatments that do exist.
But according to Colaiacovo, the problem is bigger than women’s health alone, noting that mental health often plays a role in the fertility journey. She underscored how mental health pressures are rising across the country, while benefits stakeholders are trying to juggle a growing list of priorities, from chronic disease to preventive care to gender-specific needs. In that environment, communication often breaks down, and many employees still do not understand what help is available to them.
She believes the shortfall on mental health support is broad and systemic. In her view, employers, insurers, advisors, and the healthcare system are all falling short, even if that is not due to indifference. Colaiacovo suggests that mental health support in benefits has been treated too narrowly for too long. Employers have tended to rely on standard psychology coverage and employee assistance programs, but that’s not enough anymore.
“There's so many things that need to be constantly communicated and employees need to constantly be reminded of the services that are available to them but there's only so much time in the day. I think from a mental health perspective, we've historically always just deferred to whether plans cover a psychologist benefit in the benefit program and whether sponsors have EAPs. Both are very great resources and support for mental health but I think we need to evolve that space. We as a society, we as a health care system, we as an industry. Because there's preventative care, there's care as you're in a crisis or care that's still good for your mental health. You don't necessarily need to be in a crisis to access those services.”
The starting point for any employer is education, Colaiacovo said, adding decision makers need to understand what menopause, perimenopause, and infertility actually mean for an employee's financial, mental, and physical well-being.
From there, it’s about taking stock of what the current plan already covers and pressing advisors and carriers for answers on where the gaps are. While drug coverage matters, whether it’s HRT, HPV vaccines, or migraine treatments, higher mental health maximums can make a real difference by keeping people in treatment longer without out-of-pocket costs.
Virtual healthcare platforms with dedicated women's health services, including menopause coaching, can also help employees navigate a Canadian healthcare system that still lacks knowledge on how to diagnose and treat these conditions, she suggests. But Colaiacovo argues the benefits plan is only one piece. The issue, in her view, is accommodation as much as coverage.
"It's not just necessarily about getting your drugs or doctor's visit covered. It's got to be a holistic approach to helping women get through those journeys," she said, calling for flexible work arrangements, like time off for appointments, the ability to work from home during difficult symptoms and reduced hours when needed.
To that end, Colaiacovo emphasized awareness can’t rest with one group alone. While employers may lack the time or resources to educate staff properly, carriers and advisors also play an important role in helping employers with awareness and communication. Colaiacovo underscored how there can always be improvements in these areas. Notably, employees themselves are also stretched, dealing with work, families, finances, and caregiving responsibilities, which means benefits education can easily get lost.
Improving both fertility and mental health support requires shared responsibility across the system, alongside a much stronger effort to connect people with both plan-based and external resources, Colaiacovo underscored.
“We, the collective, need to ensure that everyone's aware of what's available to them,” she said.
