Healthcare Access

The Opportunity

Companies that design health benefits around what employees actually need, rather than what a standard plan happens to cover, see higher utilization, stronger retention among experienced employees, and a meaningful signal to the market that they take care of their people. Women's health coverage is one of the clearest places where that signal lands.

The Business Case

The Mayo Clinic estimates that menopause-related productivity losses cost U.S. employers $1.8 billion annually in missed workdays alone. Related healthcare costs exceed $24 billion per year.⁴

One in ten women has declined a job offer because the employer did not offer adequate menopause support.⁵

McKinsey and the World Economic Forum project that closing the women's health gap could add at least $1 trillion to the global economy annually by 2040.⁶

Comprehensive women's health coverage is not a cost center. It is a retention strategy for the employees who are often most difficult and most expensive to replace.

The broader women's health gap carries an even larger price tag. That gap begins in the workplace, where what an employer covers, and what it does not, shapes whether women can access the care that keeps them healthy and productive across every stage of their working lives.

What the Research Shows

Women spend nearly 30 percent more out of pocket on healthcare than men. In 2024, that gap totaled $8.8 billion.¹ Only 40 percent of employers currently offer fertility benefits, despite one in six people globally experiencing infertility.² Only 15 to 29 percent of organizations offer any menopause-specific support, despite menopause affecting every woman who lives long enough to experience it.³

Menopause typically arrives between ages 45 and 55, when many women are at the peak of their professional influence. Symptoms including cognitive fog, disrupted sleep, anxiety, and fatigue have measurable impact on performance and attendance. These are not personal problems. They are workforce planning issues that respond directly to policy design.

Maternal health.

The United States has the highest maternal mortality rate of any high-income country. In 2024, roughly 17.9 women died for every 100,000 live births, a rate double or triple that of peer nations including Sweden, Japan, Germany, the United Kingdom, and France. More than 80 percent of these deaths are considered preventable.⁷ Black women die at a rate of 44.8 per 100,000 live births, more than three times the rate for white women.⁸ These disparities do not disappear at the hospital door. They begin with what insurance covers, what care is accessible, and whether an employer's health plan supports women through pregnancy, postpartum recovery, and the full arc of reproductive health. A health plan that technically covers pregnancy but leaves gaps in postpartum mental health care, lactation support, or high-risk obstetric access is not fully meeting the standard.

Chronic conditions disproportionately affecting women.

Endometriosis affects an estimated one in ten women of reproductive age and takes an average of seven to ten years to diagnose from the onset of symptoms.⁹ PCOS affects up to 13 percent of women globally and is similarly underdiagnosed.¹⁰ Both conditions have measurable impact on work attendance, productivity, and career trajectory. Research published in F&S Reports found that women with PCOS reported missed work, reduced quality of work, and feeling held back at work because of their condition.¹⁰ Longer diagnostic delays for endometriosis are associated with higher healthcare costs, more severe symptoms, and worse long-term outcomes.¹¹ These are not rare conditions. They are among the most common chronic health issues affecting working-age women, and they are among the most frequently overlooked in standard plan design.

Menstrual health conditions, including severe dysmenorrhea associated with endometriosis and PCOS, represent a related and largely unaddressed category. Illinois introduced legislation in 2026 that would provide up to 40 hours of paid menstrual leave annually for employees experiencing menstrual health conditions.¹² No federal law currently mandates this. Organizations that name menstrual health conditions explicitly in their leave and accommodation policies, and that ensure their health plans cover diagnosis and treatment of the underlying conditions causing debilitating symptoms, are ahead of where legislation is heading.

Mental health coverage and parity.

Women account for 71 percent of all mental health-related workplace leaves.¹³ Nearly one in three women describes their mental health or emotional wellbeing as fair or poor.¹⁴ Women experience anxiety disorders at rates approximately 1.6 times higher than men and are significantly more likely to experience depression.¹⁴ And yet less than 30 percent of women receive mental health care despite the high prevalence of conditions.¹³

Federal law requires mental health parity in insurance coverage, meaning mental health benefits must be covered at the same level as medical and surgical benefits. In September 2024 the Department of Labor issued strengthened MHPAEA enforcement rules.¹⁵ Despite this, coverage gaps remain. Plans that technically include mental health coverage but impose session caps, narrow provider networks, or prior authorization requirements that do not apply to physical health care are not meeting the spirit of parity. For women, who use mental health services at higher rates and face higher rates of undertreatment, these gaps are not technical compliance issues. They are access failures.

Preventive care and screening.

Mammograms, cervical cancer screenings, bone density scans, cardiovascular risk assessments, and postpartum depression screenings are among the preventive services that catch serious conditions early when they are most treatable and least expensive. Coverage gaps in preventive care do not show up as acute costs immediately. They show up years later as catastrophic ones. A health plan audit that does not include a review of preventive care coverage for age-appropriate women's health screenings is an incomplete audit.

A Note on the Coverage Gap

Traditional insurance plans, whether HMO or PPO, were not designed around women's health needs at midlife. Many of the most effective interventions for menopause, perimenopause, and hormone-related conditions are available through specialized women-centered telehealth platforms that fall outside what a standard plan covers. Organizations that provide a flexible wellness stipend usable on these platforms address this gap practically and affordably. Companies that do this earn the benefit of both Pillar 2 and Pillar 5 working together.

The coverage gap is not limited to midlife hormonal health. Standard plans frequently exclude or inadequately cover diagnosis and treatment of endometriosis and PCOS, postpartum mental health care beyond the immediate delivery period, lactation support and equipment, and specialized care for chronic conditions that disproportionately affect women. A plan audit that asks only whether maternity care is covered, and not whether the full continuum of women's health needs is addressed, will miss the gaps that matter most to the women in the workforce.

What Good Looks Like

Good represents accessible baseline practices. Better reflects more intentional investment. Best describes what the most forward-thinking companies are doing right now.

Questions Worth Asking

• Does our health plan cover fertility treatment, HRT, and menopause-related care?
• Do employees know what their plan covers without having to decode a benefits document?
• Are there women's health needs in our workforce that our current plan does not address?
• Do we offer any flexible wellness benefit that employees can use on platforms outside our standard plan?
• When did we last review our health benefits through the lens of what women in our workforce actually need?
• Does our plan cover diagnosis and treatment of conditions like endometriosis and PCOS, or do employees with these conditions face gaps and delays in getting care?
• Does our mental health coverage meet true parity, not just legal minimums, in terms of session limits, network access, and prior authorization requirements?
• Does our postpartum coverage extend beyond the delivery itself to include mental health care, lactation support, and the full recovery period?
• When did we last review our preventive care coverage to confirm that age-appropriate women's health screenings are covered with no cost-sharing?