Should Canada Implement a Flat-Rate Reimbursement Model for Surrogacy Arrangements: A Summary From the Text Surrogacy in Canada
In the article “Should Canada Implement a Flat-Rate Reimbursement Model for Surrogacy Arrangements” (Chapter 5 of Surrogacy in Canada, 2018), law professors Vanessa Gruben, Angel Petropanagos, and Angela Cameron discuss reforming the current system. Presently, donors and surrogates are reimbursed for receipted expenses (see regulation SOR/ 2019-193). This is based on the guiding principle of the Assisted Human Reproduction Act that “commercial ends raise health and ethical concerns that justify their prohibition”. In line with this guiding principle, the authors recommend the adoption of a new model, the flat-rate model.
They argue that the flat-fee model is an improvement on the receipted expense model. Under the current reimbursement model, surrogates and donors are to be reimbursed not compensated (remain revenue neutral).
However, there are drawbacks to the receipted-expenses model. The authors examine the drawbacks in the context of surrogacy. However, note that their comments may be applied to donors and to surrogates.
The first problem with the receipted-expenses model is that it places an upfront burden on the surrogate. As they must incur the expense before submitting them for reimbursement. Second, surrogates face additional burdens related to administration and oversight. Not all aspects of surrogacy can be easy to quantify. For example, surrogates who are students cannot quantify lost time from school the same way employed surrogates can from work. Third large variations in payments are possible based on how much the surrogates choose to spend upfront or are able to spend.
The flat-rate model would eliminate much uncertainty around the potential costs associated with surrogacy. It would also render the cost of an “average” surrogacy transparent to both intended parents and surrogates.
The flat-rate model would have three areas of compensation. The first basket would be a mandatory monthly flat rate, which would be paid to a woman who acts as a surrogate over 12 months (before, during and after the birth). The reimbursement would be monthly to alleviate the burden on the surrogate for covering pregnancy related costs. If the pregnancy ends early, the fees would be prorated. The flat rate would ensure that surrogates have funds allocated towards the payment of their basic surrogacy-related needs prior to incurring expenses. It would eliminate the need for surrogates to collect and submit receipts, and it would provide clarity for surrogates and intended parents on payments.
The second basket would include a flat rate covering legal and counselling fees.
The third basket would include exceptional expenses. These payments would not be mandatory but would be paid for by intended parents on a case-by-case basis. For example, complications during pregnancy, delivery, post-partum depression, and other exceptional circumstances.
Lastly, the authors recommend rigorous oversight of the flat fee model. Presently, there is no designated body for stakeholders (like intended parents, surrogates, or service providers) to regulate the industry. But a dedicated regulatory body could be used to seek clarification about the scope of coverage or raise concerns about non-compliance.
(The article is a summary of the flat rate model proposed in the chapter in the text Surrogacy in Canada: Critical Perspectives in Law and Policy and does not represent the views of any organization.)