Financial Worksheet
| Agency Fees-Surrogacy | |
| Agency Fee - Surrogacy | $15,000 |
| INTERNATIONAL ONLY - International Client Surcharge | $1,500 |
| Estimate of Fees and Expenses Related to Surrogate: | |
| Pshychological Counseling and Screening | $1,500 |
| Fee to Surrogate's Attorney to Review Surrogacy Agreement |
$1,000 (estimate, cap of $1,200) |
| Third Party Escrow Account Fee | $1,500 |
|
Fee for Gestational Surrogate (experienced GS's may command higher compenstation) |
$22,000-$35,000+ |
|
Monthly Incidentals (travel to doctors appointments, parking, childcare, FedEx, faxes, healthy diet, etc) |
$200 per month |
| Maternity Clothing Allowance | $500 (add $250 for multiples) |
|
Health Insurance for Surrogate (premiums, co-pays and deductibles) |
$3,600-$30,000+ (estimate, actual costs apply) |
| Life Insurance for Surrogate |
$400-$600 (estimate, actual costs apply) |
| Back-Up Insurance | $1,500-$45,000 * |
| *If Surrogate's Insurance pays all claims this fee will be returned to IP's, less a $1,500 broker's fee. If invoked deductible will be capped based on policy selected and age of surrogate. | |
| Possible Additional Fees and Expenses Related to Surrogate | |
| Multiple Pregnancy | $5,000 |
|
Additional Transfer Fee (per transfer, as necessary) |
$750 |
| Fee for Travel and Lodging Expenses if Surrogate Lives 90+ Miles from IVF Clinic | actual costs apply |
| Fees for Lab Tests Required by FDA for Intended Parents | $1,000 * |
| Invasive Procedures | $500 (most procedures) |
| Caesarian Section (if ordered by Obstetrician) | $1,000 |
| Loss of Uterus | $2,500 |
|
Companion Travel (if desired, for invasive procedures only) |
actual costs apply |
| Companion Lost Wages | variable with negotiated cap |
| Childcare and Housekeeping During Doctor Ordered Bed Rest | variable with negotiated cap |
| Surrogate Lost Wages | variable with negotiated cap |
| INTERNATIONAL ONLY-Health Insurance for Child Once Born |
$4,500-$50,000+ (variable, check with provider-twin exclusion) |
| *(usually included in IVF Clinic Cycle Fees, check with your clinic) | |
| 3rd Party Fees | |
| IVF Clinic Cycle (less for frozen embryo transfer) |
$15,000-$20,000 (estimate, check with IVF clinic) |
| Donor Egg (if applicable) | $5,000-$10,000 (estimate |
|
Intended Mother or Egg Donor Medications (if not covered by insurance) |
$4,000 |
| Surrogate Medications | $2,000 |
| Attorney Fees-Surrogacy Agreement | $3,000 |
| Pre-birth Order | $2,500 |
| Court Filing Fees | $200-$500 |
| All 3rd Party Costs are estimates only. Check with your provider for exact prices. | |
| Custom Egg Donor Search Fees | ||
| Agency Fees | ||
| Agency Fee-Custom Egg Donor Search and Match | $8,000 | |
| Donor Expenses-Local Donor | $500 (estimate, actual cost apply) | |
| Fees and Expenses Related to Egg Donor | ||
| Donor Compensation | $8,500 (estimate, varies) | |
| 3rd Party Fees | ||
| Genetic Screening | $500-$3,000+ * | |
| Donor Medications | $4,000 | |
|
IVF Clinic Cycle (less for frozen embryo transfer) |
$15,000-$20,000 per cycle (esimate, check with IVF clinic) |
|
| Attorney Fees-Egg Donor Agreement | $1,000-$1,500 | |
| Independent Attorney for Egg Donor | $1,000 | |
| *(optional, but recommended for certain high risk populations) | ||
| All 3rd Party Costs are estimates only. Check with your provider for exact prices. | ||
Fees and Costs above are subject to change. Agency fees will be guaranteed at the current rate on the date that the agreement between the Intended Parent(s) and Family Forward Surrogacy is signed. Other fees and expenses are estimates only, and may be higher or lower depending upon the specific circumstances of the Intended Parents and the Gestational Surrogate.