Aetna Agrees to Cover Fertility Treatments for Same-Sex Couples
The insurance giant will ensure fertility treatments are covered equally for all members, both same-sex and straight.
Insurance giant Aetna has agreed to cover the cost of fertility treatments for same-sex couples as part of a lawsuit settlement.
Under the deal, announced on May 3, Aetna will introduce a new standard health benefit plan that includes coverage for artificial insemination costs as a benefit for all policyholders, regardless of sexual orientation.
Aetna will also take steps to ensure that requirements to proceed with in vitro fertilization (IVF) are no more burdensome for same-sex couples than for opposite-sex couples.
Previously, a female health plan beneficiary with a male partner could have received coverage for infertility treatments by claiming the couple had been unable to become pregnant after six or 12 months (depending on their age) of intercourse.
But a beneficiary with a female partner had to pay out-of-pocket for their first six or 12 cycles of artificial insemination before getting coverage for any additional rounds, or becoming eligible for IVF treatments otherwise covered by their plan.
Aetna has also agreed to compensate class action members, including members of certain New York commercial insurance plans who were or would have been denied reimbursement for artificial insemination.
To compensate those policyholders and beneficiaries, the company will create a $2 million common fund, and Aetna will re-process eligible insurance claims to reimburse class members for any out-of-pocket costs previously incurred, up to their plan limits. Aetna will also separately pay the costs of the administrator and special master who allocate the common fund.
A federal judge still has to approve the deal before it takes effect.
The settlement seeks to align Aetna’s policy with guidelines from the American Society for Reproductive Medicine, so that all eligible plan members will have equal access to fertility treatments, regardless of sexual orientation.
Aetna was hit with a class-action lawsuit in September 2021, brought by the National Women’s Law Center on behalf of Emma Goidel and her partner Ilana Caplan. They were forced to pay more than $50,000 to successfully conceive.
Other plaintiffs soon joined the lawsuit, seeking to challenge the company’s policy regarding reimbursement for fertility procedures.
The plaintiffs argued that Aetna’s definition of what constitutes infertility led to unequal insurance coverage for same-sex couples. They also claimed that the policy violated Section 1557 of the Affordable Care Act, which prohibits sex-based discrimination, including against LGBTQ individuals, in insurance coverage.
The plaintiffs additionally argued that the policy violated New York City and state laws prohibiting discrimination based on sexual orientation.
Aetna, the health insurance arm of CVS Health Corp., covers nearly 19 million people with commercial coverage, including employer-sponsored health insurance.
A CVS Health spokesman told The Associated Press that the company was pleased to resolve the case and “committed to providing quality care to all individuals regardless of their sexual orientation or gender identity.”
Goidel, who became pregnant with her second child after six cycles of artificial insemination, and one unsuccessful attempt at in vitro fertilization, told AP she was “thrilled” that Aetna would be amending its policy, and expects to be reimbursed under the settlement.
“You never know when you start trying to conceive and you have to do it at the doctor, how long it’s going to take and how much it’s going to cost,” she said of the price tag associated with the treatments.
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