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Aetna agrees to settle lawsuit over fertility coverage for LGBTQ+ customers

The insurer will make coverage of artificial insemination standard for all customers nationally and work to ensure that patients have equal access.
A sign sits on the campus of the insurance and managed health care company Aetna.
Posted at 2:05 PM, May 04, 2024

Aetna has agreed to settle a lawsuit that accused the health insurer of discriminating against LGBTQ+ customers in need of fertility treatment.

Under the deal announced Friday, the insurer will make coverage of artificial insemination standard for all customers nationally and work to ensure that patients have equal access to more expensive in-vitro fertilization procedures, according to the National Women’s Law Center, which represented plaintiffs in the case.

Aetna, the health insurance arm of CVS Health Corp., covers nearly 19 million people with commercial coverage, including employer-sponsored health insurance.

The insurer will set aside a $2 million fund to reimburse people who had coverage from some of its commercial insurance plans in New York and were denied reimbursement for artificial insemination, a procedure in which sperm is placed directly in a woman’s uterus.

A CVS Health spokesman said 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.”

A federal judge still must approve the deal.

The settlement stems from a 2021 lawsuit filed in a federal court in New York. Emma Goidel said she and her spouse, Ilana Caplan, spent more than $50,000 on fertility treatments to conceive their second child after Aetna rejected several requests for coverage.

The couple had insurance through a Columbia University student health plan.

Their plan required people who cannot conceive a child naturally to first pay thousands of dollars for cycles of artificial insemination before the insurer would start covering fertility treatments.

The lawsuit noted that heterosexual couples didn’t have the same costs. They just had to attest that no pregnancy had occurred after several months of unprotected sex before they got coverage.

“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,” Goidel said. “It was unexpected, to say the least.”

Goidel became pregnant with the couple’s second child after six cycles of artificial insemination — which each cost a few thousand dollars — and one unsuccessful, $20,000 attempt at in vitro fertilization, where an embryo is created by mixing eggs and sperm in a lab dish.

Goidel said she’s “thrilled” that Aetna changed its policy as part of the settlement, and she expects to be reimbursed.

Fertility treatment coverage has grown more common in recent years, especially among employers eager to recruit and retain workers.

The benefits consultant Mercer says 45% of employers with 500 or more workers offered IVF coverage last year. That’s up from 36% in 2021. Many place limits on the number of treatment cycles or set a lifetime maximum for the benefit.

Many insurers also cover artificial insemination as a standard benefit for all policyholders, according to Sean Tipton of the American Society for Reproductive Medicine.