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

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 provide standard artificial insemination coverage for all customers nationwide and will work to ensure patients have equal access to more expensive IVF procedures, according to the National Women’s Law Center, which represented the 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 were covered by some of its commercial insurance plans in New York and who were denied reimbursement for artificial insemination, a procedure in which sperm is placed directly into a woman’s uterus. .

A CVS Health spokesperson said the company was pleased to resolve the case and is “committed to providing quality care to all individuals, regardless of their sexual orientation or gender identity.”

A federal judge still needs to approve the settlement.

The settlement stems from a 2021 lawsuit filed in New York federal court. Emma Goidel said she and her wife, 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.

His plan required people who are unable to conceive a child naturally to first pay thousands of dollars for artificial insemination cycles before the insurer would begin covering fertility treatments.

The lawsuit noted that heterosexual couples did not face the same costs. They just needed to certify that no pregnancy had occurred after several months of unprotected sex before they could get coverage.

“You never know when you start trying to get pregnant and have to go to the doctor, how long it will take and how much it will 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 – each costing a few thousand dollars – and an unsuccessful attempt at in vitro fertilization, costing $20,000, in which an embryo is created by mixing eggs and sperm in a laboratory dish.

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

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

Benefits consultant Mercer says 45% of employers with 500 or more workers offered IVF coverage last year. This represents an increase from 36% in 2021. Many place limits on the number of treatment cycles or set a maximum lifetime 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.

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This story has been corrected to show that the complainant’s last name is Goidel, not Goins.