Aetna Settles Lawsuit, Agrees to Cover Fertility Treatments for LGBTQ+ Individuals

Aetna, the health insurance arm of CVS Health Corp., has reached a landmark settlement in a class-action lawsuit alleging discrimination against LGBTQ+ plan members in its treatment coverage. The preliminary agreement, filed in the U.S. District Court for the Southern District of New York on Friday, requires Aetna to change the definition of "fertility" in its health plans to make coverage more accessible and affordable for LGBTQ+ couples.

Why this matters: This settlement sets a precedent for other insurers to follow, potentially leading to more equitable access to fertility treatments for LGBTQ+ individuals nationwide. As fertility treatment coverage becomes more common, this agreement could have a significant impact on the healthcare and family-building options available to the LGBTQ+ community.

Under the terms of the settlement, Aetna will establish a $2 million fund to reimburse individuals who had coverage from certain commercial insurance plans in New York and were denied reimbursement for artificial insemination. The insurer, which covers nearly 19 million people with commercial coverage, including employer-sponsored health insurance, will also work to ensure that patients have equal access to more expensive in-vitro fertilization (IVF) procedures.

The lawsuit, filed in 2021 by Emma Goins and her spouse, Ilana Caplan, accused Aetna of discriminating against LGBTQ+ customers in need of fertility treatment. The couple spent over $50,000 on fertility treatments to conceive their second child after Aetna rejected several requests for 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," said Emma Goins. "It was unexpected, to say the least."

The lawsuit noted that heterosexual couples didn't face the same costs, as they only had to attest that no pregnancy had occurred after several months of unprotected sex before receiving coverage. "I'm thrilled that Aetna changed its policy as part of the settlement, and I expect to be reimbursed," Goins added.

Key Takeaways

• Aetna settles lawsuit, agrees to modify LGBTQ+ fertility treatment coverage.
• $2 million fund established to reimburse individuals denied coverage.
• Aetna to ensure equal access to IVF procedures for LGBTQ+ patients.
• Settlement sets precedent for other insurers to follow.
• Federal judge approval needed for deal to take effect.