The litigation accused the health insurer – which is owned by pharmacy chain CVS Health – of having separate IVF coverage policies for same-sex and heterosexual couples.
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BY RON SHINKMAN
A national insurer under criticism for its reproductive health benefits design has agreed to settle a lawsuit and change its policies regarding IVF and other reproductive health coverage for same-sex couples.
Aetna – which is owned by pharmacy chain giant CVS Health – will set aside $2 million to reimburse same sex couples who had previously been denied coverage under its prior policies.
The insurer was sued in September 2021 by playwright Emma Goidel, who obtained her Aetna coverage through Columbia University.
Goidel’s lawsuit, a class-action filed in federal court in New York City, argued that Aetna’s policy of requiring same-sex couples to undergo a dozen rounds of intrauterine insemination at their own expense before it would provide IVF coverage was discriminatory. By contrast, heterosexual couples only had to claim 12 consecutive months of trying to get pregnant before IVF coverage would kick in.
Under the terms of the settlement, Aetna has agreed to change its coverage policy. “Aetna will apply and administer its clinical policies such that individuals with a uterus in an eligible LGBTQ+ relationship at the time of seeking IVF are not required to undergo any greater number of IUI cycles to qualify for IVF than individuals with a uterus in a heterosexual relationship,” the settlement stated.
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Aetna has also agreed to reimburse same sex couples who had IVF coverage from the insurer but previously had to pay for IUI treatments out of their own pocket. Each enrollee would be eligible to a default payment of $2,300, although they may apply for additional compensation if they spent money on procedures exceeding that sum.
“We celebrate this significant stride toward achieving justice for LGBTQ+ people who have faced obstacle after obstacle trying to access the health care services that they need to build their families,” said Alison Tanner, an attorney with the National Women’s Law Center, which represented Goidel in the litigation
Court records indicate 5,621 individuals belong in the various classes of plaintiffs, although only 850 are currently confirmed as qualifying for reimbursement, according to the settlement. The other individuals would have to prove they were in a same-sex relationship and denied fertility benefits in order to qualify. Any money left over from the $2 million fund will be donated to a charity of choice decided by the plaintiffs and Aetna.
The attorneys who represented Goidel and the other class members will receive $1.65 million in legal fees separate from the $2 million settlement fund. Aetna will also pay $130,000 to administer the settlement, which is comprised primarily of notifying class members that they may be due compensation.
“We are committed to providing quality care to all individuals regardless of their sexual orientation or gender identity and pleased to reach a resolution to this matter,” Aetna said in a statement provided to Inside Reproductive Health. A spokesperson for the health insurer declined to answer specific questions.
Meanwhile, Aetna was sued again in federal earlier this month, this time in Los Angeles. The plaintiff in that case, Amelia Rynkowska, claims Aetna has ambiguous language in its group employer coverage that appears to exclude coverage of many reproductive services completely.
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