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A California federal district court has approved a preliminary settlement agreement in a class-action lawsuit against Aetna over coverage for fertility treatments for same-sex couples versus heterosexual couples. As part of the settlement, Aetna will cover artificial insemination or in vitro fertilization for same-sex couples in the same manner as it does for heterosexual couples. Aetna will also pay $2 million in damages for qualifying plan members based in California.
Mara Berton and June Higginbotham, a same-sex couple, paid out-of-pocket expenses of $45,000 to conceive a child. In contrast, heterosexual couples with the same Aetna insurance coverage received coverage for many of their conception-related costs.
Aetna advised Berton that she was ineligible for fertility benefits because she did not meet the definition of infertility under the terms of her insurance plan. Policyholders had to engage in six to 12 months of "unprotected heterosexual sexual intercourse" without conceiving to meet the definition of infertility and qualify for fertility benefits under the Aetna plan.
On the other hand, women without male partners could access fertility benefits only after six to 12 unsuccessful cycles of artificial insemination, based on their age. In the class action lawsuit, Berton and the other plaintiffs argued that the Aetna policy treated LGBTQ plan members differently from heterosexual plan members. Due to the large amount of uncovered expenses required for LGBTQ plan members, the ultimate effect of the plan was to deny them any coverage for fertility benefits.
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