Aetna Infertility Settlement Grants Historic Win for LGBTQ Couples

Company
Aetna

Why
Denied fertility coverage

Total Settlement Amount
$2M

Maximum Individual Claimant Award
$12,300

Claim Deadline
August 26, 2025

Aetna infertility coverage policies have reached a historic turning point, marking the first time LGBTQ+ couples in the United States can seek reimbursement for previously denied fertility coverage. The insurance giant, serving nearly 19 million people with commercial coverage, has agreed to establish a $2 million common fund for affected class members in a landmark class action lawsuit. Previously, LGBTQ+ couples faced discriminatory practices, including requirements to pay for up to a year of artificial insemination before becoming eligible for coverage - a burden not placed on heterosexual couples. This groundbreaking settlement emerged after a compelling lawsuit, Goidel v. Aetna, filed in September 2021 in the U.S. District Court for the Southern District of New York, when a couple challenged Aetna's fertility coverage policy after spending over $50,000 out-of-pocket for fertility treatments. The resolution not only provides immediate compensation through a $2,300 default reimbursement per class member but also signals a significant shift toward equitable access to healthcare for all families seeking fertility treatments.

Couple Spends $50,000 to Challenge Aetna's Policy

Emma Goidel and her spouse, Ilana Caplan, faced substantial financial barriers while seeking fertility treatments under their Columbia University student health plan. The couple's journey to conceive their second child resulted in out-of-pocket expenses exceeding $50,000 after Aetna denied multiple coverage requests for infertility treatments.

Specifically, Goidel underwent six cycles of artificial insemination, with each cycle costing several thousand dollars. Furthermore, the couple invested $20,000 in one unsuccessful attempt at in vitro fertilization (IVF). Meanwhile, heterosexual couples under the same plan faced significantly different requirements, needing only to confirm unsuccessful pregnancy attempts after months of unprotected intercourse to receive Aetna IVF coverage.

The discriminatory Aetna infertility policy required LGBTQ+ couples to pay for six to twelve cycles of artificial insemination independently before becoming eligible for coverage. Consequently, between 2020 and 2021, Goidel completed six intrauterine insemination (IUI) cycles and one IVF cycle. The financial burden was substantial, as a single IUI cycle ranged from hundreds to $5,000, while IVF treatments could cost up to $30,000 per cycle.

"Health insurance must protect that right by covering medical costs equally for those who need fertility treatment to reproduce—not discriminating against queer people," Goidel stated. The couple's experience ultimately led to their decision to challenge Aetna's policy through legal action, questioning whether Aetna insurance covers IVF equally for all couples.

Insurance Giants Face Mounting Pressure

The Aetna lawsuit settlement has intensified scrutiny on insurance industry practices, as currently only six states and Washington D.C. require private insurers to provide fertility coverage explicitly inclusive of LGBTQ+ people. Throughout the United States, fertility-related healthcare often remains uncovered by insurance, with 32 states and 5 territories having no requirements for private insurers to cover fertility treatments.

Across the nation, mounting pressure for change is evident as more states consider expanding coverage. Notable progress includes Colorado, Delaware, Illinois, Maine, Maryland, New Jersey, and New York, which have adopted more inclusive coverage mandates.

The landscape of fertility coverage reveals significant gaps. According to current data, 21 states mandate private insurers to cover fertility treatments, yet only 15 include IVF coverage. Notably, just New York and Illinois provide fertility coverage through Medicaid.

Similar cases have emerged against other major insurers, including UnitedHealthcare and Blue Cross Blue Shield. The pressure extends beyond individual cases, as advocacy groups actively work to update infertility definitions in existing insurance laws across states like California and Massachusetts, citing Section 1557 of the Affordable Care Act to combat discrimination in healthcare coverage.

The financial implications for insurers are substantial. Currently, 45% of employers with 500 or more workers offer IVF coverage, marking a significant increase from 36% in 2021. This trend suggests growing recognition of fertility coverage as a crucial employee benefit, placing additional pressure on insurance providers to adapt their policies and ensure Aetna fertility coverage and similar plans meet the needs of all couples.

Settlement Creates Legal Precedent

Under the settlement approved by a federal judge in the U.S. District Court for the Southern District of New York, Aetna has committed to groundbreaking policy changes for fertility coverage. The insurance provider will establish a $2 million fund to compensate beneficiaries who incurred out-of-pocket expenses under the previous policy.

Following the settlement terms, Aetna will modify its clinical policies to align with the American Society for Reproductive Medicine guidelines. Subsequently, the company will introduce a new standard health benefit plan that includes artificial insemination coverage for all members, irrespective of sexual orientation. The Aetna national infertility unit will play a crucial role in implementing these changes and ensuring equitable access to fertility treatments.

In fact, this marks the first instance in U.S. history where LGBTQ+ couples previously denied fertility coverage can apply for reimbursement. As a result of the settlement, Aetna will re-process eligible claims and ensure equal access to fertility treatments, addressing concerns about whether Aetna covers IUI and other fertility procedures for all couples.

The National Women's Law Center, representing the plaintiffs, emphasizes that discriminatory coverage policies remain an industry-wide challenge. This settlement establishes a crucial legal framework, as thirteen states now mandate insurers to cover fertility treatments for same-sex couples. Yet, the law exempts companies with self-funded insurance policies where employers directly handle employee claims.

The resolution represents a significant advancement in healthcare equity, though Aetna maintains its position of no wrongdoing in the settlement. Through these policy modifications, the company demonstrates its commitment to providing quality care regardless of sexual orientation or gender identity, setting a new standard for Aetna infertility coverage.