Aetna Fertility Discrimination Settlement: $2M

• Aetna members who had a claim or precertification request for artificial insemination or in vitro fertilization (IVF) denied between Sept. 1, 2017, and May 31, 2024.
  
  
• Class members are divided into four categories based on their eligibility and Aetna’s records.

Class members seeking additional compensation must provide documentation, including:

• Billing records for fertility treatments
• Medical records confirming services and expenses
• Denial letters from Aetna
• Other documentation of out-of-pocket costs or harm

Aetna has agreed to a settlement resolving claims that its insurance policies discriminated against LGBTQ+ individuals by making it financially burdensome for same-sex couples to access fertility treatments.

According to the lawsuit, Aetna’s fertility coverage requirements disproportionately affected LGBTQ+ couples by enforcing coverage rules that were easier to meet for heterosexual couples. Plaintiffs argued that Aetna’s policy violated New York anti-discrimination laws by requiring individuals to prove infertility through unprotected heterosexual intercourse before approving coverage for treatments like artificial insemination and IVF.

As a result, same-sex couples allegedly had to pay out of pocket for procedures that should have been covered under their health insurance plans.

Aetna, one of the largest health insurance providers, denies any wrongdoing but agreed to settle the case to avoid prolonged litigation.

Under the Terms of the Settlement

• Eligible class members will receive a default payment of $10,000.
• Class members may receive an additional $2,300 if Aetna failed to reimburse expenses for artificial insemination treatments that should have been covered.
• Total estimated payments may reach $12,300, though payments may be reduced if there are more than 200 claimants.

Class members are divided into four categories:

• Category A: Aetna’s records confirm the claimant was in an eligible LGBTQ+ relationship. These members do not need to file a claim to receive settlement payments.
  
  
• Category B: Aetna does not have enough information to confirm eligibility. These individuals must submit an attestation form to qualify for settlement payments.
  
  
• Category C: Includes individuals whose eligibility is unclear or who underwent artificial insemination but did not submit claims during the class period. These members must submit both an attestation form and a claim form.
  
  
• Category D: Includes members whose initial denial was later reversed by Aetna. These individuals must submit both an attestation form and a claim form.

Additional Compensation Options:

• Out-of-Pocket Expenses. Class members may request additional compensation for medical costs they incurred due to Aetna’s denial of infertility treatment coverage.
  
  
• Miscellaneous Harm Payments. Class members who experienced other harm, such as financial hardship or emotional distress, may submit a claim for additional damages.
  
  
• Proof of Greater Covered Care. Individuals who received more treatment than what Aetna reimbursed can submit documentation for further compensation.

Plaintiffs argue that Aetna’s fertility coverage policies unfairly restricted access to reproductive healthcare for same-sex couples. This settlement aims to compensate individuals who faced financial burdens due to these policies while requiring Aetna to make changes to its coverage practices.