Aetna Agrees to National Settlement Covering IVF for Same-Sex Couples

Many young women, like Mara Berton and June Higginbotham, grew up yearning to start families and become mothers. However, as a lesbian couple, they found themselves excluded from receiving the same fertility treatment coverage that was available to their heterosexual counterparts.

Living in California, Berton and Higginbotham faced the challenge of paying $45,000 out of their own pockets for fertility treatments, while their heterosexual colleagues covered by the same insurance plan incurred fewer expenses due to insurance coverage.

In an exclusive discussion with CalMatters, Berton explained her motivation behind joining a lawsuit to challenge Aetna's policies. She expressed a deep commitment to ensuring that other couples wouldn't have to endure the same hurdles. 'We're fighting for family creation,' she emphasized.

Recently, a significant ruling was made by U.S. District Judge Haywood Gilliam Jr. This landmark preliminary agreement in a class action case compels Aetna to extend fertility treatment coverage to same-sex couples, equating their benefits with those of heterosexual couples. This is the first instance of such a nationwide requirement being imposed on a health insurer, potentially benefiting 2.8 million LGBTQ members, including 91,000 Californians.

As part of the settlement, Aetna has agreed to allocate at least $2 million in damages to members residing in California who meet certain criteria. Eligible individuals must file claims by June 29, 2026.

Alison Tanner, a senior litigation counsel with the National Women's Law Center, expressed optimism that Aetna's policy change sets a precedent. 'This is about rectifying an inequality,' Tanner stated, noting that same-sex couples had previously been treated unjustly.

A new law coming into effect in January will require approximately 9 million more Californians to receive fertility benefits, modifying the term 'infertility' to encompass both same-sex couples and single individuals.

Before the settlement, Aetna's criteria forced enrollees to attempt a period of unprotected heterosexual relations without conception to qualify for fertility benefits. According to the lawsuit, women without male partners faced obstacles, needing to undergo numerous artificial insemination cycles before accessing these benefits.

The attorneys argued that Aetna's former policy systematically marginalized LGBTQ enrollees, denying them access to financially burdensome fertility treatments.

Phillip Blando, an Aetna spokesperson, reiterated the company's pledge to equality in reproductive health coverage. 'Aetna is dedicated to ensuring fair access to infertility and reproductive health services,' Blando declared.

As the main plaintiff, Berton described feeling shocked when Aetna agents informed her she did not fit their definition of infertility. Despite multiple appeals, she faced rejection, an experience her wife, Higginbotham, found 'dehumanizing.'

The couple was instructed to undergo extensive artificial insemination rounds contrary to medical advice which suggested fewer attempts. Experts like Sean Tipton have criticized such policies for discouraging beneficiaries from testing their entitlements.

Advancements in medical definitions now encompass LGBTQ individuals and single parents under the umbrella of infertility, aimed at preventing denial of insurance claims similar to those Berton faced. This change prompted a broader adoption of fertility coverage inclusive policies.

Concerns over limited donor sperm availability, especially matching Higginbotham's Jewish and Native American background, were another hurdle. 'Insurance shouldn't dictate these personal choices,' Berton asserted.

With support from family, the couple decided to proceed with treatments independent of coverage. After several unsuccessful insemination attempts, they transitioned to IVF, improving the odds of using their selected donor.

The couple faced emotional and physical strains during the process, resulting in hormone therapy, egg retrievals, and a miscarriage. Despite the difficult journey, they now have twin daughters who fill their lives with joy.

Although their personal journey was complete before the lawsuit resolution, Higginbotham hopes this agreement can pave the way for other LGBTQ couples to achieve their family goals.

The settlement represents a major advancement in pivotal reproductive rights. Higginbotham remarked on its significance as a corrective measure, ensuring a fairer path forward for others who wish to expand their families but face financial and policy barriers.