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Aetna’s Pregnancy Coverage is Limited & Discriminative, Lawsuit Says

— September 22, 2021

Infertility procedures, family planning, and pregnancy are all difficult to cover with Aetna’s limited policy.

Aetna, an insurance company, has a policy that defines infertility as “not becoming pregnant after 12 months of unprotected heterosexual sex or 12 months of therapeutic donor insemination.”  Anything within a year prior to pregnancy, such as intrauterine insemination (IUI) treatments, are not included in its pregnancy coverage, according to the policy.  LQBTQ intercourse is also not covered, which has led many people to believe that the insurer’s program is discriminative.

Aetna’s infertility program also only allows for six months of trying to get pregnant if the person seeking to do so is 35 or older.  Then, Aetna’s plan will cover IUI and in vitro fertilization (IVF) treatments.  The convoluted pregnancy coverage process is not only difficult to understand during what should be a happy time for couples but it means that many individuals are unable to do much, if any, family planning in advance if they need financial assistance.

Aetna's Pregnancy Coverage is Limited & Discriminative, Lawsuit Says
Photo by Andre Furtado from Pexels

Any plan outside of Aetna’s restrictive pregnancy coverage window means large out-of-pocket costs to those trying to start families.  One employee, Emma Goidel, and her partner (who is of the same sex), were forced to go that route and paid an estimated $45,000.

“It really feels like a queer tax,” Goidel said.  She filed a lawsuit against Aetna in an attempt to recoup some of their costs as well as change the policy itself.  The suit, filed in the Southern District of New York this month, has reached class action status.  Noel León of the civil rights law firm Emery Celli Brinckerhoff Abady Ward & Maazel and the National Women’s Law Center filed it on her behalf and on behalf of others who have been met with unmanageable costs because of the restrictions.

The suit alleges “Aetna’s policy discriminates against LGBTQ policy-holders seeking fertility treatment.”  Moreover, it alleges the policy “violates both the New York State Human Rights Law and the New York City Human Rights Law.”

The filing contends Aetna’s policy violates the Affordable Care Act’s Section 1557, which prohibits discrimination in healthcare based on “race, color, national origin, sex, age or disability.” The Biden Administration announced in May that it would extend the section’s ban on sex-based discrimination to protect against discrimination on the basis of sexual orientation or gender identity.

León said the poicy “undermines the rights of queer people to form families in the way that they choose.  It has a disproportionate impact on those who are living with low incomes who are disproportionately people of color, people with disabilities, or people living with [other] marginalized identities.”

The complaint has identified at least 17 other Aetna student health plans in New York state that contain the same verbiage as that outlined in the infertility treatment program.

“These schools together enroll over 150,000 students in New York, including over 60,000 professional and graduate school students,” the complaint reads.  Goidel added, “Reproductive rights have to be more than just the right to end a pregnancy.  They have to include the right to begin a pregnancy.  No one should have to pay thousands of dollars to start a family.”

Aetna responded, “We learned of this suit only this morning and are still actively investigating the facts.  Aetna is committed to equal access to infertility coverage and reproductive health coverage for all its members, and we will continue to strive toward improving access to services for our entire membership.”


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Aetna sued over fertility treatment coverage for LGBTQ people

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