Millions of LGBTQ people across the U.S. could benefit from the settlement in a class action lawsuit against healthcare insurance giant Aetna, which had been improperly making LGBTQ policyholders pay more out of pocket than others for fertility services. It builds upon a previous settlement and offers nationwide enforcement.
The Case
California spouses Mara Berton and June Higginbotham had been trying to have a child via assisted reproduction. Their doctor recommended intrauterine insemination (IUI), and Berton sought coverage under her Aetna healthcare plan. She was denied, because under Aetna’s then-policy, there were only two ways to qualify for coverage of (in)fertility treatments: tell Aetna you’d been having frequent, unprotected sexual intercourse for 12 months (or 6 months if the person with the womb is over 35), or spend the same amount of time on intrauterine insemination (IUI) first, paid for out of pocket.
“I am unable to engage in ‘frequent, unprotected heterosexual sexual intercourse’ because I am a woman married to a woman,” Berton wrote in an appeal to the company, according to her complaint (PDF). She explained that the denial of coverage “violated federal law and was unethical.” Additionally, even six cycles of insemination is more than many doctors recommend before moving on to methods like in vitro fertilization (IVF), her complaint asserted.
Her appeal was denied, and the company claimed that “coverage for IUIs was not ‘medically necessary’ under the terms of Mara’s plan because she did not meet the Infertility Policy’s definition of ‘infertile.'”
Berton and Higginbotham therefore had to pay thousands of dollars out of pocket before they could access the same benefits that different-sex couples get simply by stating that they’ve been having regular, unprotected sex. This unequal treatment “caused great mental strain” that “exacerbates the physical and emotional toll of IUI itself, which is substantial,” said the complaint. In 2023, Berton filed a class action lawsuit, with the help of the National Women’s Law Center (NWLC) and law firms Katz Banks Kumin and Altshuler Berzon.
In May 2024, another queer mom, Emma Goidel, had reached a settlement in a similar class action case, on behalf of the 150,000 people covered by Aetna’s student health plans in New York. That settlement was given final approval on October 14, 2025. As part of that settlement, Aetna agreed to update its clinical policy to be consistent with new guidelines from the American Society for Reproductive Medicine (ASRM) (which I wrote about at length here), making the definition of “infertility” more inclusive of LGBTQ and single people who seek fertility healthcare.
The Settlement
Last week, the U.S. District Court for the Northern District of California preliminarily approved a settlement in Berton’s case. Under the settlement, Aetna agrees to provide assisted insemination benefits for all people in its plans nationwide. Those who meet the criteria for Advanced Reproductive Technology (ART), such as IVF, “will not be required to undergo additional cycles of artificial insemination before qualifying for ART coverage for subsequent pregnancy attempts.” And Aetna will implement policies “to ensure that Aetna’s medical directors can consider the limited availability of plan members’ chosen sperm for purposes of qualifying for IVF coverage, alongside other relevant clinical criteria.”
The NWLC, which assisted both Goidel and Berton, said that Berton’s settlement “strengthens and expands upon the policy changes achieved in the Goidel settlement and ensures that these changes can be legally enforced not just in New York and California, but nationwide.”
An estimated 2.8 million LGBTQ Aetna members across the country could benefit, according to CalMatters, which called this a “landmark” settlement and noted that it is “the first case requiring a health insurer to apply this policy nationally across all of its enrollees.”
In addition, eligible LGBTQ+ California residents who were, or would have been, denied coverage for artificial insemination under Aetna’s California commercial and student insurance plan can file for compensation. (Visit californiainfertilitysettlement.com for details.)
Berton and Higginbotham, now the mothers of twins, said in a statement:
We are thrilled with this victory for thousands of queer families. Our family helped us with the resources needed to bring our beautiful twin girls into the world, but we know that’s not an option for every queer couple. This court order ensures that queer families on Aetna plans will have access to their coverage for fertility treatments. Queer couples across the country on Aetna plans should know that if they decide to pursue fertility treatment to grow their families, they can now do so without unfair financial burden and sacrifice.
They added, “We sincerely hope other major insurance carriers will follow Aetna’s lead.”