Berton v Aetna Inc. & Aetna Life Insurance Co.
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF CALIFORNIA
Case No. 4:23-cv-01849-HSG
If you were an Aetna member in California in an LGBTQ+ relationship trying to get pregnant who couldn’t get benefits for IUI or ICI treatment between April 17, 2019 and December 31, 2024, you may be entitled to compensation.
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In 2023, Named Plaintiff Mara Berton filed a Complaint against Aetna Inc. & Aetna Life Insurance Co. (“Aetna”). Ms. Berton alleged, on behalf of herself and others similarly situated, that Aetna denied equal access to insurance coverage for infertility treatment to individuals in LGBTQ+ relationships. Ms. Berton claimed that Aetna’s policy was discriminatory to her and others like her seeking to get pregnant through artificial insemination. This is because under Aetna’s policy, she would have had to pay out-of-pocket to complete up to 12 cycles of artificial insemination (e.g., intrauterine insemination (IUI), intra-cervical insemination (ICI), or intravaginal insemination (IVI)) to qualify as “infertile” and receive fertility treatment coverage. By contrast, Ms. Berton alleged that people in straight relationships only had to say that they had 12 months of frequent intercourse to qualify as “infertile,” and did not have to pay out-of-pocket for infertility treatment.
Aetna denies that it did anything wrong. The Court did not make a final ruling in favor of either Ms. Berton or Aetna.
The following classes of individuals have been certified by the Court to participate. The Class Period is between April 17, 2019 and December 31, 2024. The classes of individuals and are defined as:
1. Category A Class Members, comprising California residents who the Parties agree sought and were denied coverage for IUI or ICI due to the Definition of Infertility during the Class Period and whose Aetna records suggest they were individuals with uteruses in an Eligible LGBTQ+ Relationship during the Class Period;
2. Category B Class Members, comprising California residents who the Parties agree sought and were denied coverage for IUI or ICI due to the Definition of Infertility during the Class Period, and who submit an attestation certifying that they were individuals with uteruses in an Eligible LGBTQ+ Relationship at the time they sought coverage (the “Attestation”);
3. Category C Class Members, comprising California residents who submit an Attestation, were members of an Aetna plan during the Class Period, and provide evidence of out-of-pocket expenses for IUI or ICI services received that would have been covered by their Aetna plan; and
4. Category D Class Members, comprising California residents who sought coverage for IUI or ICI during the Class Period that was denied, then followed by an approval within 90 days or otherwise paid by Aetna, and who meet the following:
Category D-A is made up of individuals whose Aetna records indicate were individuals with uteruses in an Eligible LGBTQ+ Relationship during the Class Period and who provide evidence of out-of-pocket expenses for artificial insemination services received that would have been covered by their Aetna plan, but have not yet been paid;
Category D-B is made up of individuals who submit an Attestation and who provide evidence of out-of-pocket expenses for artificial insemination services received that would have been covered by their Aetna plan, but have not yet been paid.
Under settlement terms, if the settlement receives final court approval, Aetna will compensate members of the affected class as follows:
• If there are 175 or fewer Class Members, Aetna has agreed to pay all eligible Class Members a “Default Monetary Payment” of $10,000. But if there are more than 175 Class Members, Class Members will equally split a $1,750,000 Settlement Fund and will receive less than $10,000.
• Aetna has agreed to separately pay Class Members for what their plan would have paid to providers for artificial insemination if Aetna’s allegedly discriminatory policy had not been applied to them, unless those claims were previously paid.
• Aetna has agreed to create a “Special Harms Common Fund” in the amount of $250,000 for Class Members who submit proof of additional costs or harms. Any funds remaining in the Special Harms Common Fund after those claims are determined will be split equally among Class Members who cashed their first checks. Claims made on this fund will be decided by an independent third party, retired United States Magistrate Judge, Steven Gold.