Aetna Life Insurance agreed to a $2 million class action settlement after allegations that its infertility coverage rules in New York effectively treated LGBTQ+ members differently when they sought fertility care such as intrauterine insemination (IUI) and in vitro fertilization (IVF). The suit focuses on the way many insurers historically defined “infertility” using heterosexual benchmarks—often requiring proof of unprotected intercourse over time before benefits apply—standards that can function as a barrier for same-sex couples and some transgender people who must use assisted reproduction from the outset. The settlement covers claims and precertification denials (or related approvals) during September 1, 2017 through May 31, 2024, with eligible class members potentially receiving payments (reported as up to $12,300) depending on their category and documentation. The lawsuit was filed because plaintiffs alleged discrimination based on sex, sexual orientation, and gender identity, arguing that Aetna’s administration of fertility benefits denied equal access to covered treatment for people in eligible LGBTQ+ relationships, pushing some to pay out of pocket or delay care. While Aetna did not admit wrongdoing, the case is significant because it pressures insurers to align benefit design and utilization management with nondiscrimination expectations, not just in policy language but in how claims are evaluated and what “proof” is demanded. It also highlights how administrative requirements—like prior denials, specific billing codes, or attestations—can determine whether patients can realistically use benefits that exist on paper. More broadly, the dispute fits into a wider wave of litigation and regulatory scrutiny over fertility coverage equity, where plaintiffs challenge “clinical infertility” definitions and prerequisites that disproportionately burden LGBTQ+ families. In the insurance industry, these cases intersect with New York insurance and health-plan rules, evolving medical standards for infertility treatment, and civil-rights protections that increasingly treat unequal access to covered reproductive healthcare as a form of unlawful discrimination, encouraging employers and insurers to revise plan terms, prior-authorization criteria, and claims workflows to avoid repeating the same disparities.