Pregnant workers in the LGBTQ+ community often encounter greater barriers than their cisgender or heterosexual counterparts, particularly when accessing company-sponsored health insurance. The challenges for pregnant workers are especially prevalent in obtaining fertility care, such as intrauterine insemination (IUI) and in vitro fertilization (IVF). Section 1557 of the Affordable Care Act prohibits sex discrimination in any federally funded health program, and a growing body of federal litigation now applies that prohibition to insurer-administered fertility benefits that exclude LGBTQ+ workers. Presently, 18 states and Washington, D.C. have infertility insurance laws, with requirements ranging from mandating private insurers to cover fertility treatments to merely offering coverage, which employers may choose not to select (MAP – Movement Advancement Project, “Fertility Healthcare Coverage”). Of these, six states and Washington, D.C. have language that is explicitly inclusive of LGBTQ+ people, while three states have language that may exclude LGBTQ+ people or couples. Where this coverage is not offered or is exclusionary, LGBTQ+ people must spend thousands of dollars for fertility care, while it may be guaranteed for other individuals. Today, 53% of LGBTQ+ adults live in states with no private-insurer fertility mandate, and a single IVF cycle can exceed $18,000 out-of-pocket.

Legal Framework: Section 1557 of the Affordable Care Act

Section 1557 of the Affordable Care Act protects individuals from sex discrimination in any health program or activity that receives any funding from the Department of Health and Human Services. It specifies that in terms of sex discrimination, an individual’s sex, including pregnancy, childbirth, and related medical conditions are protected. In turn, many claims challenging health insurance’s fertility policies invoke Section 1557 to argue that definitions of infertility or proof requirements that exclude same-sex couples constitute unlawful discrimination. Recently, the Ninth Circuit held that Section 1557 of the Affordable Care Act applies to an insurer if any part of the entity receives federal funds, even when the specific health plans at issue are not federally funded, though whether the insurer is ultimately liable under that section is a fact-specific inquiry. Pritchard v. Blue Cross Blue Shield of Illinois, No. 23-4331, slip op. (9th Cir. Nov. 17, 2025). Specifically, how insurers can be held liable in the context of fertility care to LGBTQ+ employees remains to be tested.

Case Study: Kulwicki v. Aetna Life Insurance Company

In 2022, a lesbian registered nurse, Tara Kulwicki, filed a complaint alleging that the medical plan offered by her employer, Wellstar Health System Inc. and Wellstar Cobb Hospital Inc., and administered by Aetna, Inc. and Aetna Life Insurance Company imposed discriminatory barriers on homosexual couples to seeking access fertility care. Under Kulwicki’s medical plan, fertility treatment such as intrauterine insemination (IUI) and in vitro fertilization (IVF) is covered only for couples who can meet the plan’s definition of “infertile.”

The medical plan’s definition for “infertile” is as follows: “For a woman who is under 35 years of age: 1 year or more of timed, unprotected coitus, or 12 cycles of artificial insemination; or [f]or a woman who is 35 years of age or older: 6 months or more of timed, unprotected coitus, or 6 cycles of artificial insemination. For heterosexual couples, infertility could be established by showing that six to twelve months of unprotected sex without contraception did not result in a pregnancy. The plan, however, defines “unprotected sex” as exclusively sexual intercourse between a man and woman. This definition effectively excludes homosexual couples as they do not have the capacity to become pregnant through unprotected sex with their partner. If couples are unable to prove they meet the definition, as in Kulwicki’s case, they are forced to pay high out-of-pocket costs, often totaling thousands of dollars, for IUI and IVF treatments before they qualify for coverage.

In Kulwicki’s case, Section 1557 is used as the basis for the claim. Kulwicki alleged Aetna administered Wellstar’s plan, denied her IUI precertification for not meeting “infertility,” and that the plan and Aetna’s policy tied infertility to unprotected heterosexual intercourse or multiple insemination cycles, resulting in out-of-pocket costs for non-heterosexual women.

The United States District Court for the District of Connecticut later denied Aetna’s renewed motion to dismiss for failure to join Wellstar, holding Aetna could face Section 1557 liability for its own role and that damages could provide complete relief without Wellstar.  Most recently, on September 24, 2025, the court denied Aetna’s motion for partial summary judgment, finding factual disputes about Aetna’s collaborative role in shaping the plan language and its reserved contractual rights to align plan terms with Aetna systems, policies, and governing law. As a result, Tara Kulwicki’s class action will continue against Aetna. The court noted Aetna’s active role in shaping the plan’s infertility definition and retaining authority to ensure terms aligned with its systems, policies, and governing law.

Comparative Cases: Echoes of Kulwicki

Courts addressing similar infertility definitions have allowed claims to proceed where LGBTQ+ members face cost or proof burdens not imposed on heterosexual couples.

In Berton v. Aetna Inc. et al. (4:23-cv-01849, 2023), Mara Berton filed a suit against Aetna in violation of the Affordable Care Act after her insurance denied coverage for fertility treatment. This case raises question of first impression as to the “burden of proof” required to demonstrate infertility. In this case, the court denied Aetna’s motion to dismiss a Section 1557 claim where the plan formerly required “frequent, unprotected heterosexual sexual intercourse” or donor insemination cycles, and postJanuary 2023 language still required “eggsperm contact,” allowing heterosexual couples to attest through intercourse while same-sex couples had to incur costs for donor insemination cycles. The court found these allegations plausibly facially discriminatory. The court also rejected Rule 12(b)(7) arguments, concluding complete relief through damages could be afforded without joining the employer plan sponsor.

In Murphy v. Health Care Service Corporation (Blue Cross Blue Shield of Illinois) (No. 22-cv-2656, 2023), the court denied a motion to dismiss, holding that even under a 2020 policy listing multiple infertility pathways, the definition of “unprotected sexual intercourse” as malefemale intercourse left similarly situated samesex participants with no costfree route to establish infertility, plausibly alleging intentional discrimination under Section 1557 standards. 

Two parallel actions against Aetna have already produced settlements that reshape the landscape. In Goidel v. Aetna Life Insurance Co., No. 1:21-cv-07619 (S.D.N.Y.), the court granted final approval on October 14, 2025 of a class settlement that aligned Aetna’s infertility definition with American Society for Reproductive Medicine guidelines and made intrauterine insemination a standard medical benefit. Weeks later, in Berton v. Aetna Inc., No. 4:23-cv-01849 (N.D. Cal.), the Northern District of California preliminarily approved a settlement under which most eligible class members who submit a qualifying claim will receive approximately $11,000 in compensation, with claims due by June 29, 2026.

Conclusion

Recent litigation underscores that insurers cannot avoid responsibility where they actively shape, interpret, or administer plan terms that disadvantage LGBTQ+ patients, including fertility coverage definitions and proof requirements. Section 1557 of the Affordable Care Act applies to health programs or activities receiving federal funding, and courts have allowed claims to proceed where infertility definitions or evidentiary burdens effectively exclude same-sex couples. The court in Kulwicki allowed a class action to proceed based on allegations that the insurer administered a plan tying “infertility” to unprotected heterosexual intercourse or multiple insemination cycles and played an active, collaborative role in shaping infertility language while reserving contractual rights to align plan terms with its policies. Other courts have similarly denied motions to dismiss Section 1557 claims where plans with definitions of “unprotected sexual intercourse” limited to male-female intercourse, leaving same-sex participants with no cost-free route to establish infertility. Taken together, courts are scrutinizing not only employers’ selection of plans but also insurers’ roles in designing and administering plan terms that may impose discriminatory barriers.

Employers should be proactive in counteracting harmful policies by incorporating specific protective language into their company policies and providing robust support systems for their transgender, nonbinary, and intersex employees. Employees who suspect their plan’s infertility definition imposes additional cost or proof burdens on same-sex couples should preserve all denial letters, plan booklets, and out-of-pocket receipts, and consult counsel promptly.

Isabelle Megosh, Lily Miller, and Ting Cheung are with Sanford Heisler Sharp McKnight, a national civil rights and employment law firm that represents employees in discrimination, harassment, and benefits-related litigation.

I understand why some will say I shouldn’t be so negative about a candidate. But the reality is, Suzanne Goode is one person who deserves the negativity. She has shown herself to walk with MAGA Republicans, and that is not the vibe conducive to the welcoming place Rehoboth is today. While I believe there may be a change coming to the country in the mid-term congressional elections, we still see our lives impacted by local mayors, and town commissions, as much as by Congress. 

Goode has been a commissioner for two years. Fellow commissioners find her difficult to work with. It isn’t just that she doesn’t agree with them, often on the losing end of 6-1 votes, but she has shown herself to be nasty and insulting to the people she was elected to work with, including city employees. 

She has shown she has no real respect for the business community, or for that matter, the truth. She has said of Rehoboth, “They really are in trouble. I never expected to get involved, but once I saw how dysfunctional everything was, that’s what inspired me.” Well Rehoboth is neither in trouble, nor dysfunctional. She lies suggesting Rehoboth is on the brink of bankruptcy, while the truth is, there will be a budget surplus at the end of this budget year, and projected surpluses through 2030. She claims she supports the LGBTQ community but then speaks out in ways that show she really doesn’t. Things like objecting to rainbow crosswalks. I figure that is something she got from Florida Gov. Ron DeSantis, whom she has supported. She said, “Unfortunately, the rainbow crosswalks have potentially reduced the upkeep of conventional crosswalks.” That is not the person we want as mayor of Rehoboth who would oppose spending the very few dollars to maintain the rainbow crosswalks. 

She pretends to be more in tune with the community by cleaning up her Facebook page. At one time it showed support for DeSantis, and attacks on Hillary Clinton, President Barack Obama, and the ACA. Sounds very similar to the felon in the White House.

I love Rehoboth Beach. Today it is a place where everyone is welcome. A place where everyone can live in harmony. Where young people from around the world are welcomed for summer jobs, and residents and visitors enjoy learning from them about their lives, and cultures. 

Those of you who are older will remember that wasn’t always the case. When I first visited in 1984, I heard the stories about incidents occurring when Joyce Felton and Victor Pisapia opened the Blue Moon, in 1981. Some locals would drive by the patio on Baltimore Avenue, throw eggs, and shout insults at those standing there. People were being beat up on the boardwalk for just being who they were. These, and other incidents, are why Murray Archibald and Steve Elkins co-founded CAMP Rehoboth, the LGBTQ community center. They, supporters, and dedicated volunteers, along with some commissioners, and a supportive police chief, worked hard to make Rehoboth what it is today: A safe and welcoming place for all. CAMP trained police officers to work with those that may be different from themselves. They worked to change Delaware laws. They made it comfortable for members of the LGBTQ community to open businesses here, to move here, and live in a place that not only respected them, but wanted them. 

Rehoboth has come too far to elect someone who could take the city backwards. Someone who tried to get her husband elected to the Commission to get another vote. Someone who will try to do it again if she is elected mayor. That is not what Rehoboth is about. People here are better than that. I hope the people of Rehoboth are smarter than that. While we can always disagree on some things, that is only natural, we must do it both honestly, and respectfully. It is unfortunate that Goode does neither.  

Suzanne Goode does not in any way live up to her name. Suzanne Goode is really not good for Rehoboth. There are four candidates running for mayor, and they could split the vote enough to let her win. So, I suggest to the voters, coalesce around the person who appears to have the most support at the moment, Susan Stewart, and cast a ballot for her. She will make a positive difference for the city. Electing Stewart as mayor is the way to ensure the Rehoboth Beach we love, will continue to be a wonderful place for all to work, live, and visit, for years to come. Voting takes place on Saturday, Aug. 8, from 10 a.m.-6 p.m. at the Rehoboth Beach Convention Center. 

Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.

Everyone has now had more than a month to recover from Pride 2026. Even for those who have not yet put away all their seasonal rainbow paraphernalia or are still finding glitter in unexpected places, June is now a memory; hence, community members and allies have work to do.

The LGBTQ community of Washington, D.C., and the DMV region, is not defined (or limited) by any specific month, annual event, or organization. There is no singular agenda, arbiter, or leader. Considering the efficacy of some organizations and the competency and integrity of certain individuals, that is a good thing. This creates more opportunities for more people.

June is Pride month, but some LGBTQ celebrations in D.C. happen annually in May. Others, including several in Maryland and Virginia, occur on dates in July through October. Regardless of scheduling, the planning process begins (or at least should begin) immediately following the current year’s festivities. With the end of the fiscal year rapidly approaching, time is of the essence. It behooves organizers not to wait until January or the spring to secure funding.

Money is one thing all nonprofits and community organizations need, especially those without corporate sponsorship. A donation or sponsorship of any amount can make the biggest impact if the recipient is a new or smaller organization. Also, be intentional with your spending; patronize LGBTQ businesses, purchase tickets to LGBTQ events, and subscribe to or advertise with LGBTQ media. If organizing events, book local LGBTQ performers, DJs, and hosts/emcees, and offer free resource tables to organizations when you can.

Donating your time and talents can also be impactful, especially to organizations without salaried staff. Some LGBTQ organizations need people for events, and others need help with data entry or miscellaneous administrative tasks. Outdoors, indoors, or online, you can help with something that limited staff or volunteers have put on the proverbial back burner, such as updating graphics or a website. If you seek a leadership role, there are often opportunities to become a board member of a local LGBTQ organization. At the very least, make an effort to like and share information about events, fundraising, and calls for volunteers on social media.

For some people, looking beyond LGBTQ organizations may be a good use of their time and energy. Help create the inclusion that may be missing from “mainstream” organizations. With this being an important election year, registering voters, working at a polling location, or supporting a candidate might be the best use of your time for the next several months.

Whatever inquiries you make, don’t expect immediate responses, immense gratitude, or an enthusiastic welcome. (Unless you contact Team Rayceen Productions; I try to provide all three.) Many organizations have poor communication, often because of personnel limitations or inquiry volume, so your email or DM may not be answered quickly, or at all. Some “groups” are essentially run by an individual, so be patient and, when necessary, persistent.

That leads to something else very important to consider: whether an organization is worthy of your time, talents, and/or money.

Reviewing a website and reading a mission statement is a good start, but that is just a starting point. What is their reputation? What have they accomplished? Do they put their resources to good use?

If they are a tax-exempt organization, information such as their revenue and executive compensation is available on the ProPublica Nonprofit Explorer website. The Charity Navigator website provides additional data and tools. However, the most helpful information may come from members of the community.

Unfortunately, some individuals use their positions to enrich themselves. One such person sits in prison today. Despite receiving numerous accolades and positive media coverage, many people had an idea that something was amiss long before charges were filed. Not that embezzlement, fraud, or other shenanigans are commonplace, but it certainly happens. Look out for red flags. Be leery if asked to sign a non-disclosure agreement. Remove yourself from uncomfortable or inappropriate situations. Report inconsistencies, irregularities, and unethical behavior. Demand transparency and accountability. Don’t let your interest in helping your community lead to your reputation being sullied by association.

If you are unable to find an organization you want to support, consider starting your own. Create whatever it is you cannot find. Start small; your focus could be helping people in need, organizing community events, or forming an activity group. You could create programming for LGBTQ History Month in October. If you want a new Pride month event in your county, town, or neighborhood, start planning now. (Shameless Plug: Rayceen Pendarvis, Empress of Pride, is available for booking.)

Pride should be more than parties and parades, but I hope those things motivate people to be more involved in their communities. The LGBTQ community and its members exist 12 months a year. Whatever your schedule and capacity may be, there is probably something you can do to help.

 Zar is a mononymous D.C.-based LGBTQ community advocate, speechwriter, and songwriter who co-founded and served as creative director for Team Rayceen Productions.