• Sam Wares

Blue Cross and Blue Shield Antitrust Litigation – Benefit Plan / Subscriber



Settlement Fund: $2.67 billion ($1.78 billion fully-insured and $120 million self-funded)


Class Period: Fully Insured Groups is from February 7, 2008 through October 16, 2020; Self-Funded Accounts September 1, 2015 through October 16, 2020


Claim Filing Deadline: November 5, 2021


Defendants: Blue Cross Blue Shield Association (“BCBSA”) and Settling Individual Blue Plans


Overview

Preliminary approval of the settlement agreement was granted on November 30, 2020. The hearing for final approval is scheduled to occur on October 20, 2021.


The Plaintiffs allege that Settling Defendants violated antitrust laws by entering into an agreement where the Settling Defendants agreed not to compete with each other in selling health insurance and administration of Commercial Health Benefit Products in the United States and Puerto Rico, as well as agreeing to other means of limiting competition in the market for health insurance and administration of Commercial Health Benefit Products.

  • The settlement includes net proceeds (after covering legal and admin fees) of approximately $1.78 billion for eligible fully insured plans, and approximately $120 million for self-funded groups.

  • Claim values will be equal to the sum of premiums paid by Fully Insured Groups back to 2008, or administrative fees for Self-Funded Accounts back to 2015 for a Blue Cross or Blue Shield commercial health benefit product (medical, pharmaceutical, vision, and dental).

  • Payments from the settlement fund will be a pro rata share of the total premiums paid or administrative fees paid dependent upon the total value of all submitted claims amongst all eligible entities.

  • Both the group plan and individual subscribers can submit claims to receive compensation. Valid claims submitted by individual subscribers will decrease the amount paid to a group for its claim.

  • A valid and timely claim must be submitted by a group, or on its behalf by a third-party, to be eligible to receive compensation from the settlement—there are not any automatic payments.

Our service relieves groups of the potential burden of having to gather historical data pertaining to multiple plans spanning many years. Instead, you can activate our service by completing our enrollment form in just a few minutes to ensure that your organization capitalizes on this opportunity.


Eligibility

The Damages Class includes all Individuals, Insured Groups (and their employees), and Self-Funded Accounts (and their employees), that purchased, were covered by, or were enrolled in a Blue-Branded Commercial Health Benefit Product sold, underwritten, insured, administered, or issued by any Settling Individual Blue Plan during the respective class periods. The class period for the fully insured Individuals and Insured Groups (and their employees) is from February 7, 2008, through October 16, 2020 (“Settlement Class Period”). The class period for the Self-Funded Accounts (and their employees) is from September 1, 2015 through October 16, 2020 (“Self-Funded Settlement Class Period”). Dependents, beneficiaries (including minors), and non-employees are NOT included in the Damages Class.


Self-Funded Accounts encompass any account, employer, health benefit plan, ERISA plan, non-ERISA plan, or group, including all sponsors, administrators, fiduciaries, and Members thereof, that purchased, were covered by, participated in, or were enrolled in a Self-Funded Health Benefit Plan during the Self-Funded Settlement Class Period. A Self-Funded Health Benefit Plan is any Commercial Health Benefit Product other than Commercial Health Insurance, including administrative services only (“ASO”) contracts or accounts, administrative services contracts or accounts “ASC”), and jointly administered administrative services contracts or accounts (“JAA”).


For associational entities (e.g., trade associations, unions, etc.), the Self-Funded Account includes any member entity which was covered by, enrolled in, or included in the associational entity’s Blue- Branded Commercial Health Benefit Product. A Self-Funded Account that purchased a Blue-Branded Self-Funded

Health Benefit Plan and Blue-Branded stop-loss coverage remains a Self-Funded Account.


Excluded from the Damages Class are:

  • Government Accounts;

  • Medicare and Medicaid Accounts;

  • Settling Defendants themselves, and any parent or subsidiary of any Settling Defendant (and their covered or enrolled employees);

  • Individuals or entities that file an exclusion or opt out from the Settlement; and

  • The judge presiding over this matter, and any members of his judicial staff, to the extent such staff were covered by a Commercial Health Benefit Product not purchased by a Government Account during the Settlement Class Period.

The Injunctive Relief Class includes all Individuals, Insured Groups, Self-Funded Accounts, and Members that purchased, were covered by, or were enrolled in a Blue-Branded Commercial Health Benefit Product sold, underwritten, insured, administered, or issued by any Settling Individual Blue Plan during the applicable Settlement Class Period. Dependents, beneficiaries (including minors), and non-employees are included in the Injunctive Relief Class.


Injunctive relief provides benefits in addition to the $2.67 billion fund in the form of prospective benefits, which according to the judge who is overseeing the case, the settlement offers "forward-thinking, pro-competitive reforms that will change the nature of defendants' business moving forward".


Here are some details on the injunctive relief:

  • Elimination of the Blues’ national revenue cap on competition when they are not using the Blue names and marks;

  • Ability for certain Qualified National Accounts that could only seek one Blue bid to now seek bids from two Blue Plans;

  • Limits the Blue Cross Blue Shield Association’s restraints on acquisitions;

  • Provides guidelines to permit direct contracting between Non-Provider Vendors and Self-Funded Accounts;

  • Limits on use of Most Favored Nations Clauses and Differentials;

  • Five-Year Monitoring Period: For a period of five years from the court’s entry of Final Judgment and Order of Dismissal, a Monitoring Committee shall review new rules or regulations proposed by BCBSA and submitted to the Monitoring Committee, and shall mediate disputes related to the Injunctive Relief.

Need more information? Call MCAG at 1-800-355-0466 to learn more or CLICK HERE to complete our contact form and an MCAG representative will respond shortly.
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