• Riley Bostwick

Blue Cross and Blue Shield Antitrust Litigation – Benefit Plan



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: TBD


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


Overview

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 is expected to have 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 are equal to the sum of premiums paid 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 premiums 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.


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Managed Care Advisory Group

3434 Granite Circle
Toledo, Ohio 43617

1-800-355-0466
info@mcaginc.com

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