THE BLUE CROSS BLUE SHIELD ANTITRUST SETTLEMENT
As you recall from our February 15, 2021 article we released on this subject, a settlement was reached with the Blue Cross Blue Shield Association over class action litigation alleging that the Blue Cross Blue Shield Association violated antitrust laws by limiting Blue Cross Blue Shield plans from competing with each other. It was alleged that the purported impact of these actions resulted in limiting healthcare market options, thereby increasing pricing. The parties worked out this settlement arrangement to avoid further litigation.
The settlement is composed of a monetary component as well as injunctive relief. The class eligible for monetary damages are 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. All capitalized terms are further defined within the Settlement Agreement. Those eligible to participate in the settlement are Individuals and groups who were Fully Insured from February 7, 2008 through October 16, 2020 (the “Settlement Class Period”), and groups (and their employees) who were Self-Funded from September 1, 2015 through October 16, 2020 (the “Self-Funded Settlement Class Period”). Dependents and beneficiaries (including minors) are not included in the Damages Class. “Government Accounts” are also excluded from the settlement. A “Government Account” includes state, county, municipal entities, or the federal government. Utilities, school districts, public libraries, transportation authorities, waste disposal districts, police departments, and fire departments are not included in the “Government Account” definition. If you have any questions regarding the definitions pertaining to the settlement, we will refer you to the settlement website or hotline listed below or to the FAQ website: https://www.bcbssettlement.com/faq.
The money remaining in the Settlement Fund after payment of attorneys’ fees, expenses, and the cost of providing the notice of the settlement and of administering the settlement is estimated to be approximately $1.9 billion, which will be distributed to Damages Class Members who submit valid and timely proof of claim forms. As for the amount each group and each individual could be entitled to if they elect to participate in the settlement, we cannot estimate how much money one might receive since the amount depends on how many participate in the settlement.
If you or your company believes it may have a claim, filing a claim can be completed either online via the following link https://secure.bcbssettlement.com/ or by submitting a paper form, which can be downloaded from the settlement website here https://tinyurl.com/dus3n4ht or obtained by calling Blue Cross Blue Shield at 1-888-681-1142. In addition, if you are concerned that your name may not be included in the records listing those eligible for the settlement and you want to make sure you receive notification, you can register by providing your email to the website maintained for this settlement https://www.bcbssettlement.com. Both employers and employees will receive notice of the settlement through a Court-approved notice program. The settlement and the court’s preliminary approval order do not obligate employers to notify employees of the settlement.
Those filing a claim for settlement proceeds will be asked to provide certain pieces of information, like your company name and the name of the particular Blue Cross Blue Shield plan you were enrolled in during the settlement timeframe. For example, Community Insurance Company dba Anthem Blue Cross Blue Shield (Ohio) is a common Blue Cross Blue Shield plan in Ohio. The claim form also asks for the group number and coverage dates. If you do not have such information, we have been told by Blue Cross Blue Shield that they have turned over the details they had on file regarding clients to the settlement administrator and that employers and individuals should fill out their claim form to the best of their ability and if additional information is needed, Blue Cross and Blue Shield may contact you. For questions about how to complete the claims form or about the settlement process, one can also email info@BCBSsettlement.com.
One of the questions on the claims form asks the percentage of the premiums the employer contributed each year. Those percentages are part of the calculation to determine how much each client will receive from the settlement. The group will have two options when it comes to supplying this information. They are the Default Option and the Alternative Option. If the Default Option is selected, the following percentages would be applied automatically. No proof of the actual percentage of the premiums paid will be required.
For Fully-Insured Plans, the Default Option assumes
Single Coverage – 85% Employer/15% Employee
Family Coverage – 66% Employer/34% Employee
For Self Funded Plans, the Default Option assumes
Single Coverage – 82% Employer/18% Employee
Family Coverage – 75% Employer/25% Employee
If you select the Alternative Option, then instead of using the percentages assigned under the Default Option listed above, the settlement will use the actual percentages of premiums that the employer and employees paid each year. But you will have to provide supporting documentation for each year proving those percentages, which may be challenging to gather. Therefore, unless the actual percentages you paid are much higher than the Default Option percentages or the total amount of the premiums each year is large, it may be simpler to select the Default Option to avoid the time and effort it will take to gather all the documentation required under the Alternative Option.
Several clients have been contacted by various outside entities offering to help them with the settlement process in exchange for a percentage of the settlement proceeds. While it is your choice how you would like to proceed, our experience has been that the settlement form is very straightforward, so you may try to fill it out yourself before you pay for assistance.
Link to Printable Claim Form: https://tinyurl.com/dus3n4ht
Blue Cross and Blue Shield hotline number: 1-888-681-1142
This article is for general informational purposes only. It does not necessarily address all specific issues and should not be construed as, nor is it intended to provide legal or accounting advice. Questions regarding specific issues and application of these rules can be directed to Blue Cross Blue Shield using the resources listed above or can be directed to your legal counsel.