Q: I received notice of a class action settlement from BCBSM. It states that it is being sent pursuant to an order of the U.S. District Court in Alabama. What, if anything, do I stand to get from this settlement? Does the settlement contain any changes to the way the TRUST or other networks are administered?
You received this notice if, according to BCBSM’s records, you are an individual, insured group health plan or self-funded health plan (the “Class Members”) that purchased (or paid a portion of the premiums for) health insurance from BCBSM between February 7, 2008 and October 16, 2020 (the “Claim Period”).
The lawsuit that resulted in this settlement has been pending in an Alabama Federal District Court for several years. The plaintiffs alleged that the Blue Cross Blue Shield Association (BCBSA) and most state Blue Cross Blue Shield plans (including BCBSM) entered into agreements and followed certain business practices that violated the antitrust laws and that these illegal agreements/practices resulted in health insurance premiums being higher than they would have been in their absence. As part of this settlement, $2.67 billion is to be paid into a fund. Part of this fund (estimated to be $1.9 billion) will be used to make refunds to the Class Members who paid the allegedly inflated premiums. The notice you received instructs you to complete a claim form to participate in the settlement and receive a payment. When the payment will be made and how much it will be are unknown at this time.
You must submit a claim form prior to November 5, 2021 to be eligible for any payment from this settlement. The claim form is available at: https://www.bcbssettlement.com/documents. The claim form consists of three sections. Which section you complete depends on the capacity in which you are providing the information. If you are providing the information on behalf of your medical practice which paid the premiums, in whole or in part, for BCBS coverage for your employees during the Claim Period you should complete Section A on behalf of the practice. If you individually paid the premiums for your own BCBS coverage during the Claim Period you should complete Section B. If you were enrolled in a health insurance plan sponsored by your employer and paid a portion of the premiums during the Claim Period you should complete Section C.
The information requested in each section form the claim form is consistent and fairly straight forward (e.g. your name, employer’s name, addresses, phone number, email address, name of the plan, coverage dates, etc.).
For those individuals who paid part of the premium for coverage provided by an employer sponsored plan, the settlement amount will be allocated between you and your employer. The settlement agreement provides that 15% (if a fully insured plan) or 18% (for administrative plans) of the settlement amount will be allocated to employees who had single coverage and employees who had family coverage will be allocated 34% (if a fully insured plan) or 25% (if an administrative plan). These are default allocations. If you believe another allocation should be applied, you must complete section D of the claim form. Only if you do not want to follow the default allocations and are completing section D of the claim form will you have to specify the premium amounts you have paid. Section D requires you to include an alternate percentage and documentation supporting it. This documentation should include proof you paid premiums more than the default percentage.
The Settlement Agreement contains other requirements that BCBSA, BCBSM and the other settling Blue Plans no longer enforce certain provisions in their licensing and other agreements and cease certain other business practices. However, none of these requirements directly affect the enforcement or administration of network participation agreements with physicians or other providers of health care services.
Daniel J. Schulte, JD, MSMS Legal Counsel is a member and managing partner of Kerr Russell.