Blue Cross Blue Shield Antitrust Settlement



You may be eligible to receive a cash payment from the $2.67 Billion recovered in this Class Action Settlement if you are an Insured Group or Self-Funded Account that purchased a Blue Cross or Blue Shield (BCBS) health insurance or administrative services plan between February 7th, 2008, and October 16th, 2020.



Settlement Amount: $2,670,000,000



Class Period:



  • Fully Insured Individuals and Insured Groups: February 7, 2008, through October 16, 2020
  • Self-Funded Accounts: September 1, 2015 through October 16, 2020


Class Members:



Insured Groups and Administered, Self-Funded Accounts including but not limited to Employers, Unions, Trade Groups and Associations 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.


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 Settlement are:

  • Stand-alone Blue-Branded vison or dental plans
  • Government Accounts
  • Medicare and Medicaid Accounts
  • Dependents, beneficiaries (including minors), and non-employees
  • Settling Defendants themselves, and any parent or subsidiary of any Settling Defendant (and their covered or enrolled employees)


settlement breakdown



fully insured groups




$1.78 Billion





Class Period

02/07/2008 to 10/16/2020





self-funded groups




$120 Million





Class Period

09/01/2015 to 10/16/2020



Default premium allocations



If both the Employer and Employee submit a claim.
If an Employee does not submit a claim 100% will be allocated to Employer.



Single Coverage

85% to Employer / 15% to Employee


Family Coverage

66% to Employer / 34% to Employee



Single Coverage

82% to Employer / 18% to Employee


Family Coverage

75% to Employer / 25% to Employee




Definitions:



  • “Insured Group” means a health benefit plan, group account, or employer, including all Members, sponsors, administrators, and fiduciaries thereof, that purchases, subscribes to, or is covered by Commercial Health Insurance. For associational entities (e.g., trade associations, unions, etc.), this includes any member entity which is covered by, enrolled in, or included in the associational entity’s Blue-Branded Commercial Health Benefit Product. For clarity, this definition excludes all Government Accounts.“Blue-Branded” means a product or service marketed, offered, or sold under any of the Blue Cross and/or Blue Shield service marks, trademarks, names, and/or symbols.
  • “Commercial Health Benefit Product” means any product or plan providing for the payment or administration of health care services (including but not limited to medical, pharmacy, dental, and vision products and services) or expenses through insurance, reimbursement, or other similar healthcare financing mechanism, for Members in the U.S. (however funded, including insured or self-funded). Excluded from this are products or plans offered under the:
    • Children with Special Health Care Needs Program (CSHCN) Children’s Health Insurance Program (CHIP)
    • Civilian Health and Medical Program of the Department of Veteran’s Affairs (CHAMPVA) Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)
    • Indian Health Service, Tribal, and Urban Indian Health Plan
    • Medicaid Medicare Medicare Advantage (including but not limited to Medicare Advantage Prescription Drug Plans and Special Needs Plans, including but not limited to Medicare-Medicaid or Dual-Eligible Plans) Medicare Stand-Alone Prescription Drug Plans
    • Refugee Medical Assistance Program
    • State Maternal and Child Health Program (MCH) or TriCare.
    • For purposes of clarity, it excludes any product or plan purchased or offered by a Government Account.


Deadlines:



  • Fairness Hearing: October 20-21, 2021
  • Claim Filing Deadline: November 5, 2021


Background:



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 related 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.


Settling Defendants deny all allegations of wrongdoing and assert their conduct results in lower healthcare costs and greater access to care for their customers. The Court has not decided who is right or wrong. Instead, Plaintiffs and Settling Defendants agreed to a Settlement to avoid the risk and cost of further litigation. This Settlement is subject to approval by the court and may be subject to modification prior to approval, and any appeals may also modify the terms of the Settlement. ​



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This is not an official Court Notice. Information contained in this Summary is subject to change.



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