George et al. v. CNH Health & Welfare Benefit Plan et al.

www.CNHPlanSettlement.com


Frequently Asked Questions

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1. WHY DID I RECEIVE THE NOTICE?

Important Update: On May 18, 2018, the Court issued a Final Order approving the Settlement. Checks reflecting financial payments under the terms and conditions of the Settlement were mailed to Settlement Class Members or their designated payees on August 10, 2018.

The Notice was sent to you pursuant to an Order of the United States District Court for the Eastern District of Wisconsin (the “Court”) because our records show you or someone in your family received medical services between August 1, 2010, and September 20, 2017, from an Out-of-Network Provider that were reimbursed by the CNH Plan at amounts less than the provider’s billed charges. The judge presiding over this case is the Honorable J.P. Stadtmueller, United States District Judge.

The Court directed us to send you the Notice because, as a potential Class Member, you had a right to know about your options and how a class action lawsuit may generally affect your legal rights before the Court ruled on the proposed settlement of this case. In accordance with the Court’s Final Order, the claims administrator approved by the Court has made payments to everyone who has a valid claim under the terms and conditions of the Settlement Agreement.

The Notice explains the Litigation, the Settlement, your legal rights, what benefits are available, who may be eligible for them, and how to receive them. The purpose of the Notice is to inform you of this case, that it is a putative class action, how you might be affected, and how to exclude yourself (i.e. “Opt-Out”) from the Class if you wish to do so. It is also being sent to inform you of the terms of the proposed Settlement, and of a hearing to be held by the Court to consider the fairness, reasonableness, and adequacy of the proposed Settlement, and the application by Class Counsel for attorneys’ fees and reimbursement of expenses (the “Final Settlement Hearing”).

The Final Settlement Hearing was held on May 4, 2018, at 8:30 a.m., at the United States Courthouse, United States District for the Eastern District of Wisconsin, 517 East Wisconsin Avenue, Courtroom 425, Milwaukee, Wisconsin 53202.

On May 18, 2018, the Court issued a Final Order approving the Settlement. Distribution of the Settlement Fund occurred on August 10, 2018.

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2. WHAT IS A CLASS ACTION?

In a class action lawsuit, under the federal rules, one or more people, called class representatives, sue on behalf of others with similar legal claims. All of these people together are called a class or class members. In a class action, one court resolves the issues for all class members, except for those who specifically ask to be excluded from the class, thus providing the class members with both consistency and efficiency. When the class representatives reach a proposed settlement with the defendants in a class action, the proposed settlement must be approved by the court, after court-approved notice is provided to potential class members and the court holds a hearing, which class members can attend, to determine, among other things, that the settlement is fair, reasonable, adequate and in the best interests of the class.

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3. WHAT IS THIS LITIGATION ABOUT?

On December 19, 2016, this putative class action, under the case caption George et al. v. CNH Health & Welfare Benefit Plan et al., was filed in the United States District Court for the Eastern District of Wisconsin, Case No. 2:16-cv-01678-JPS (the “Litigation”).

The Plaintiffs in this Litigation are Brenten George and Denise Valente-McGee, on behalf of themselves and other participants or beneficiaries of the CNH Plan. The Defendants in this Litigation are the CNH Plan, CNH and Anthem. The Plaintiffs and Defendants in this Litigation are collectively referred to as the “Parties.”

On March 3, 2017, the Plaintiffs filed an Amended Class Action Complaint (“Complaint”), which alleges, among other things, that Defendants underpaid claims for medical services rendered by Out-Of-Network Providers, i.e., physicians and other healthcare practitioners who at the time of the service did not participate in the participating provider network(s) under the terms and conditions of the CNH Plan. Plaintiffs challenge Defendants’ use of a Medicare-based methodology to determine the amount of reimbursement allowed under the CNH Plan for professional medical services provided by Out-of-Network Providers, alleging that methodology is contrary to applicable provisions of the CNH Plan. Plaintiffs allege that participants are harmed when the use of the Medicare-based methodology results in underpayment of benefits under the CNH Plan, and that they have legal claims under the Employee Retirement Income Security Act of 1974, codified in part at 29 U.S.C. § 1132 (“ERISA”). Defendants denied and continue to deny the factual allegations and legal claims asserted in the Complaint, and denied and continue to deny any wrongdoing or liability.

There was no trial in the Litigation to determine the truth of Plaintiffs’ allegations. Instead, after months of pre-trial discovery and other court proceedings, Plaintiffs agreed to settle their claims against Defendants. The Settlement is not an admission by Defendants of any fault, wrongdoing or liability whatsoever. Defendants instead have agreed to the Settlement solely to eliminate the uncertainties, expense and burden of further litigation.

On July 19, 2017, and July 20, 2017, the Parties participated in mediation with the assistance of an independent mediator, Michael J. Cohen, Esq. The Parties subsequently submitted a Final Settlement Agreement setting out terms of the proposed Settlement to the Court, along with the Plaintiffs’ motion for preliminary approval of the Settlement. On September 20, 2017, the Court entered an order containing preliminary approval of the Settlement, conditional certification of the Settlement Class, and authorization for this Notice to be sent to potential Settlement Class Members, and scheduling the Final Settlement Hearing to consider whether to grant final approval to the Settlement.

The Final Settlement Hearing was held on May 4, 2018. On May 18, 2018, the Court issued a Final Order approving the Settlement. Distribution of the Settlement Fund occurred on August 10, 2018.

To obtain further information about the claims asserted in the Litigation, you may review a copy of the Amended Complaint filed in the Litigation on the Court Documents page. Certain other filings and orders from the Court are also available to you on this website.

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4. DO I HAVE A LAWYER IN THIS CASE?

The Court has appointed Douglas P. Dehler and Christa Wittenberg of O’Neil Cannon Hollman DeJong & Laing, S.C. and John B. Tuffnell of Tuffnell Law S.C. as Class Counsel for settlement purposes to represent you and other members of the Settlement Class.

You do not have to pay Class Counsel. If you want to have your own lawyer, and have that lawyer appear in court for you in this case, you must hire one at your own expense.

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5. WHY IS THERE A SETTLEMENT?

The Court did not decide in favor of either side. Rather, both sides agreed to settle all claims that were or could have been asserted against Defendants in the Litigation in exchange for monetary consideration. That way, the Parties avoid the uncertainties and cost of a trial and possible appeal, and the affected members of the Settlement Class who qualify will receive compensation.

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6. WHAT ARE THE TERMS OF THE SETTLEMENT?

In the Settlement Agreement, the individual Plaintiffs (“Settling Plaintiffs”), represented by counsel (“Class Counsel”), agreed to settle all claims that were or could have been asserted against Defendants in this Litigation in exchange for monetary consideration. Various terms of the Settlement Agreement are summarized in this section and elsewhere in this Notice. A copy of the entire Settlement Agreement, which is dated August 28, 2017, may be reviewed on the Court Documents page.

  • a. Settlement Consideration

The Settlement establishes a Total Settlement Fund in the amount of $750,000.00. Settlement Class Members who submit or are deemed to have submitted claims for compensation from this fund will be entitled to payments from the Total Settlement Fund as described in the Settlement Agreement and summarized below. Other amounts, as approved by the Court, such as the costs of notice and administration of the Settlement up to $100,000.00, attorneys’ fees and litigation expenses for Settlement Class Counsel, and incentive payments to the individual Settling Plaintiffs, will be paid by Defendants directly and not out of the Total Settlement Fund.

On May 18, 2018, the Court issued a Final Order approving the Settlement. Financial payments will be paid from the Total Settlement Fund to Settlement Class Members who did not Opt-Out of the Settlement.

  • b. The Release, Dismissal with Prejudice, and Revocation of Assignment

As part of the Court’s final approval of the Settlement, the Litigation has been dismissed with prejudice as to Defendants. In addition, Defendants are released and discharged of any and all claims, up through the entry of the Preliminary Approval Order in this case, that are, were, or could have been asserted against Defendants based on or arising from the allegations in this Litigation. The Settlement Class Members are barred from suing Defendants and the other released persons for claims that are covered by the releases. Settlement Class Members are deemed to have revoked any purported assignment of, or relating to, any of the claims that are covered by the releases and to have agreed to indemnify Defendants if any third party (such as your medical provider or a debt collector) sues Defendants, asserting any claim covered by the releases.

The release, revocation of assignment and indemnification, covenant not to sue, and dismissal with prejudice provisions of the Settlement Agreement affect your legal rights and you should review these provisions carefully.

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7. HOW DO I QUALIFY TO PARTICIPATE IN THE SETTLEMENT?

You did not need to do anything to qualify to participate in the Settlement. You received the Notice packet because claims records show that you may be entitled to receive a financial payment under the Settlement. If you did not Opt-Out of the Settlement, you were automatically deemed to have filed a claim for compensation from the Total Settlement Fund and a financial payment under the terms and conditions of the Settlement has been mailed to you. If you completed a valid Payee Form, a financial payment was mailed to the person you designated to receive your settlement payment.

You did not need to submit a claim form or other documents to be eligible to receive financial payment under Settlement. Please note, however, that if the potential value of your claim for additional compensation under the Settlement is more than $500, you must have submitted a valid and timely Claim Form and required documentation of one or more Balance Bills for the full value of your claim(s) in order for your claim to be recognized at that full value (subject to pro rata distribution) under the Settlement. Class Members with claims for additional compensation valued at more than $500 received a Claim Form with their Notice packet. For more information about the Claim Form (including the due date and mailing address for submitting the form), refer to FAQ 9: “Do I Need to File a Claim For Payment? If I Need to File a Claim Form, How Do I File It?”

Whether or not you mailed in a Claim Form or Payee Form, as a Settlement Class Member, you are bound by all orders and judgments entered in connection with the Settlement and Settlement Agreement, including the release, revocation of any purported assignment and indemnification, covenant not to sue, and dismissal with prejudice provisions described in this Notice, unless you Opted-Out, i.e., excluded yourself, from the Settlement Class.

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8. HOW WILL THE SETTLEMENT FUNDS BE ALLOCATED?

Important Update: On May 18, 2018, the Court issued a Final Order approving the Settlement. Checks reflecting financial payments under the terms and conditions of the Settlement were mailed to Settlement Class Members on August 10, 2018. If you completed a valid Payee Form, a financial payment was mailed to the person you designated to receive your settlement payment. Any settlement check you or a designated payee receive must be deposited promptly because it will become void 120 days after the distribution date. Any Settlement Class Member or their designated payee who fails to negotiate their check within the 120-day period forever waives and releases any claim for payment under the Settlement.

Note, there are several defined terms that appear frequently in this section. Please see the Explanatory Notes below for the definitions of these terms.

The Settlement provides for two types of financial payments to be paid out of the Total Settlement Fund, if the Settlement is finally approved by the Court:

  1. Minimum Compensation Paid to All Settlement Class Members: You automatically qualified and received a minimum financial payment in the amount of $20 from the Total Settlement Fund, unless you Opted-Out of the Settlement.
  2. Additional Compensation to Eligible Class Members: If you met the eligibility criteria defined below and did not Opt-Out of the Settlement, you also automatically qualified for additional compensation and received a portion of the value of your eligible claims pursuant to the terms of the Settlement.

    The value of your claims is defined in the Settlement Agreement as your “Total Alleged Underpayment.” For each Settlement Class Member who meets the eligibility criteria set out below, claims data is used to calculate the Total Alleged Underpayment under Plaintiffs’ theories in this Litigation for all of his or her Eligible Partially Allowed OON Professional Claims, minus the $20 minimum payment amount he or she will receive under the Settlement.

    Eligibility Criteria for Additional Reimbursement:

    • Union Settlement Class Members: (i) any participant or beneficiary included in the subgroups of the Plan applicable to active and retired members of the United Autoworkers Union during the Settlement Class Period (“Union Settlement Class Members”) on the dates they received Covered Professional Services that resulted in Partially Allowed OON Professional Claim(s), (ii) who received such services on or before December 31, 2016, and (iii) whose Total Alleged Underpayment for such claims is greater than $0, are Eligible Settlement Class Members.

    • Non-Union Settlement Class Members: (i) any participant or beneficiary not included in the subgroups of the Plan applicable to active and retired members of the United Autoworkers Union during the Settlement Class Period (“Non-Union Settlement Class Members) on the dates they received Covered Professional Services that resulted in Partially Allowed OON Professional Claim(s), (ii) who received such services on or before December 31, 2014, and (iii) whose Total Alleged Underpayment for such claims is greater than $0, are Eligible Settlement Class Members.

You may not have received the entire value of your claim for additional compensation. The amount that you received was determined on a pro rata basis, which means the amount you received under the Settlement was reduced depending on the total amount of claims submitted or deemed to be submitted by other eligible Settlement Class Members. You received a portion of the remaining funds in the Total Settlement Fund (in an amount up to but not exceeding your Total Alleged Underpayment amount) based on a percentage determined by the value of your claims compared to the total value of all Settlement Class Members’ claims.

Please note, however, that if the potential value of your claim for additional compensation under the Settlement is more than $500, you must have submitted a valid and timely Claim Form and required documentation of one or more Balance Bills for the full value of your claim(s) in order for your claim to be recognized at that full value (subject to pro rata distribution) under the Settlement. Class Members with claims for additional compensation valued at more than $500 received a Claim Form with their Notice packet. If you failed to return the Claim Form, or your Claim Form was denied by the Settlement Administrator because it was untimely or invalid for any reason, the value of your claims under the Settlement Agreement were set at the greater of $500 or the partial value of your claim as to which you timely submit a valid Claim Form with required documentation of a Balance Bill, and you were eligible for a Settlement Payment up to that amount, subject to the pro rata reduction described above. For more information about the Claim Form (including the due date and mailing address for submitting the form), refer to FAQ 9: “Do I Need to File a Claim For Payment? If I Need to File a Claim Form, How Do I File It?”

Explanatory Notes:

“Allowed Amount” or “Allowable Amount” means the amount Defendants determined to be eligible for reimbursement under the Plan for a Plan Member’s Covered Professional Services submitted for reimbursement under the Plan, before the application of co-insurance, deductibles, and coordination of benefits for coverage under another plan or health benefits policy.

“Balance Bill” means a written bill, invoice, or other demand for payment from a provider or provider’s representative seeking payment from a Plan Member for the difference between a providers’ billed charge and the Defendants’ Allowed Amount for a Covered Professional Service. A Balance Bill does not include a bill for any other amounts, such as Denied Claims, co-insurance, deductibles, and coordination of benefits. Under the Settlement Agreement, a Balance Bill includes any written bill for this amount regardless of when or how it is presented to the Plan Member, including a bill for the entire billed charge that the provider presented to the Plan Member in person at the time of the Covered Professional Service, as well as a bill that the provider sent to the Plan Member by mail or other means after reimbursement of the Allowed Amount for the Covered Professional Service under the Plan.

“Denied Claim” means any claim line for which the Allowed Amount equals $0. Denied Claims are not included in this Settlement.

“Out-Of-Network Provider” means a professional provider of health care services or supplies (such as a physician or other healthcare practitioner) who did not participate as a member of the participating provider network(s) on the date services were provided as defined under the terms and conditions of the Plan.

“Partially Allowed” or “Partially Allowed OON Professional Claim” means any claim line for a Covered Professional Service provided by an Out-of-Network Provider to a Plan Member that is not a Denied Claim and for which the Allowed Amount is less than the amount billed by the provider. Partially Allowed OON Professional Claim excludes claim lines for Covered Professional Services that were (i) claims involving coordination of benefits for which Medicare was primary, and (ii) claims successfully negotiated by National Care Network (i.e., those claim lines Out-of-Network Provider agreed to accept a certain amount negotiated by National Care Network as full reimbursement and to not bill the Plan Member for the difference between that negotiated amount and the provider’s charge).

“Eligible Partially Allowed OON Professional Claim” means (i) for Union Settlement Class Members, only those Partially Allowed OON Professional Claims for Covered Professional Services received on or before December 31, 2016, and (ii) for Non-Union Settlement Class Members, only those Partially Allowed OON Professional Claims for Covered Professional Services received on or before December 31, 2014.

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9. DO I NEED TO FILE A CLAIM FOR PAYMENT? HOW DO I FILE A CLAIM?

If your claim(s) under the Settlement is valued at less than $500, you need not submit a claim for payment. Unless you Opted-Out, i.e., excluded yourself, from the Settlement Class, you received a minimum settlement payment of $20, and possibly more depending on the value of your claim as shown by claims data and other information obtained and provided by the Defendants in the Litigation.

If the potential value of your claim(s) for additional compensation under the Settlement is more than $500, you received a Claim Form with the Notice. You must have timely submitted the completed Claim Form and required documentation of one or more Balance Bills for the full value of your claims in order to receive that full value (subject to pro rata distribution) under the Settlement.

The completed Claim Form and required documentation of a Balance Bill must have been mailed to the following address (which appears on the Claim Form):

George v. CNH Health & Welfare Benefit Plan
c/o GCG
PO Box 10473
Dublin, OH 43017-4073

The Claim Form (if you received one) must have been postmarked by no later than March 19, 2018, or it will not be a valid and timely Claim Form and will be denied by the Settlement Administrator. For those Settlement Class Members who received a Claim Form with this notice, if you did not submit that Claim Form, or if your Claim Form is denied by the Settlement Administrator because it is untimely or invalid for any reason, the value of your claims under the Settlement Agreement will be set at the greater of $500 or the partial value of your claim as to which you do timely submit a valid Claim Form with required documentation of one or more Balance Bills, and you will be eligible for a Settlement Payment up to that amount, subject to pro rata reduction.

IF YOU HAVE QUESTIONS ABOUT THE CLAIM FORM, WHAT ADDITIONAL DOCUMENTATION WAS REQUIRED, OR WHICH SPECIFIC MEDICAL SERVICES ARE AT ISSUE, PLEASE CONTACT THE SETTLEMENT ADMINISTRATOR AT (844) 402-8589.

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10. WILL PAYMENT UNDER THE SETTLEMENT BE SENT TO ME OR MY MEDICAL PROVIDER?

This Settlement has been approved by the Court, so if you did not Opt-Out of the Settlement, you were automatically deemed to have filed a claim for compensation from the Total Settlement Fund and received a financial payment under the terms and conditions of the Settlement.

If you submitted a timely Payee form to designate someone else (e.g., your medical provider) to receive the financial payment under this Settlement, any settlement payment for which you are eligible was made to the person(s) you designated.

The Payee Form must have been returned by first class mail, postmarked no later than March 19, 2018.

IF YOU DID NOT COMPLETE AND MAIL IN THE PAYEE FORM BY MARCH 19, 2018, THEN ANY SETTLEMENT PAYMENT WAS MADE TO YOU. In all events, you will be responsible for resolving any disputes or disagreements concerning whether someone else is entitled to the Settlement Payment for which you may be eligible.

Note, checks reflecting financial payments under the terms and conditions of the Settlement were mailed to Settlement Class Members or their designated payees on August 10, 2018.

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11. HOW WILL THE LAWYERS BE PAID?

The Court has approved the Settlement, and Class Counsel’s application to the Court for an award of attorneys’ fees and out-of-pocket expenses in the total amount of $350,000.00. The attorneys’ fees and expenses awarded by the Court will be paid by Defendants directly and will not reduce the amount of the Total Settlement Fund described above. In addition, the Court approved of an incentive award in an amount of $5,000, payable by Defendants directly (rather than from the Total Settlement Fund) to each of the two Settling Plaintiffs, in recognition of their time and effort in connection with the Litigation.

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12. HOW DO I TELL THE COURT THAT I DO NOT LIKE THE SETTLEMENT? MAY I SPEAK AT THE FINAL SETTLEMENT HEARING?

Class Member objections were required to have been postmarked by March 19, 2018. The court held the final approval hearing on May 4, 2018. On May 18, 2018, the Court issued a Final Order approving the Settlement.

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13. WHAT IF I DO NOT WANT TO BE PART OF THE SETTLEMENT?

Your request to Opt-Out must have been returned by first-class mail, postmarked no later than March 19, 2018.

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14. WHAT WILL HAPPEN AT THE FINAL SETTLEMENT HEARING? DO I NEED TO ATTEND THE FINAL SETTLEMENT HEARING?

The Final Settlement Hearing was held on May 4, 2018, at 8:30 a.m., at the United States Courthouse, United States District for the Eastern District of Wisconsin, 517 East Wisconsin Avenue, Courtroom 425, Milwaukee, Wisconsin 53202. At the hearing the Court approved the Settlement. On May 18, 2018, the Court issued a Final Order approving the Settlement.

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15. WHAT IF I DO NOTHING AT ALL?

As explained above, the Settlement was approved by the Court, so if you did not Opt-Out of the Settlement, you were automatically deemed to have filed a claim for compensation from the Total Settlement Fund and a financial payment under the terms and conditions of the Settlement has been mailed to you or your designated payee. Unless you Opted-Out, i.e., excluded yourself, from the Settlement Class, you are bound by the terms of the Settlement, including the release and covenant not to sue provisions of the Settlement Agreement described above.

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16. WHAT SHOULD I DO IF MY SETTLEMENT CHECK IS LOST OR MUTILATED?

For information about requesting a replacement check, please contact the Settlement Administrator by calling toll-free 1-844-402-8589

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17. HOW DO I GET MORE INFORMATION?

The Notice is a summary and does not describe all details of the Settlement. Complete copies of the Settlement Agreement, the Amended Complaint filed in the Litigation, the Preliminary Approval Order, the Final Order approving the Settlement, and other court orders in this case, except those (if any) filed under seal, may be examined and copied during regular office hours, and subject to customary copying fees, at the Clerk of the Court’s Office, United States District Court, Eastern District of Wisconsin, 517 East Wisconsin Avenue, Courtroom 425, Milwaukee, WI 53202. Certain of these documents may also be obtained on the Court Documents page on this website. You can also contact the Settlement Administrator at (844) 402-8589.

PLEASE DO NOT CALL OR WRITE THE COURT OR THE CLERK OF THE COURT FOR INFORMATION OR LEGAL ADVICE.

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