Alexandra Carr brought a class action lawsuit on July 9, 2015 against Defendant United HealthCare (“UHC”) alleging that UHC administered claims for mental health treatment in a discriminatory manner in violation of the Mental Health Parity and Addiction Equity Act (“Parity Act”), 29 U.S.C. § 1185a.  Ms. Carr is an enrollee in a group health plan—the Kaiser Aluminum Fabricated Products LLC Medical Choice Plus Hourly Active Union Plan (the “Plan”)—covered by the Parity Act for which UHC is the Claims Administrator. Ms. Carr challenged Defendant’s administration of a cap on coverage of outpatient, in-network mental health office visits at 40 visits per year, and a 50% reduction on reimbursement for visits 21-40, when no such caps or limitations applied to medical and surgical services. The action sought relief on behalf of a class of similarly situated participants and beneficiaries in the Plan.

The parties have reached an agreement to settle both the prospective and retrospective class claims. Kaiser  amended the Plan terms to provide coverage under the Kaiser Plan without the limitations at issue in Ms. Carr's complaint, beginning on January 1, 2016. Under the terms of the Settlement Agreement, UHC affirms that it is administering the Kaiser Plan without the limitations. This  Plan amendment is reflected in the Settlement Agreement, and effectively achieves the injunctive relief sought in the Complaint.

The Settlement Agreement also establishes that UHC will reprocess previously submitted claims of Settlement Class Members who had benefits denied or reduced based on the challenged mental health limitations and pay Settlement Class Members the reprocessed claim amounts through distributions from the Settlement Fund. Specifically, Defendant will provide the Claims Processor – Nickerson & Associates – with a list of Settlement Class Members who had benefits denied or reduced as a result of the challenged mental health limitations, including the name and contact information and the amount denied or reduced. The Claims Processor will calculate the amount owed to each Settlement Class Member as the amount denied or reduced, less a $15.00 per visit co-pay.  The Claims Processor will establish a trust account into which UHC will pay the portion of the Settlement Amount  within 30 days of the Effective Date of the Settlement Agreement. The Claims Processor will pay Settlement Class Members the reprocessed claim amounts through distributions from this Settlement Fund. Settlement Class Members are not required to file claim forms to receive these Reprocessed Claim Amounts. 

The forgoing is just a summary.  If you are a class member, then you should review the entire agreement.  You can find a complete copy of the proposed settlement agreement here.  You can find a copy of the class notice here.