Frequently Asked Questions for Class Members

Health Net Class Action Litigation - Overview

Three class action lawsuits were filed by health plan subscribers and beneficiaries against Health Net and have been settled for up to $215 million. The Settlement resolves Health Net’s failure to properly pay claims submitted by their members who received covered services and/or supplies from Out-of-Network Providers. These actions claim that Health Net made inadequate reimbursement to its members for Covered Services by using the Ingenix databases and/or other protocols or methods. The class actions also challenged the quantity and quality of the information Health Net provided; about how Health Net will pay for covered ONET Services; how Health Net explained its benefit denials; and how Health Net decided appeals from subscribers who disagreed with Health Net’s decisions. Health Net denies the factual allegations and legal claims asserted in these Complaints, and denies any wrongdoing or liability.

As part of the Settlement, Health Net will initiate certain business practices for the benefit of Class Members. These detailed business practices are described in the Notice.

1.___Q: Why did I receive this information when I was never a Health Net subscriber or beneficiary?
A: Your name and address were provided to us by Health Net or one of Health Net’s predecessors - Physicians Health Services, PHS, Foundation Health Systems, or First Option Health Plan; as someone who was or is a Health Net subscriber or beneficiary. Please refer to the Notice document on page 2 that describes the nature and reasons for the lawsuit.

2.___Q: What are my options?
A: There are several things you can do: (1) file a claim; (2) request exclusion from the Class; or (3) do nothing at all. If you submit a valid and timely proof of Claim Form, you may ultimately share in the distribution proceeds. If you submit a valid and timely request for exclusion, you will not share in the distribution of the proceeds, and you will not be bound by any judgment or order in the litigation. If you do nothing at all, you will not share in the distribution of the proceeds, but you will be bound by any judgment or order in the litigation.

3. ___ Q: What do I need to do in order to take part in this class action and receive a payment?
A: In order to be eligible for a payment from this class action, you must complete, sign and mail your Claim Form, a copy of your Blue Sheet with any changes, corrections or updates, and supporting documentation (if required), so that it is postmarked no later than August 25, 2008 to the address on page 6 of the Claim Form. You must submit supporting documentation if you decide to file Group B or C claims, or if you make changes and/or corrections on your Blue Sheet.

4. ___ Q: When can I expect to receive my payment?
A: This class action involves a very large number of potential participants. Claims submitted to the Claims Administrator must be reviewed and evaluated. Claims submitted for Group B and C categories will be examined by Health Net. Those Class Members who submitted incomplete or deficient claims will be given an opportunity to provide additional information and documentation in support of their claims. Once all claims are reviewed and evaluated, payments to eligible claimants will be determined, and a court order approving distribution is received, payments will be issued. We expect that this process will take a substantial amount of time. Please be patient.

5. ___ Q: How much money am I likely to receive from this class action?
A: The settlement provides Class Members with a Cash Settlement Fund of $175 million for claims in the Group A category; and an additional Prove-Up Settlement Fund for up to $40 million for claims in Group B and Group C categories. For Group A claims, the Claims Administrator will determine your proportionate share of the net Cash Settlement Fund, based on the data provided on the Blue Sheet and any additional information you may provide, in accordance with the Plan of Allocation. Health Net will process Group B and Group C claims and determine your payment from the Prove-Up Fund in accordance with the Plan of Allocation. Once the Prove-Up Settlement Fund is exhausted, any remaining valid Group B or Group C claims will be included in the Cash Settlement Fund and become Group A claims. It is not possible to estimate your potential payment until all claims have been reviewed and processed.

6.____ Q: Why did I receive more than one Notice, Claim Form and Blue Sheet?
A: Every Health Net subscriber who has or had a member ID number was sent a Notice, Claim Form and Blue Sheet. A common reason for having more than one member ID number can be due to a change of employment during the class period (1995 – 2007); or your employer changed health plans and you received a new member ID number.

7. ___ Q: If I receive more than one Notice, Claim Form and Blue Sheet, do I have to file more than one claim?
A: Yes. Every Claim Form and Blue Sheet represents a unique member ID number. To insure that each claim is properly processed, please submit each and every Claim Form and Blue Sheet you may have received.

8.___ Q: What is a Blue Sheet?
A: The Blue Sheet is a record of a Class Member’s claim and payment history. This information was provided to the Claims Administrator by Health Net. Claimants should review this information for accuracy and completeness. Any changes or additions to the data on your Blue Sheet must be documented.

9. ___ Q: Some of the information on my Blue Sheet is either missing or wrong. How do I complete/correct it?
A: You should make your changes, corrections and updates in Section B of your Blue Sheet. If, for example, the incomplete or erroneous record is referenced as Item No. 5 in Section A, you should write "5" in the "Item No." field in Section B; you should skip Section 1, and then write what you believe is the accurate information in Sections 2 through 5. You should make any additional entries, as necessary, based on your claim category (Group A, B or C), in Sections 6 through 10. Please note that all changes and corrections require supporting documentation, such as an EOB (Explanation of Benefits from Health Net) for that covered ONET services or supplies.

10.___ Q: Some of the information (such as Date of Service, Allowed Amount and/or Balance Bill) is not printed on my Blue Sheet. I also have asterisks in Section 1 for these entries. What does it mean and what should I do?
A: Certain records received by the Claims Administrator in connection with a Class Member’s claim(s) were incomplete. In such cases, only the available information was printed on the Blue Sheets. A Claimant can correct and/or include missing charges from ONET Providers by listing the charges on their Blue Sheet in Part B. All changes and corrections to the Blue Sheet must be supported with documentation such as an EOB (Explanation of Benefits from Health Net) for that covered ONET services or supplies.

11. ___ Q: I believe I am a Class Member, but I did not receive my Claim Form and Blue Sheet. How can I obtain a copy of these documents?
A: In order to receive a copy of your personalized Proof of Claim and Blue Sheet, you need to submit a Request Form. A copy of the Request Form is available on the Claims Administrator’s website: www.berdonclaims.com. You will need to provide your Health Net member ID number, as listed on your Health Net member card, to receive a pre-printed Blue Sheet. If that information is not available, you will be issued a Claim Form and a blank Blue Sheet. You will have to supply documentation called for in the Blue Sheet about your covered ONET claims in order to receive a share of the settlement.

12. ___ Q: I am the primary insured. Does my Blue Sheet have information for the services and supplies I personally used, or those used by the dependents listed in my coverage as well?
A: The information on the Blue Sheet is grouped by the Member IDs of primary insured. The details listed in Part A of each Blue Sheet include all available information for the primary insured, as well as his or her dependents.

13. ___ Q: Some of my claims were completely denied by Health Net. How much will I be able to recover for such claims?
A: This settlement considers only those cases where the Allowed Amount paid by Health Net was greater than zero, but less than the ONET Provider’s billed amount. Any claims that were denied completely (Allowed Amount paid by Health Net was zero) will not be considered for purposes of calculation of a Claimant’s share of the proceeds.

14. ___ Q: What is a Group A claim?
Class members who either do not qualify to file a Group B or C claim, or do not wish to comply with the documentary requirements may file a Group A claim. Group A claims are based solely on the data provided on the Blue Sheets. No additional information or documentation is required from the claimant, unless the Blue Sheet is incomplete or is changed or updated by the claimant. A valid Group A claim is eligible to receive a proportionate share from the 175 million dollar Cash Settlement Fund.

15.___ Q: What is a Group B claim?
To qualify as a Group B claim, a Class member must have paid their Out-of Network Provider for all or part of their Balance Bill in excess of $100 and have not been previously reimbursed by Health Net. To make a Group B claim, Class Members must submit a valid Claim Form, clearly indicating in Section 6 of the Blue Sheet the intent to make a Group B claim, along with appropriate documentation verifying they have paid their Out-of-Network Provider on or before April 24th, 2008. Group B claims will be processed by Health Net on a first-come first served basis and may be eligible for reimbursement from the 40 million dollar Prove-Up Settlement Fund. Once the Prove-Up Settlement Fund is exhausted, any remaining valid Group B claims will be included in the Cash Settlement Fund and become Group A claims.

16. ___ Q: What is a Group C claim?
To qualify as a Group C claim, you must establish you have received an unpaid Balance Bill in excess of $100 from your Out-of- Network Provider on or before April 24th, 2008 for covered Out-of-Network services provided after May 5th, 2005 and before July 31, 2007. Group C claims will be processed by Health Net on a first-come first served basis. Valid Group C claims may be eligible to have their Balance Bills discharged by Health Net from the 40 million dollar Prove-Up Settlement Fund. Once the Prove-Up Settlement Fund is exhausted, any remaining valid Group C claims will be included in the Cash Settlement Fund and become Group A claims. To make a Group C claim, Class Members must submit a valid Claim Form, clearly indicating in Section 6 of the Blue Sheet the intent to make a Group C claim along with the necessary supporting documentation.

17. ___ Q: Am I restricted to one category of claims?
A. No. You can file a claim(s) in one or more categories if the claim meets the definition of each group. Be sure to clearly mark the Claim Form and Section 6 of the Blue Sheet if you are going to file a claim(s) in more than one group. Please refer to Question 14, Question 15 and Question 16 for more information regarding Group A, Group B or Group C claim(s).

18. ___ Q: Are all benefit claims listed on my Blue Sheet subject to recovery from this settlement?
A: No. Payments from the Cash Settlement Fund and the Prove-Up Fund will be made in accordance with the Plan of Allocation, which appears in the Notice. For purposes of the Plan of Allocation, a claim for Unpaid Benefits arises when a Class Member received Covered Out-of-Network Services or Supplies and the claim for such Services or Supplies was processed by Health Net with a check payment date in the claims system on or before July 31, 2007, such that the Allowed Amount is greater than zero, but less than the ONET Provider’s billed amount.

Additionally, as some information listed on the Blue Sheets is incomplete (such records are marked with asterisks in Section 1), it cannot be used in calculation of payments, unless completed and documented by Claimants.

19. ___ Q: What is a "Reference Number"?
A: The Reference Number is your Health Net medical ID number.

20. ___ Q: What type of supporting documentation is deemed acceptable?
A: The documentation requirements will vary based on the type of claim you are planning to make. The following documents will typically be accepted, if you made corrections or updates on your Blue Sheet and wish to make a Group A claim:

- Balance Bill received from your ONET Provider

- Explanation of payments statement received from Health Net

- Cancelled check

- Credit card statement

- Bill from collection agency

Please note that only those documents that clearly identify the service in question and provide all required information (such as date of service, provider’s name, amounts billed or paid, etc.) will be accepted in support of your claim. You should not send any original documents to the Claims Administrator, as your documents will not be returned.

The documentation requirements for the claims made for Group B or Group C categories may be somewhat different. Please see pages 3 and 4 of the Claim Form for detailed instructions.

21. ___ Q: I’d like to ask the Claims Administrator to obtain the necessary documentation for my claim on my behalf. What do I need to do?
A: If you are requesting the Claims Administrator to contact your ONET Provider(s) and attempt to obtain the required documentation, you need to place a checkmark in the box in Section 10 (for each item on your Blue Sheet), and complete the Authorization Form for each Provider. The Claims Administrator will attempt to obtain the required documentation at no cost to you. However, please be aware that the ONET Provider(s) may request a service fee or other like charges to process the request for documentation. Any such charges by the ONET Provider will be solely your responsibility. You can obtain a copy of the Authorization Form on Claims Administrator’s website: http://www.berdonclaims.com/. The form(s) must be mailed to the Claims Administrator with your Claim Form.

22. ___ Q: What if I missed the filing deadline; will my late claim be accepted?
A: If a Group A claim is not mailed to the Claims Administrator so that it is postmarked no later than August 25, 2008, the claim may be rejected and you will not receive any payment from the Cash Settlement Fund.

If a Group B or Group C claim is not mailed to the Claims Administrator so that it is postmarked no later than August 25, 2008, the claim will be rejected and you will not receive any payment from the Prove-Up Settlement Fund.

However, if late Group A claims are accepted for processing, then any late Group B and Group C claims that may be accepted for processing, will be processed like Group A claims. Late Group B and Group C claims will not be included in the Prove-Up Settlement Fund.

23. ___ Q: Previously, I have excluded myself from this action. Is it possible for me to be included in this Settlement, at this point?
A: Yes. You will need to mark the appropriate check box to Question 1. on page of the Claim Form.

24. ___ Q: How can I exclude myself from this Settlement?
A: If you do not wish to be a Class Member and participate in the proposed Settlement, then you must submit a written request for exclusion to the Claims Administrator. Your request for exclusion must be postmarked no later than June 23, 2008. Please see the Notice for detailed instructions.

25. ___ Q: I believe I have assigned my claims to my ONET Provider. How does it affect my claim in this class action? And, how should I answer the related question on the Claim Form?
A: Checking the box on the Claim Form is for informational purposes only. If you gave your ONET Provider an assignment (so that the Provider would be paid directly by Health Net) it does not prevent you from filing a claim and/or receiving money. However, if you receive any proceeds from this class action, you will now be responsible to make payment(s) directly to your ONET Provider(s).

26. ___ Q: I am preparing a Claim Form on behalf of another person. What additional information is required in this case?
A: Please be sure to include your contact information, should the Claims Administrator have questions about the claim. If you are signing the Claim Form, be sure to include evidence that you have the authority to do so. An example of the type of authority includes (but is not limited to the following):

- parent for a minor child; or

- guardian for a minor child; or

- executor, or executrix of an estate; or

- administrator of an estate; or

- power of attorney.

27. ___ Q: What if I moved and need an address change?
A. You must send written notification, including the name of this litigation, your name, your old address, your new address, and your Health Net member ID Number, to:

By Mail To:   Health Net Class Action Litigation
                     c/o Berdon Claims Administration LLC
                     P.O. Box 9007
                     Jericho, NY 11753-8917

or

By Fax To:    (516) 931-0810

28. ___ Q: Where do I send my completed claim form?
A: You must complete and sign the Claim Form, and submit it with the Blue Sheet and all supporting documentation, postmarked no later than August 25, 2008, to:

By Mail To:   Health Net Class Action Litigation
                     c/o Berdon Claims Administration LLC
                     P.O. Box 9007
                     Jericho, NY 11753-8917

or, if via courier:

                     Health Net Class Action Litigation
                     c/o Berdon Claims Administration LLC
                     One Jericho Plaza, Suite 106
                     Jericho, NY 11753

For an acknowledgment of receipt of your claim, please send it Certified Mail, Return Receipt Requested.

29. ___Q: What is the Settlement Hearing and do I have to attend?
A. The Court has scheduled a hearing on July 24, 2008, to consider the fairness, reasonableness, and adequacy of the proposed Settlement and to consider the request of Plaintiffs’ counsel for the award of attorney’s fees and expenses. It is not necessary for you to appear at the Settlement Hearing. The Class will be represented by the Plaintiffs’ Counsel.