BCBS Settlement Tier 1, 2, 3 — Which One Are You?
The $2.67B settlement pays out in three tiers with different formulas and amounts. Most people qualify for exactly one — here's how to identify yours and what to expect.
Why Three Tiers Exist
The BCBS antitrust harm was felt differently by different payers. An individual who bought their own BCBS plan directly was hurt for the full premium overcharge. An employee whose employer paid 80% of their premium was hurt only on the 20% they contributed. An employer paying 80% of premiums for 200 employees was hurt on the much larger employer-share aggregate.
The court approved a three-tier structure to fairly allocate the $2.67B fund across these very different damage profiles. Each tier has its own formula, point system, and payout range.
Tier 1: Individual Fully-Insured
- Who qualifies
- You purchased BCBS health insurance directly — through a state exchange, the federal marketplace, or directly from a BCBS plan (not through any employer).
- Payout formula
- Premium dollars paid × years of coverage in class period × state market-share multiplier. The full premium counts because YOU paid the full overcharge.
- Typical range
- $100–$1,500. The longer your BCBS-direct period (2008-2020) and the higher your premiums, the larger your share.
Example: Self-employed consultant in North Carolina, $7,200/year average premium for 11 years 2009-2020. NC has a high state multiplier (~85% BCBS market share). Estimated payout: $1,200-$1,450.
Tier 2: Employee Premium Contribution
- Who qualifies
- Your employer offered a fully-insured BCBS group plan and you paid a portion of your premium via paycheck deduction. Your share is whatever percentage came out of your wages.
- Payout formula
- (Your employee contribution × years) × tier-2 weighting factor. Lower than Tier 1 because you only experienced the harm on your share, not the full premium.
- Typical range
- $50–$750. Many Tier-2 payouts land in the $100-$300 range — adequate but not life-changing.
Example: Software engineer at a mid-size company, $1,200/year employee contribution for 9 years on a BCBS-IL plan. Estimated payout: $180-$280.
Tier 3: Employer / Group
- Who qualifies
- Your business purchased a fully-insured BCBS group plan. You (the employer) paid the bulk of premiums for your workforce.
- Payout formula
- Total employer premium paid × group size × duration × tier-3 factor. The largest formula because employers paid the largest aggregate amounts.
- Typical range
- $500–$50,000+. Small businesses (5-15 employees) commonly received $5,000-$20,000. Larger fully-insured groups received six-figure payouts.
Example: Law firm with 12 attorneys + staff, fully-insured BCBS plan, ~$120K/year aggregate premiums for 9 years 2010-2019. Estimated payout: $18,000-$32,000.
Can I Be in Multiple Tiers?
Yes — rare but real. Common scenarios:
- Small business owner who was both Tier 3 (employer) and Tier 2 (employee on their own group plan) — each requires a separate claim.
- Individual who bought direct BCBS for years, then switched to employer-sponsored — split into Tier-1 years and Tier-2 years.
- Job changes mid-class-period where one job had a fully-insured BCBS plan and the next had self-insured (excluded). Tier-2 years count only for the eligible period.
What You're NOT (Common Exclusions)
- Self-insured (ASO) plan member: Your employer used BCBS as administrator but bore the risk themselves. Excluded.
- Medicare standalone: Medicare original coverage is not BCBS. Excluded. Medicare Supplement through BCBS may qualify partially.
- Medicaid recipient: Medicaid-eligible coverage is excluded.
- Federal Employees Health Benefits (FEHB): A separate carve-out program with different settlement framework.
- Dependent only, no premium contribution: If you were on a parent's or spouse's plan but never paid into it, the premium-payer is the claimant.
Frequently Asked Questions
How do I know which tier I was placed in?
Check your claim confirmation letter or the BCBSsettlement.com portal. Your tier is determined by the documentation you submitted (W-2 with BCBS deductions = Tier 2, individual policy = Tier 1, etc.).
Can my tier change after I filed?
Generally no — tiers are set at validation. However, if you provided additional documentation showing you actually belonged in a different tier, the administrator can reclassify before payment.
Why is Tier 1 the highest individual payout?
Tier 1 claimants paid 100% of their own premium, so they experienced the full antitrust overcharge directly. Tier 2 only saw the harm on their employee contribution share.
Is Tier 3 really paying $50,000+?
Yes, for larger fully-insured groups. A 50-person company with high-cost BCBS coverage over 10+ years can easily reach $40K-$80K. Some very large fully-insured employers received seven-figure payouts.
My check seems too small for my tier — what do I do?
Tier ranges are estimates. Your actual amount depends on your specific premium history, years, and state. If you believe an error was made, contact the administrator with documentation.