Cigna $5.7M Out-of-Network Claims Class Action Settlement

Individuals covered by health benefits under a LocalPlus plan Cigna administered and who received an explanation of benefits that incorrectly listed their provider as in-network when they were actually out-of-network due to a system error may be eligible to submit a claim for a cash payment from a class action settlement.

Cigna Health and Life Insurance Co. agreed to pay $5.71 million to resolve a class action lawsuit alleging it misclassified certain out-of-network health care providers as in-network, which resulted in some members receiving unexpected balance bills.

Who can file a Cigna settlement claim?

Class members must meet the following criteria:

• A LocalPlus Plan for which Cigna provided administrative services covered them for health benefits.
• They received medical treatment and an explanation of benefits from Cigna indicating the provider was in-network.
• The provider they received treatment from was actually out-of-network due to a configuration error in Cigna’s system.
• They received a balance bill because the provider did not honor in-network status.

How much is the class action payout?

• Pro rata cash payment: Eligible class members can submit a claim to receive a pro rata cash payment. The settlement administrator will determine the final amount by the number of valid claims.
• If the total value of all approved claims is $300,000 or less, each claimant will receive the full amount of their documented balance bill, including interest, penalties or debt collection fees directly related to the balance bill.
• If the total value of approved claims exceeds $300,000, each claimant will receive a proportional share of the $300,000 fund and not the total balance bill amount.

• Injunctive relief: Cigna will not recategorize any additional LocalPlus Plan out-of-network claims coded as in-network in error.

How to claim a class action rebate

To receive a settlement payment, eligible class members must submit a claim form. They can submit a claim online or print snd mail a PDF claim form to the settlement administrator. Class members must submit their claim online or postmark it by Jan. 5, 2026.

Settlement administrator's mailing address: Cigna LocalPlus Settlement Administrator, Attn: claim forms, 1650 Arch St., Suite 2210, Philadelphia, PA 19103

Additional instructions:

Class members must:

• Provide their name, address, phone number, email, Cigna member ID and Cigna claim ID
• Attach proof of the balance bill or, if unpaid, a signed affirmation that they will use settlement funds to pay the balance bill
• Certify under penalty of perjury that the information is accurate and that they meet the class criteria

Required proof and claim information

• To submit an online claim, class members must provide the notice ID and confirmation code from their settlement notice.
• The claim form requires the Cigna member ID and Cigna claim ID.
• All class members must provide proof of the balance bill they received from the health care provider.
• Class members who have paid their balance bill must provide proof of payment, including any interest, penalties or debt collection fees incurred.
• Class members who have not paid their balance bill must submit a signed attestation agreeing to use the settlement payment to pay the owed balance bill, including any interest, penalties,or debt collection fees.

$5.71 million settlement fund

The $5,712,152.03 settlement fund includes:

• Attorneys' fees and costs: $750,000
• Service awards to class representatives: $10,000 each ($20,000 total)
• Cash payments to approved claimants: $300,000
• Injunctive relief: $4,642,152.03

The defendant will pay settlement administrator costs separately.

Important dates

• Deadline to file a claim: Jan. 5, 2026
• Opt-out deadline: Jan. 5, 2026
• Final approval hearing: March 24, 2026

When is the Cigna out-of-network settlement payout date?

The settlement administrator will issue payments to valid claimants after it completes claim processing and the court grants final approval of the settlement.

Why is there a class action settlement?

This class action lawsuit alleged Cigna violated the Employee Retirement Income Security Act by misclassifying certain out-of-network providers as in-network due to a configuration error. As a result, some members received unexpected balance bills.

Cigna denies any wrongdoing but agreed to settle to avoid the risks and expense of further litigation.

Sources

1. Official class notice
2. Official settlement website FAQ page
3. Official settlement agreement