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Elevance Health sees the market for level-funded health plans as a "burgeoning" and "highly competitive field."
The expertise needed to offer a successful level-funded plan is "of great economic value," according to a complaint Elevance filed Friday in the U.S. District Court for the Eastern District of Virginia.
Elevance — the Indianapolis-based parent of Anthem Blue Cross — is suing Maria Gregory, a former Elevance underwriting executive, over her decision to leave in July to take a position as a senior underwriter at Gravie, a benefit plan administrator.
Elevance has accused Gregory of a breach of a covenant not to compete.
Elevance, Gravie and Gregory could not immediately be reached for comment.
Level-funded plans: The provider of a level-funded health plan offers a self-insured employer a package of administrative services, stop-loss insurance and a claim funding account for a fixed monthly payment.
Related: NABIP urges regulators to standardize level-funded health plans
If an employer with a level-funded plan has a low level of claims, the employer gets credit for the good performance.
If the employer has a high level of claims, the stop-loss insurance can cover most or all of the excess costs.
The Elevance complaint: Elevance markets the Anthem Balanced Funding program to small and midsize employers.
When Gregory left, she was overseeing about 80 employees. She was in charge of underwriting for small employers, or those with 50 or fewer employees; for "key accounts," or employers with 51 to 99 employees; for multiple employer welfare arrangements; and for level-funded plans.
Gregory agreed when she received Elevance stock grants not to take a position that would involve competing with Elevance within 12 months of leaving Elevance, according to the Elevance complaint.
Elevance and Gravie: Elevance sees Gravie's level-funded plan program, the Comfort program, as a competitor to its own level-funded plan program, the company told the court.
Gravie also competes with Elevance in the managed care market, by offering employers access to the Cigna and Aetna Signature Administrators health care provider networks, the company said.
Elevance and level-funded plans: In the complaint, Elevance emphasized its interest in the level-funded plan market.
"Elevance Health's Anthem Balanced Funding plan has experienced substantial year-over-year growth, and the continuation of this growth is a core component of Elevance Health's strategic plan for the future of its business," the company said.
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