Central Benefits Mutual Insurance v. Blue Cross & Blue Shield Ass'n

711 F. Supp. 1423, 11 U.S.P.Q. 2d (BNA) 1103, 1989 U.S. Dist. LEXIS 4765, 1989 WL 44561
CourtDistrict Court, S.D. Ohio
DecidedMarch 22, 1989
DocketC-2-88-508
StatusPublished
Cited by10 cases

This text of 711 F. Supp. 1423 (Central Benefits Mutual Insurance v. Blue Cross & Blue Shield Ass'n) is published on Counsel Stack Legal Research, covering District Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Central Benefits Mutual Insurance v. Blue Cross & Blue Shield Ass'n, 711 F. Supp. 1423, 11 U.S.P.Q. 2d (BNA) 1103, 1989 U.S. Dist. LEXIS 4765, 1989 WL 44561 (S.D. Ohio 1989).

Opinion

FINDINGS OF FACT AND CONCLUSIONS OF LAW

GRAHAM, District Judge.

Plaintiffs Central Benefits Mutual Insurance Company (“CBMIC”) and Central Benefits National Life Insurance Company (“CBNLIC”) filed this action on May 6, 1988 against defendant Blue Cross and Blue Shield Association (“Association”), raising various federal and state antitrust claims. On June 22, 1988, the Association filed an answer and counterclaim against CBMIC, CBNLIC, and Mid-Ohio Healthcare Plan, Inc., d/b/a Health One. The Association’s counterclaim alleged breach of the service mark licensing agreements between the Association and CBMIC, service mark infringement in violation of § 32(1) of the Lanham Trade-Mark Act, as amended, 15 U.S.C. § 1114(1), and false designation of origin and false description or representation in violation of § 43(a) of the Lanham Trade-Mark 15 U.S.C. § 1125(a).

This matter is presently before the Court on the motion for preliminary injunction filed by the Association on November 21, 1988. The Association is seeking preliminary, injunctive relief solely against defendant CBNLIC on the grounds of service mark infringement and false designation of origin and false description or representation. This matter came on for hearing February 13-16, 1989 and is now ripe for decision.

FINDINGS OF FACT

The Blue Cross and Blue Shield Association is a not-for-profit corporation organized and existing under the laws of the State of Illinois with its principal place of business in Chicago, Illinois. The Association has its roots in local, community based health insurance plans formed approximately fifty years ago. The plans which offered hospitalization coverage developed the Blue Cross name and service marks. The separate and independent plans which offered medical and surgical coverage developed the Blue Shield name and service marks. These plans were typically sponsored by local hospital associations, medical societies, labor unions, business groups, and churches.

In 1952 all of the Blue Shield plans assigned their rights in the Blue Shield name and marks to the Blue Shield Medical Care Plans, a/k/a the Blue Shield Association. The Blue Shield Association in turn licensed the member plans to use the name and marks. The plans traditionally operated within their own exclusive geographic areas.

In 1972 all of the Blue Cross plans assigned their rights in the Blue Cross name and marks to the Blue Cross Association. The Blue Cross Association in turn licensed the member plans to use the name and marks. These plans also traditionally operated within their own exclusive geographic areas. Blue Cross of Central Ohio, predecessor of CBMIC, was one of the plans that assigned its rights to the name and marks to the Blue Cross Association and received a license in return.

In 1982 the Blue Cross Association and the Blue Shield Association merged to form the Blue Cross and Blue Shield Association. All the license agreements and ownership rights in the Blue Cross and Blue Shield names and marks were assigned to the Blue Cross and Blue Shield Association. The members of the Association are seventy-five separate and autonomous health insurance companies located throughout the United States. Most member plans now possess both Blue Gross and Blue Shield licenses and offer a full range of coverage including hospitalization, medical, surgical, dental, and other health care benefits.

The Association is owned and controlled by the member plans. In fact, by majority *1425 vote, the plans could dissolve the Association and return ownership of the Blue Cross and Blue Shield names and marks to the individual plans. CBMIC is a member plan of the Association.

The purposes of the Association, as stated in its Articles of Incorporation, include promotion of the public health and safety, protection of the Blue Cross and Blue Shield names and marks, and the development and maintenance of membership standards. Regular membership in the Association is restricted to Blue Cross Plans, Blue Shield Plans, and Blue Cross and Blue Shield Plans. Art. II, § 1 of Bylaws. The Association is funded in part by monthly dues assessed against its members. Art. II, §§ 1, 2 of Bylaws. The Association is governed by a board of directors, two-thirds of which must be composed of chief executive officers of member plans. The remaining one-third is composed of either plan chief executive officers or plan board members. The Association itself is not a health insurance company nor does it provide health insurance products and services. Its primary function is as owner and licensor of the Blue Cross and Blue Shield names and marks. In that capacity, the Association monitors compliance with the licensing agreements and policies any service name or service mark infringement. The Association currently owns twenty-three valid service mark registrations with the United States Patent and Trademark Office.

The Association also provides support services for its member plans. First, the Inter-Plan Service Benefit Bank serves as a clearing house for the transfer of funds between the plans. Second, the Association supplies a private telecommunication system which provides computer access for and links all the plans. Third, the Association contracts with the federal government to provide health insurance for federal employees. Since the Association is not an insurance company itself, it subcontracts with member plans to provide health care coverage for the federal employees within each plan’s service area. Fourth, the Association contracts with the United States Department of Health and Human Services to deliver Part A of the Medicare program, which it likewise subcontracts with its member plans. Finally, the Association provides national networks on behalf of its member plans for various new health care products. The networks serve as national marketing vehicles for the member plans. These networks include HMO USA, Preferred Care USA, and Custom Care USA.

The health care insurance traditionally offered by Blue Cross and Blue Shield member plans has three basic distinctive features. First, the insurance is a prepaid service benefit program. Each member plan contracts with hospitals, physicians, and other health care providers within its geographic area. The advantage of this arrangement is that the health care providers file their claims directly with the plan, thus obviating the subscribers’ filing of claims. The claims are paid directly by the member plan to the health care provider. The plans negotiate prices for various services with the providers. This differs from indemnity programs which require the subscriber to pay the health care provider and then seek indemnity from his insurance company. Second, the coverage is portable. A subscriber of one plan can travel anywhere in the United States and process a claim through any other plan. That plan will then be reimbursed through the Inter-Plan Bank by the originating plan. In addition, a subscriber who changes residence can automatically transfer his coverage to the member plan in his new locale with a minimum of paperwork and delay. Finally, the member plans are community based not-for-profit plans. Traditionally each plan had its own exclusive service area, although this is no longer true in Ohio. See infra.

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711 F. Supp. 1423, 11 U.S.P.Q. 2d (BNA) 1103, 1989 U.S. Dist. LEXIS 4765, 1989 WL 44561, Counsel Stack Legal Research, https://law.counselstack.com/opinion/central-benefits-mutual-insurance-v-blue-cross-blue-shield-assn-ohsd-1989.