September 23, 2015.
from United States District Court for the Western District of
Arkansas - Fayetteville.
Teresa Bell, Plaintiff - Appellant: Richard Andrew Bright,
Taylor King And Associates, Arkadelphia, AR; Gabriel S.H.
Hopkins, Public Justice, Washington, DC; Matthew W.H.
Wessler, Gupta & Wessler, Washington, DC.
Blue Cross and Blue Shield of Oklahoma, a Division of: Health
Care Service Corporation, a Mutual Legal Reserve Company
agent of Health Care Service Corporation, Blue Cross and Blue
Shield of Texas, a Division of: Health Care Service
Corporation, a Mutual Legal Reserve Company agent of Health
Care Service Corporation, Defendants - Appellees: Mark H.
Allison, Carl F. Cooper III, Dover & Dixon, Little Rock, AR;
Adam P. Feinberg, Anthony F. Shelley, Miller & Chevalier,
Association of Federal Health Organizations, Amicus on Behalf
of Appellee(s): David M. Ermer, Ermer Law Group, Washington,
United States, Amicus on Behalf of Appellee(s): Kenneth P.
Elser, U.S. Attorney, U.S. Attorney's Office, Western
District of Arkansas, Fort Smith, AR; Alisa Beth Klein, Henry
Charles Whitaker, U.S. Department of Justice, Civil Division,
Appellate Staff, Washington, DC; Benjamin C. Mizer, U.S.
Department of Justice, Civil Division, Washington, DC; Susan
G. Whitman, U.S. Office of Personnel, Washington, DC.
WOLLMAN, COLLOTON, and KELLY, Circuit Judges.
appeal concerns a dispute between Teresa Bell and two Blue
Cross and Blue Shield insurance carriers that administer
Bell's government-sponsored benefit plan (" the
Plan" ). Bell was injured in a motor vehicle accident in
Arkansas, and the Plan paid medical benefits on Bell's
behalf. Bell then received a payment from a different carrier
that insured the party who was allegedly responsible for
Blue Cross carriers contend that under the terms of
Bell's benefit plan, she must use any monies obtained
from the alleged tortfeasor's insurer to reimburse the
Plan for medical benefits paid by Blue Cross. Bell responds
that under Arkansas law, she is not required to reimburse the
Plan unless she has been wholly compensated for her injuries,
and that she was not " made whole" by the payments
from Blue Cross and the alleged tortfeasor's insurer.
Blue Cross's position is that a provision of the Federal
Employees Health Benefits Act, 5 U.S.C. § 8902(m)(1),
expressly preempts Bell's state-law defense, and that the
Plan governs the question of reimbursement. We conclude that
federal law preempts the Arkansas state-law defense, and that
Bell must reimburse the Plan. We therefore affirm the
decision of the district court.[*]
Federal Employees Health Benefits Act of 1959 ("
FEHBA" ), 5 U.S.C. § § 8901-14, creates a
" comprehensive program of health insurance for federal
employees." Empire HealthChoice Assur., Inc. v.
McVeigh, 547 U.S. 677, 682, 126 S.Ct. 2121, 165 L.Ed.2d
131 (2006). Under the Act, the Office of Personnel
Management, commonly known as OPM, contracts with private
carriers to offer federal employees a variety of healthcare
plans. 5 U.S.C. § 8902(a). One of these plans is the
Blue Cross and Blue Shield Service Benefit Plan, a
government-wide plan that is established between OPM and the
Blue Cross and Blue Shield Association. See 5 U.S.C.
§ 8903(1); McVeigh, 547 U.S. at 682. Blue Cross
and Blue Shield companies in their respective localities
administer this plan.
contract between OPM and a carrier like Blue Cross must
include " a detailed statement of benefits
offered." 5 U.S.C. § 8902(d). OPM issues official
descriptions of plan terms through a " statement of
benefits" or " brochure." See id.
§ § 8902(a), (d), 8907. The Statement of Benefits
for the contract at issue here includes a section discussing
the rights of the parties when others are responsible for
injuries to an employee. It provides, among other things,
that if another person causes an employee to suffer an
injury, and the Plan pays benefits for that injury, the
employee must agree that the Plan is entitled to be
reimbursed for its benefit payments even if the employee is
not " made whole" for all of her damages in the
recoveries that she receives.
Bell, an employee of the Department of Veterans Affairs,
received health-care benefits through a government-sponsored
plan that was administered by Blue Cross and Blue Shield of
Oklahoma and Blue Cross and Blue Shield of Texas
(collectively, " Blue Cross" ). In October 2010,
she sustained personal injuries and medical expenses from a
motor vehicle accident that occurred in Arkansas. Bell's
benefit plan paid $33,014.01 in medical benefits on her
behalf. Bell also pursued a third party who allegedly caused
her injury, ...