CareFirst BlueChoice, Inc. v. Matthew Skipper, et al.

Summary

The Supreme Court of Maryland held that a putative class action was not moot when the insurer tendered individual relief while a substantially identical action was pending in federal court and the plaintiffs promptly refiled in state court before having a reasonable opportunity to seek class certification. The Court further held that Maryland Insurance Article § 15-810(c), together with applicable regulations, requires coverage for medically necessary expenses arising from in-vitro fertilization to the same extent as other pregnancy-related procedures. The Court concluded that the policy exclusion for ovum transplants, certain reproductive procedures, and preservation techniques did not exclude medically necessary embryo-thawing expenses associated with IVF, and remanded for further proceedings.

Holdings

1. A tender of individual relief to a putative class representative does not moot a class action before the representative has had a reasonable opportunity to seek class certification, including necessary discovery. This rule extends to a putative class action initially filed in another court, dismissed there for lack of jurisdiction, and promptly refiled in substantially the same form in state court.
2. Policy Exclusion 16.11 does not apply to any medically necessary expenses arising from IVF procedures. Whether embryo thawing is covered turns on whether it was a medically necessary component of the IVF procedure, not on whether IVF is similar to the procedures listed in the exclusion.

Questions Presented

1. Whether CareFirst's tender of individual relief to the putative class representatives while a substantially similar class action was pending in federal court rendered the subsequently refiled state-court action moot or deprived the Skippers of standing.
2. Whether the Skippers' complaint failed to state a claim because Policy Exclusion 16.11 excluded coverage for embryo thawing associated with IVF.
3. Whether Maryland Insurance Article § 15-810(c), COMAR 31.11.06.06B(11), and Maryland Insurance Administration Bulletin 13-01 require individual health insurance policies purchased through the Health Benefit Exchange to cover medically necessary expenses arising from IVF procedures to the same extent as other pregnancy-related procedures.

Disposition

remanded