Group Health Claim Form

Step 1 of 3

In re Group Health Plan Litigation

United States District Court for the District of Minnesota (Case No. 23-cv-00267-JWB-DJF)

CLAIM FORM

GENERAL CLAIM FORM INFORMATION

You may complete and submit this Claim Form online or by mail if you are a Settlement Class Member. The Settlement Class consists of all individuals who logged into healthpartners.com and virtuwell.com between January 1, 2018 and November 10, 2023 (the “Settlement Class”).

If you wish to submit a Claim for a settlement cash payment, please provide the information requested below. You must submit your Claim via the Settlement Website by the Claims Deadline of April 7, 2025, or complete and mail this Claim Form to the Settlement Administrator, postmarked by April 7, 2025.

Settlement Class Members who submit a timely and valid Claim Form will be eligible to receive a pro rata cash payment from the Net Settlement Fund. Each Settlement Class Member will receive, at most, one (1) payment.

The Notice includes only a summary of your legal rights and options. Call (888) 833-7170 for more information.

This field is hidden when viewing the form

Payment will be mailed in the form of a check to the address you provide. If you would like to receive a payment electronically (e.g., via Venmo, PayPal, or ACH), you must submit a Claim Form online.