Fill and Sign the Individually and as Class Representatives of All Others Similarly Form

IN THE CIRCUIT COURT OF COUNTY, MISSISSIPPI AND PLAINTIFFSVS. NO. DEFENDANT COMPLAINT COME NOW , individually; and as class representatives of all others similarly situated and having a like common interest and on behalf of themselves and on behalf of the members of the class of persons which they represent (hereinafter collectively referred to as "Plaintiffs"), and assert the following causes of action against Defendant, , (hereinafter referred to as " "). CLASSSES REPRESENTED I. , and subscribe to health and accident policies provided through their employer, the State of Mississippi, under their respective state employee benefit plans. Plaintiffs , and appear on behalf of themselves individually, and as class representatives for those state and local employees who are subscribers of health and accident insurance policies in the State of Mississippi. II. is a professional service employer and is a subscriber to a health and accident insurance policy which he/she provides for his/her business. Plaintiff appears on behalf of himself/herself individually and as class representative of those others who are professional service employer subscribers of group health and accident insurance policies issued by . JURISDICTION OVER THE PARTIES II. Named Plaintiffs are adult resident citizens of County, Mississippi and are subscribers to health insurance policies, having filed claims against their policies of insurance with the Defendant during the time period pertinent to this lawsuit. III. Members of the represented class are resident citizens of the State of Mississippi and are subscribers of health and accident insurance policies. IV. Defendant, is a Mississippi insurance corporation, organized and doing business in the State of Mississippi. Defendant may be served with process of this Court by service upon its registered agent for service of process, , , , Mississippi. JURISDICTION OVER THE SUBJECT MATTER EQUITY JURISDICTION V. Plaintiffs invoke the equitable class action jurisdiction of this Court. Plaintiffs seek equitable relief for themselves and for all others similarly situated, having a like common interest in this litigation. (Said grounds for equitable relief are set forth more fully hereinbelow). VI. Additionally, Plaintiffs invoke the class action jurisdiction of this court on the ground that the named Plaintiffs and the Plaintiff represented class members have a common purpose in pursuit of a common adversary. Plaintiffs and the represented plaintiff class would show that they constitute an ascertainable class; share a well-defined community of interest in questions of fact and law affecting members of the class and have a right of recovery based upon the same essential facts. JURISDICTION ON THE LAW SIDE OF THIS COURT VII. Incidental to the equitable relief sought by Plaintiffs would show that they, along with the represented class, are entitled to damages at law as set forth more fully hereinbelow. THE CONTROVERSY VIII. During a certain period of time and continuing into the present, Defendant has engaged in clandestine business practices to the detriment of the Plaintiff subscribers. Since these activities were clandestine, Plaintiffs cannot at this time plead a specific time period that the conduct began occurring; but Plaintiffs assert that the clandestine practices began at least three years prior to the filing of this suit and continue to this date & and will continue until judgment is entered in this matter. IX. These clandestine business practices include, but are not limited to, secretive and non-disclosed agreements with health care providers. Under these clandestine agreements, bargained for reduced health care charges for the health care provided to its clients. Meanwhile, and the health care providers colluded to fraudulently inflate and misrepresent the actual charges for the medical services provided and the benefit paid by on behalf of its insureds. X. Deceived by these fraudulent practices, the insureds have paid their percentage of the health care costs based on the inflated medical bill. As a result, the insureds paid a much higher percentage of their actual medical costs than they had bargained for in their contract of insurance, while paid less than its obligation under these policies. XI. As a further result of this deception, Plaintiffs have been required to pay premiums based on the false inflated figures held out by and the health care providers as the amount actually paid and charged. INJUNCTIVE AND OTHER EOUITABLE RELIEF XII. Plaintiffs would show that the wrongs committed by Defendant are recurring and continuous in nature. Therefore, legal remedies will be inadequate and incomplete, because every time a premium is charged or a claim is made and paid, a new cause of action will arise. In order for Plaintiffs to get complete relief Plaintiffs are entitled to an equitable injunction, in addition to the legal relief hereinafter prayed for to prevent the need for pursuing the same cause of action in a multiplicity of actions. XIII. Plaintiffs would further show that they are entitled to equitable relief on the basis of Defendant's fraud committed toward them. Plaintiffs request that Defendant be required to make restitution for the unjust enrichment and ill-gotten gains retained and/or converted by Defendant. XIV. Plaintiffs pray for an accounting for the falsified accounts and for the accounts actually paid because these are complicated and cannot be accessed without court-ordered compliance of the Defendant. BREACH OF CONTRACT XV. Plaintiffs are subscribers to health and accident insurance policies written by . A sample copy of such policy is attached hereto and made a part hereof as Exhibit "A." XVI. Plaintiffs would further show that they have met all conditions and obligations placed upon them by the said policies of insurance. XVII. Plaintiffs would show that Defendant has fraudulently, willfully, intentionally and wrongfully breached said contract of insurance by entering into secretive agreements with health care providers. As a result of these agreements, has not paid the full amount of health care coverage, which it was required to pay under said policies of insurance. As a further result of this deceptive practice, the subscribers of have been fraudulently deceived into paying a higher percentage for their health care costs than what they bargained for in their contracts of insurance. XVIII. Plaintiffs would show that they are entitled to the benefit of the bargain of their contracts of insurance and should be awarded damages from Defendant for that percentage which Plaintiffs paid for their own health care coverage over and above that which Plaintiffs were obligated to pay under their contracts of insurance. XIX. Plaintiffs are entitled to a refund of the amount of premiums they paid which were over and above the premiums they should have been charged based on the actual cost of health care coverage provided by Defendant on Plaintiffs' claims of insurance. XX. Plaintiffs would show that the bad faith conduct and unfair dealings of Defendant constitute a malicious, intentional and willful wrong against the Plaintiffs. Further, Plaintiffs would show that said actions of Defendant subject the Defendant to punitive damages. XXI. Further, Plaintiffs would show that said actions of Defendant violate a duty of good faith and fair dealing owed by Defendant to Plaintiffs in the handling of their claims under their insurance contracts. COSTS AND FEES XXII. Plaintiffs request attorney’s fees and costs as provided by Miss. Code Ann. Section 11-53-59. PRAYER FOR RELIEF WHEREFORE, PREMISES CONSIDERED, Plaintiffs ask that this there Complaint be received and filed and that process issue to Defendant. Further, Plaintiffs pray that notification to all class members represented be effected; and that all others actions to this effect be enjoined so that all persons with similar claims may be brought into this action and all may resolved. Additionally, Plaintiffs pray that the judgment of this Court be entered in their favor and against , to-wit:A. Plaintiffs respectfully request that an injunction issue enjoining the fraudulent business practices of the Defendant.B. Plaintiffs respectfully request that Defendant be ordered to account requiring the Defendant to explain its complicated and falsified accounts and amounts actually paid versus amounts falsely represented to Plaintiffs to have been paid.C. Plaintiffs request judgment against Defendant and in their favor and in to which they may be entitled in the premises. Respectfully submitted,_______________________________________ Attorney for Of Counsel: Telephone: MSB # Attorney for