Ambetter health plan members may be covered by a proposed class action alleging Centene sold ACA marketplace coverage backed by inaccurate provider directories that left patients unable to find in-network care. No class has been certified and there is nothing to file yet.
Allegations Only · No Settlement Yet
This article describes a class action complaint. The statements below are unproven allegations. Centene has not been found liable, there is no certified class, and nothing to claim at this time. This page is informational and is not legal advice.
What Is This About?
Centene Corporation, the largest insurer on the Affordable Care Act exchanges, faces a proposed class action over the provider networks behind its Ambetter marketplace plans. The case is Havrilla v. Centene Corporation, No. 1:22-cv-04126, filed August 5, 2022 in the U.S. District Court for the Northern District of Illinois against Centene Corporation, Centene Management Company, LLC and Celtic Insurance Company.The complaint alleges that Ambetter plans were marketed with provider directories that substantially overstated the doctors actually available to members, and it pleads claims under the federal racketeering statute along with several state consumer protection laws. Centene denies the allegations, and none of them has been proven.
The case is in discovery. There is no certified class, no settlement, no settlement fund and no claim form — a point worth stating plainly, because a great many readers arrive at this topic after receiving a payment from Ambetter and assuming the two are connected. They are not.
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What the Complaint Alleges
The complaint centers on what it calls ghost networks: provider directories listing physicians who are not in fact reachable through the plan because they have retired, relocated, left the network or stopped accepting new patients. The theory is that consumers chose and paid for Ambetter coverage in reliance on the breadth of those directories, then discovered on trying to use the plan that in-network care was far harder to obtain than advertised.Because the claims are pleaded under the federal racketeering statute in addition to state consumer protection laws, the case is structurally broader than an ordinary insurance dispute. Separate suits filed elsewhere have raised comparable network-adequacy allegations against Centene, including one tied to a member who died after being unable to obtain mental health treatment. Each of those allegations is likewise unproven.
Where the Case Stands
On May 2, 2024 the court granted in part and denied in part the defendants' motion to dismiss, allowing the bulk of the case — including the racketeering claims — to move forward. Only an unjust enrichment count and a claim under one state's consumer protection statute were dismissed.Discovery has run since then. The parties have taken corporate depositions and continue to litigate on a status-hearing schedule before a magistrate judge, with the most recent docket activity in August 2026. Class certification has not been briefed or decided.
What that means for a member is straightforward: a class action of this size ordinarily takes years, and class members are reached only after a court certifies a class and approves a formal notice program. Until that happens there is nothing to sign up for, and no legitimate service can file an Ambetter class action claim on anyone's behalf.
Then Why Did Ambetter Send a Check?
The payment readers most often mistake for litigation money is a Medical Loss Ratio rebate. It is a refund of premium required by the Affordable Care Act and administered under federal regulation at 45 C.F.R. Part 158, and it has nothing whatever to do with the Centene lawsuit.The rule is commonly called the 80/20 standard. Insurers in the individual and small group markets must spend at least 80 percent of premium revenue on medical claims and quality improvement activity, keeping no more than 20 percent for administration, marketing and profit. The threshold rises to 85 percent in the large group market. When an insurer falls short of the applicable standard, federal law requires it to return the difference to the people who paid the premiums.
A rebate can arrive as a mailed check or as a credit applied to a future premium bill. Either form is a return of premium dollars, not compensation for any alleged wrongdoing, and it is not an admission of anything.
How an MLR Rebate Is Actually Calculated
Three features of the calculation are routinely misunderstood, and all three matter for anyone trying to work out why they did or did not receive a payment.It is not based on one year. The medical loss ratio is averaged across three years. Rebates issued during 2026 are computed from insurers' 2023, 2024 and 2025 experience and go to people who held coverage in 2025. A single strong or weak year does not by itself create or eliminate a rebate.
It is calculated per state and per market, not per person. An enrollee's own medical usage is irrelevant. What matters is how the insurer's whole book of business performed in that state and market. If the threshold is missed there, every eligible enrollee in that pool shares proportionally in the rebate; if it is met, nobody in that pool receives one.
The deadline is fixed. Under the regulation an issuer must provide any rebate owed no later than September 30 following the reporting year, which is why these payments cluster in late summer and early fall. Rebates delivered as a premium credit follow a slightly later schedule. Insurers that owe a rebate must also send a formal notice describing it.
Across all insurers and all markets, KFF estimated from preliminary filings that roughly $759 million in rebates would be paid in 2026 — a modest figure by the standards of the past decade, and one spread across the entire industry rather than concentrated in any single company.
Why Ambetter Payments Are Landing Right Now
Ambetter members have reported receiving payments during September 2026, and the timing is not a coincidence. The federal regulation sets a hard date: an issuer must deliver any rebate it owes no later than September 30 following the reporting year. Rebates for the 2025 reporting year are therefore due by September 30, 2026, which is why checks and premium credits cluster in the second half of September.These payments are also not unusual for this insurer. Celtic Insurance Company, the Centene subsidiary that underwrites Ambetter marketplace coverage, owed some of the largest individual-market rebates in the country for the 2024 reporting year — roughly $67 million in Alabama and about $40 million in Indiana, according to the federal summary of issuers owing rebates. An insurer that missed the 80 percent standard by that margin in those states returns a substantial sum to the enrollees who paid the premiums.
The reason a company with high overall medical spending can still owe rebates like these is the one mentioned above: the regulatory medical loss ratio is not the same measure as the health benefits ratio a company reports to investors. Centene withdrew its 2025 earnings guidance on July 1, 2025 after data covering 22 of its 29 marketplace states showed morbidity far above its pricing assumptions, and its overall health benefits ratio hit 93.0 percent in the second quarter of 2025, against 87.6 percent a year earlier. Those are company-wide figures across every line of business. The rebate calculation is run separately for each state and each market, on a different formula, averaged over three years — so a single state pool can miss the standard badly even in a year when the parent company spent heavily on care nationally.
What none of this establishes is that any particular member is owed anything. The federal government publishes the per-issuer, per-state totals for a reporting year later in the calendar year, so the 2025-year figures for Ambetter were not yet public when this page was written. Members in states where the standard was met receive nothing, and that is the ordinary outcome rather than an error.
Telling a Real Payment From a Fake One
A genuine MLR rebate does not arrive unexplained. The regulation requires the insurer to send a notice describing the rebate and the reason for it, so a legitimate payment is accompanied by paperwork that a member can match against their own plan and state.That requirement is also the best defense against impersonation. Insurance and settlement themes are common in phishing and check fraud, and a payment that arrives with no notice, demands a fee, asks for banking credentials, or requires a member to verify a Social Security number to release funds does not match how rebates work — rebates require no action at all to receive. Anything a member is unsure about is worth verifying through the insurer's official member portal or the contact information printed on their own insurance card, rather than through a number or link supplied by the message itself.
Questions
Is there an Ambetter class action settlement?
No. Havrilla v. Centene Corporation is in discovery in the Northern District of Illinois. No class has been certified, no settlement has been reached, no settlement fund exists and there is no claim form. Any website offering to file an Ambetter class action claim is not describing a real claims process.
Why did Ambetter send a check or apply a premium credit?
The most common explanation is a Medical Loss Ratio rebate, a refund required under the Affordable Care Act when an insurer spends too little of its premium revenue on medical care in a given state and market. A payment can also be an ordinary premium overpayment refund. Neither has any connection to the ghost network litigation.
Why are Ambetter payments arriving in September?
Federal regulation requires an insurer to deliver any rebate it owes no later than September 30 following the reporting year, so rebates for the 2025 reporting year are due by September 30, 2026. That deadline is why payments cluster in the second half of September rather than arriving at random.
Does every Ambetter member get an MLR rebate?
No. Rebates are owed only where an insurer's medical loss ratio falls below the applicable threshold, calculated separately for each state and market and averaged over three years. Many enrollees receive nothing, and an individual's own medical usage does not affect whether a rebate is owed.
What is a ghost network?
A ghost network is the term used in the complaint for a provider directory that lists doctors who are not actually available to the plan's members, because they have retired, moved, left the network or are not accepting new patients. The complaint alleges that members bought coverage in reliance on those directories and then could not find in-network care. Those allegations are unproven.
Is there anything an Ambetter member needs to do about the lawsuit now?
No. At the discovery stage there is no class, no notice program and no deadline. If a class is later certified, class members are reached through a formal court-approved notice. Records such as plan documents, provider directory screenshots and out-of-network bills are worth retaining in the meantime.
Sources
• U.S. District Court, Northern District of Illinois — docket in Havrilla v. Centene Corporation, No. 1:22-cv-04126• Electronic Code of Federal Regulations — 45 C.F.R. § 158.240, rebating premium if the medical loss ratio standard is not met
• Electronic Code of Federal Regulations — 45 C.F.R. § 158.251, notice of medical loss ratio information
• Centers for Medicare & Medicaid Services — Issuers Owing Rebates for 2024 (per-issuer, per-state summary)
• Centene Corporation — Centene Corporation withdraws 2025 guidance, July 1, 2025
• Centene Corporation — Centene Corporation reports 2023 results
• KFF — 2026 Medical Loss Ratio rebate estimates
