Like the plaintiffs in the earlier wave of suits, the plaintiffs in the new wave of suits are accusing the health insurers and managed care companies in the Blue Cross and Blue Shield Association of colluding in ways that limited competition in the health insurance market by causing association members to avoid competing head-to-head in other association members' home markets, or "exclusive service areas."

The Blue Cross and Blue Shield Association controls use of the Blue Cross and Blue Shield trademarks. Association members conduct some of their business using companies with Blue Cross or Blue Shield in their names and other business using companies that leave out the Blues branding.

A group of health care systems that includes Temple University Health, Children's Hospital of Philadelphia and Geisinger Health is objecting to the Blues' "national best efforts rule," which has discouraged Blues from earning more than 33% of their revenue from the sale of non-Blues brand services, according to that group's complaint.

The Temple University group is also objecting to a "local best efforts rule," which requires that 80% of the revenue that a Blues carrier gets in its home markets come from the sale of Blues brand services.

"The effect of these restraints is to ban or otherwise frustrate all competition for the purchase of health care services among defendant insurance companies," the group says.

The parties in the suits could not immediately be reached for comment.

Health care providers have complained about dwindling competition in the health insurance market hurting their ability to get fair reimbursement deals.

Health coverage providers and others say the real problem is dwindling competition in the hospital and health care provider practices.

What it means: For employers struggling to pay for health benefits, watching the new wave of suits might make them feel as if they were Batman watching the Joker fighting with the Riddler.

In theory, the plaintiffs' success could reduce any excess costs created by the dominance of the Blues.

But successful hospital efforts to tame the Blues could also reduce the Blues' ability to negotiate with the hospitals for lower prices.

Hospital efforts to tame the Blues could also hurt Blues plan characteristics that make the plans appealing to employers and employees in many markets, such as big provider networks and relatively easy access to care outside of an employee's home market through the Blues' national network access programs.