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Medicare-eligible retired New York City employees or Medicare-eligible dependents enrolled in the EmblemHealth-administered GHI Senior Care plan at any time from Jan. 1, 2022, through Jan. 31, 2023, may be eligible to claim a cash payment from a class action settlement.
EmblemHealth Inc. and the City of New York agreed to pay up to $53,000,000 to settle a class action lawsuit alleging they improperly implemented $15 copays for medical services under the GHI Senior Care plan during 2022 and early 2023. The lawsuit claimed the plan's contract did not authorize these copays and that the defendants did not properly disclose them.
Who can file a claim?
Class members must be Medicare-eligible retired New York City employees or Medicare-eligible dependents enrolled in the EmblemHealth-administered GHI Senior Care plan at any time between Jan. 1, 2022, and Jan. 31, 2024.
The settlement administrator identified class members using EmblemHealth’s records and sent them a notice and customized claim form listing the dates of service, providers and potential copay amounts based on EmblemHealth’s data.
- Those who received a claim form are eligible to claim reimbursement for the copays listed on their form.
- Those who did not receive a claim form are still class members bound by the settlement but are not eligible for reimbursement unless they can show they paid a copay during the class period.
How much can class members receive?
The amount class members can claim depends on the number and type of copays they paid during the class period and whether they have documentation.
- Class members who submit proof of payment for a listed copay may receive up to the full $15 per copay.
- Class members who do not have proof of payment but attest that they paid the copay may receive up to 40% of the copay amount up to a total of $100 for all undocumented claims.
If total valid claims exceed the net settlement fund, the settlement administrator will reduce payments proportionally (pro rata).
How to claim a settlement payout
Class members must file a claim online using their unique claimant ID and GHI Senior Care member ID or complete the claim form they received and mail it to the settlement administrator.
Settlement administrator's mailing address: Senior Care Co-Pay Settlement, c/o Atticus Administration, PO Box 64053, St. Paul, MN 55164
What proof or documentation is necessary to submit a claim?
To receive full reimbursement, class members must submit proof of payment for each copay. Acceptable proof includes:
- Receipts
- Canceled checks
- Bank or credit card statements
- A signed letter from your provider confirming payment (a template is available on the settlement website)
Those who do not have documentation may still claim up to 40% of the copay amount (up to $100 total for all undocumented claims) by signing an affirmation that they paid the co-pay.
Payout options
- For online submissions: PayPal, Venmo, Zelle, direct deposit or a mailed check
- For mail submissions: Mailed paper check
$53 million settlement fund breakdown
The $53,000,000 settlement fund will include:
- Settlement administration costs: To be determined
- Attorneys' fees: $9,900,000
- Attorneys' expenses: Up to $100,000
- Service awards to class representatives: Up to $25,000 ($5,000 each for five representatives)
- Payments to eligible class members: Remaining net settlement fund after above deductions
Important dates
- Deadline to opt out: Oct. 15, 2026
- Deadline to file a claim: Oct. 30, 2026
- Final approval hearing: Mar. 24, 2027
When is the senior care copay settlement payout date?
The settlement administrator will issue payments after the court resolves any appeals and grants final approval to the settlement.
Why is there a class action settlement?
The class action lawsuit alleged EmblemHealth and the City of New York improperly imposed $15 copays in the GHI Senior Care plan starting Jan. 1, 2022, without proper contractual authority or disclosure. The plaintiffs claimed this violated the insurance contract and other laws.
The defendants denied wrongdoing but agreed to settle to avoid the risks and costs of further litigation.
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