For New York City retirees in GHI Senior Care, the paperwork decides the payout: co-pays backed by a receipt, bank or card statement, cancelled check or provider letter can be reimbursed up to 100%, while co-pays claimed on your word alone are capped at 40% and no more than $100 in total. That gap is the reason to start gathering records now. Claims in the settlement with the City of New York and EmblemHealth, capped at $53 million, are due October 30, 2026 — and only retirees who were mailed a customized Claim Form can file.
Status: Claims open, preliminarily approved | Claim deadline October 30, 2026 | Opt out by October 15, 2026 | Object by November 30, 2026 | Up to 100% of documented $15 co-pays
The $15 Co-Pays at Issue
On January 1, 2022, the defendants began charging $15 co-pays for certain medical services in the part of the GHI Senior Care plan that EmblemHealth administers. The case, Bianculli, et al. v. City of New York Office of Labor Relations, et al., Index No. 160234/2022, was filed in November 2022 in the Supreme Court of the State of New York, New York County.
The plaintiffs alleged, among other things, that the co-pays breached the contract between the City and EmblemHealth, because the Certificate of Insurance said nothing about co-pays and provided that Medicare pays the first 80% of a reasonable charge for a covered service and EmblemHealth the remaining 20%. The defendants deny all wrongdoing, liability and damages and settled to avoid the time, risk and expense of further litigation. The court has not decided who is right.
The class period is short because of what happened next. On January 11, 2023, the plaintiffs won a preliminary injunction stopping the co-pays. That injunction was vacated effective January 1, 2025, after EmblemHealth filed a revised Certificate of Insurance that expressly provides for $15 co-pays, and the co-pays came back that day. They are still in effect. Under the settlement, they cannot go above $15 before December 31, 2027.
Two Reimbursement Tracks
| Documented co-pays | Up to 100% of each $15 co-pay for which proof of payment is submitted and accepted |
| Undocumented co-pays | Up to 40% of the co-pay amounts incurred, with a maximum of $100 per class member, when you sign the affirmation but have no proof |
Accepted proof for each co-pay is a receipt, a cancelled check, a bank statement, a credit card statement, or a written letter from the medical provider confirming payment, using the provider form letter that comes attached to the Claim Form. Whatever you send must be substantially consistent with EmblemHealth’s data printed on your form. Do not send originals, redact sensitive information, and expect that documents will not be returned.
Both tracks are ceilings. If approved claims add up to more than the money available, payments are reduced pro rata.
Who Can File — and Who Is Bound Anyway
The class is all Medicare-eligible retired New York City employees and their Medicare-eligible dependents who were enrolled in the EmblemHealth-administered medical GHI Senior Care plan at any time from January 1, 2022 through January 31, 2023 — about 246,000 people. The court certified the class on October 20, 2023. It follows plan enrollment, so retirees who have since left New York are still included.
Being in the class is not the same as being able to claim. EmblemHealth used its medical provider claims data to identify members potentially charged at least one co-pay, and only they were mailed a customized Claim Form. According to the notice, a class member who did not get a Claim Form is not eligible for reimbursement, but is still bound by the settlement’s release unless they opt out. The settlement agreement treats EmblemHealth’s data as conclusive on who is in the class and how many co-pays each person was charged.
Two limits on scope: Senior Care is co-administered with Anthem/Empire Blue Cross Blue Shield, which handles the hospital component, and hospital co-pays are not part of this case. And the NYC Organization of Public Service Retirees is excluded as an organization, though its individual members are not.
Where the $53 Million Goes
The $53,000,000 is the defendants’ maximum liability, described in the notice as the approximate total of all co-pays class members could have incurred for eligible services during the class period — not what was actually paid. Subject to court approval, class counsel take $9,900,000 in fees and up to $100,000 in costs first, then each of five class representatives may receive up to $5,000. Approved claims are paid from what remains.
This is a reversionary settlement. Any part of the cap not paid out goes back to the defendants, as does money from checks not cashed or deposited within 120 days and payments returned as undeliverable.
Filing: Two Numbers and a Signature
The online claim portal on the official settlement website requires the Claimant ID printed on your mailed Claim Form and the member ID from the front of your GHI Senior Care card. Online, you correct the pre-filled name and address, confirm for each listed date of service whether you paid the co-pay, upload proof and sign the affirmation. You can save and return, and edit up to the deadline. Online filers choose PayPal, Venmo, Zelle, direct deposit or a check; paper filers are paid by check.
Paper filing uses the same customized form that came in the mail; there is no blank form to download. Claims cannot be emailed, because the form contains Protected Health Information under HIPAA. Use the portal or the mail, not both.
Every claim needs the signed affirmation that you paid the co-pays. A legal name change requires proof such as a court order, marriage certificate or divorce decree. Filing for a deceased or incapacitated member requires proof of authority, such as a death certificate, letters testamentary or administration, a power of attorney or a letter of authority. A deficient claim gets a cure letter; failing to answer one about a signature, checkbox, name change or authority leads to denial, while failing to answer one about proof of payment turns the claim into an undocumented claim capped at $100.
Deadlines and What Comes After
| October 15, 2026 | Opt-out requests postmarked, by U.S. Mail only |
| October 30, 2026 | Claims submitted online or postmarked; late claims are not accepted |
| November 30, 2026 | Written objections and notices of intention to appear |
| March 24, 2027, 2:15 p.m. | Final approval hearing, New York County |
An opt-out is void if the same person also files a valid claim. Funds are distributed within 30 days after the effective date, which falls after final approval and any appeal. The defendants can terminate the deal if more than 335 class members opt out. The Senior Care co-pay settlement page on OpenClassActions.com tracks the case and embeds the notice.
Frequently Asked Questions
How much can I get back from the Senior Care co-pay settlement?
Up to 100% of each $15 co-pay you can document with a receipt, cancelled check, bank or credit card statement, or a provider letter. Without proof, reimbursement is up to 40% of the co-pays, capped at $100 per class member. Payments are reduced pro rata if approved claims exceed the available fund.
I never received a Claim Form. Can I file?
No. The notice says class members who did not receive a customized Claim Form are not eligible for reimbursement, because EmblemHealth’s data did not show them as potentially charged a co-pay. They are still bound by the release unless they opt out by October 15, 2026.
What do I need to file online?
The Claimant ID printed on your mailed Claim Form and the member ID from the front of your GHI Senior Care insurance card, plus a signed affirmation and any proof of payment you have.
Can I email my claim?
No. Emailed claims are not accepted because the form contains Protected Health Information. File through the online portal or mail the paper form, but not both.
Are hospital co-pays covered?
No. The case covers only the $15 co-pays introduced on January 1, 2022 in the medical portion of Senior Care that EmblemHealth administers, not the hospital component handled by Anthem/Empire Blue Cross Blue Shield.
Will the $15 co-pays go away?
No. They were reinstated on January 1, 2025 and remain in effect. The settlement only holds them at no more than $15 through December 31, 2027.
Sources
- Official settlement website — SeniorCareCopaySettlement.com, including the notice (PDF), court documents, important dates and claim portal, administered by Atticus Administration LLC.
- Affirmation in support of preliminary approval with the executed settlement agreement, Bianculli, et al. v. City of New York, et al., Index No. 160234/2022, NYSCEF Doc. No. 203 (filed July 31, 2026).
- The Chief-Leader — Retirees get $53 million in settlement with city, EmblemHealth over co-pays.
- amNewYork — NYC, EmblemHealth to pay $53M worth of copays back to city retirees.
- OpenClassActions.com — EmblemHealth & NYC $53M Senior Care Co-Pay Settlement.
Source and credit: the settlement terms, deadlines and benefit details described above are drawn from our sister site’s reporting — OpenClassActions.com: EmblemHealth & NYC $53M Senior Care Co-Pay Settlement — Reimbursement for $15 Medical Co-Pays — which tracks this case against the court-approved notice and the official settlement website and is updated as the court rules.
Legal Disclaimer
This article is for informational purposes only and is not legal advice. OpenClassActions.org is a consumer news site, not a law firm and not the settlement administrator, and is not affiliated with any party to the case described. The allegations are allegations; unless a court has ruled, the defendants deny wrongdoing and no court has decided the merits. Deadlines, benefit amounts and payment timing can change as the court and the administrator act, so confirm current status on the official settlement website. You never need to pay anyone to file a claim or to receive a settlement payment.