Published
September 6, 2026
Medicare-eligible retired New York City employees and their Medicare-eligible dependents enrolled in the EmblemHealth-administered GHI Senior Care plan between January 1, 2022 and January 31, 2023 may qualify to claim reimbursement of the $15 medical co-pays they paid, from a settlement with the City of New York and EmblemHealth capped at $53 million. Claims close October 30, 2026, and only class members who received a customized Claim Form in the mail are eligible to file one.
Current Status
Claims are open. The deadline to file is October 30, 2026, for both online submissions and mailed forms, and the notice gives a date with no timezone, so none is published here. The Court granted preliminary approval and authorized the notice; customized Claim Forms have gone out to eligible class members and the claim portal on the official settlement website is live. The final approval hearing is scheduled for March 24, 2027 at 2:15 p.m. in New York County. No final approval order has been entered and no payment date has been announced.Filing depends on the customized Claim Form. It is mailed only to the class members EmblemHealth's own claims data identified as potentially exposed to at least one co-pay, and the online portal will not open without the Claimant ID printed on it. A class member who never received one is not eligible for reimbursement, but is still bound by the settlement unless they opt out by October 15, 2026.
Status
Claims Open
Claim Deadline
October 30, 2026
Online submissions and mailed forms · no timezone stated in the notice · opt out by October 15, 2026
Estimated Payout
Up to 100% of co-pays paid
Documented co-pays reimbursed up to the full amount; undocumented co-pays up to 40%, capped at $100 per class member · pro rata reduction if approved claims exceed the fund
Proof Required
Yes
The Claimant ID from the mailed Claim Form plus the GHI Senior Care member ID are required to file online · receipts, a statement or a provider letter are needed for more than the $100 undocumented cap
What Changed Recently?
The parties signed the settlement agreement on July 30, 2026 and filed it with the Court the following day, and the Court has since granted preliminary approval, appointed Atticus Administration LLC as Claims Administrator and authorized notice to the class. That is what opened the claim process: the official settlement website went live, and the administrator began sending the notice by mail and, where EmblemHealth had an address on file, by email — with a customized Claim Form for the class members eligible to file one.The dispute goes back to January 1, 2022, when the defendants implemented $15 co-pays for certain eligible medical services in the portion of the GHI Senior Care plan that EmblemHealth administers. The lawsuit was filed in November 2022. The plaintiffs alleged, among other things, that the co-pays violated the contract between the City and EmblemHealth because the Certificate of Insurance was silent on co-pays and provided that Medicare would pay the first 80% of a reasonable charge for a covered service with EmblemHealth responsible for the remaining 20%. The defendants denied all of the claims, and the settlement agreement states they deny any wrongdoing, liability or damages and agreed to resolve the case to avoid the time, risk and expense of protracted litigation. The Court has not decided whether either side should win.
Two procedural events in between explain why the class period stops where it does. The plaintiffs obtained a preliminary injunction on January 11, 2023 that barred further imposition of 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 were reinstated that day. They remain in effect. Under the settlement they will not be increased beyond $15 before December 31, 2027.
Free settlement alerts
Get notified when new class actions open to claims
Join thousands of readers who get the latest class action settlements you may qualify for — delivered straight to your inbox.
Who Qualifies?
The class covers 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 between January 1, 2022 and January 31, 2023. The notice puts the class at approximately 246,000 people. The Court certified the class on October 20, 2023. Eligibility follows the plan enrollment rather than a current address, so a retiree who has since moved out of New York is still in the class.Membership in the class and eligibility to be paid are two different things here:
- Everyone in the class is bound. A class member who does not opt out releases the claims covered by the settlement, whether or not they file anything and whether or not they ever received a notice in the mail.
- Only some of the class can claim. EmblemHealth identified, from its medical provider claims data, the class members potentially exposed to at least one co-pay for an eligible medical service during the class period. Those class members were mailed a customized Claim Form. The notice states that a class member who did not receive a Claim Form is not eligible to claim reimbursement for the co-pays at issue.
Two limits on scope are worth knowing. EmblemHealth co-administers Senior Care with Anthem/Empire Blue Cross Blue Shield: EmblemHealth handles the medical component and Anthem handles the hospital component, and this case covers only the $15 co-pays implemented on January 1, 2022 in the EmblemHealth-administered medical portion. Hospital-component co-pays are not part of it. Separately, the NYC Organization of Public Service Retirees is itself excluded from the settlement class as an entity, though that exclusion does not reach its individual members.
How Much Can You Get?
The defendants' liability is capped at $53,000,000. The notice describes that figure as the approximate total of all co-pays for eligible services that class members could have incurred during the class period, based on EmblemHealth's medical provider claims data — not the amount class members actually paid.The money is paid out in a fixed order, and claims come last. First, subject to Court approval, $9,900,000 goes to class counsel as fees and up to $100,000 as costs. Then up to $5,000 in service awards goes to each of the five class representatives, for up to $25,000 in total. What remains is the Net Settlement Amount, and it is what pays approved claims.
Each approved claim is then reimbursed on one of two 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, subject to a maximum of $100 per class member, where the claimant signs the affirmation but has no proof of payment.
Both figures are ceilings rather than guaranteed amounts. If the total of approved claims exceeds the Net Settlement Amount, the notice states that payments are reduced and distributed on a pro rata basis, so treat any dollar estimate as an estimate until the administrator issues a final calculation. This is also a reversionary settlement: any part of the $53 million not paid out reverts to the defendants rather than being redistributed among class members.
What Proof or Notice ID Is Required?
Two separate things are required: an administrator-issued identifier to open the claim at all, and payment documentation to be reimbursed above the $100 undocumented cap.To file online, the portal requires the unique Claimant ID number printed on the mailed Claim Form together with the member ID number from the front of the GHI Senior Care insurance card. The paper route is not an escape hatch either, because the form that goes back in the envelope is the same customized, pre-populated one that arrived in the mail. There is no blank claim form to download and no path for a class member who never received one.
For documented reimbursement, the notice lists the acceptable proof of payment for each co-pay: a receipt, a cancelled check, a bank statement, a credit card statement, or a written letter from the medical provider confirming the co-pay was paid, using the provider form letter attached to the Claim Form. Whatever is submitted must be substantially consistent with EmblemHealth's data as printed on the form. The notice asks claimants not to send original documents and to redact sensitive information, and states that submitted documents are not returned.
Two other documents are required in specific situations, and the notice is explicit that failing to provide them results in denial. A claimant whose name has legally changed must submit proof of the change, such as a court order, marriage certificate or divorce decree. Someone filing on behalf of a deceased or incapacitated class member must submit proof of authority to act — a death certificate, letters testamentary, letters of administration or other court-issued documentation for a deceased member, or a power of attorney or letter of authority for an incapacitated one.
The signature is not optional in any scenario. Every Claim Form must carry the signed affirmation that the class member actually paid the co-pays being claimed; the notice states a signature is required for any and all reimbursements.
An incomplete, unsigned or inadequately documented submission is not simply rejected. The Claims Administrator sends a cure letter explaining what needs to be fixed. A claimant who does not respond in time to a cure letter about a signature, a missing checkbox, a name change or legal authority will have the claim denied. A claimant who does not respond to a cure letter about proof of payment keeps the claim, but it converts to an Undocumented Claim and is capped accordingly.
What Is the Deadline?
Claims must be submitted through the online portal or postmarked by October 30, 2026. The notice gives a date with no timezone, so no timezone is published here. Late submissions are not accepted. Changes or additional documents also have to be in before that date; after it, the online claim links are deactivated, though the claim dashboard stays open for checking status.The opt-out deadline is earlier: a signed written Request for Exclusion must be postmarked no later than October 15, 2026, and the notice states it can be submitted only by U.S. Mail. Opting out means no payment and no ability to object, but it also means not being bound by the release and keeping the right to bring a separate lawsuit over these claims. A request for exclusion is void if the same class member also files a valid, timely Claim Form.
Objections run the other way and are due later. A class member who wants to stay in the settlement but disagrees with it — including with the fee request or the service awards — must submit a written objection to the Court and to counsel for all parties by November 30, 2026, stating the grounds and whether the objector or their counsel intends to appear. A separate Notice of Intention to Appear at the final approval hearing is due by that same date. Objecting does not exclude anyone from the class, and a class member may file a claim and object.
Doing nothing means no reimbursement and still being bound by the release.
How Do You Take Action?
File through the claim portal on the official settlement website at Senior Care Copay Settlement.com, using the link or QR code printed on the Claim Form.The online path is the better one where it is available. After authenticating with the Claimant ID and the GHI Senior Care member ID, the claimant reviews and corrects the pre-populated name and address, adds contact details, confirms for each listed date of service whether that co-pay was actually paid, indicates what proof is being submitted, uploads the supporting documents and signs the affirmation digitally. A claim can be started and finished later without losing the entries, and it can be edited and added to right up to the deadline. The dashboard shows near-real-time claim status afterward.
Online filers also get a choice of payment method — PayPal, Venmo, Zelle, direct deposit or a physical check by mail. Anyone who files the paper form by mail is sent a physical check; there is no payment-method choice on that route.
Claims cannot be emailed. The notice states plainly that claims sent by email will not be accepted, because the Claim Form and its attachments contain Protected Health Information under HIPAA. Use the online portal or the mail, not both.
Anyone who needs to reach the Claims Administrator — to change a mailed submission, add a document, ask about a cure letter or check claim status — should use the contact page on the official settlement website.
What Happens Next?
The next milestone is the final approval hearing on March 24, 2027 at 2:15 p.m. before the Supreme Court of the State of New York, New York County. The Court will decide whether to approve the settlement as fair, reasonable and adequate, and will rule on the requested class counsel fees and costs, the service awards and the plan of allocation. Class members are not required to attend; anyone who wants to speak has to have asked in advance.Payments follow only after final approval, and only after any appeals are resolved. The settlement agreement provides that the Claims Administrator distributes funds within 30 days after the Effective Date, which is defined to fall after the Final Approval Order is entered and, where an appeal is filed, after it is dismissed or the order is affirmed. The notice does not announce a payment date, and a scheduled hearing is not an approval order.
Two later dates are worth noting for anyone who does get paid. A class member who receives a physical check has 120 days from distribution to cash or deposit it, and money behind checks not negotiated in that window reverts to the defendants. Separately, the settlement holds the current $15 Senior Care co-pays at that level, without increase, through December 31, 2027.
The settlement could also come apart before any of that. The defendants reserved the right to terminate it if more than 335 class members opt out, and the agreement provides that the parties return to their prior positions if it is terminated or not approved.
Sources and Verification
- Official settlement website — Bianculli v. City of New York, Senior Care Co-Pay Settlement
- Notice of Class Action Lawsuit and Proposed Settlement (PDF)
- Court documents, including the Settlement Agreement and Preliminary Approval Order
- Official settlement website — Important Dates
- Official online claim portal
- Affirmation of Steve Cohen in Support of Motion for Preliminary Approval of Class Action Settlement, with the executed Settlement Agreement and exhibits — 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
Questions
I was in Senior Care but never received a Claim Form. Can I still get money?
No. The notice states that a class member who did not receive a Claim Form is not eligible to claim reimbursement for the co-pays at issue, because EmblemHealth's medical provider claims data did not identify that person as potentially exposed to a co-pay during the class period. That class member is still a member of the Settlement Class and is still bound by the settlement and its release unless they opt out by October 15, 2026.
What if I paid the co-pays but have no receipts?
A claim can still be filed. The claimant signs the affirmation on the Claim Form stating that the co-pays were actually paid, and the Claims Administrator reviews it as an Undocumented Claim. Undocumented co-pays are reimbursed at up to 40% of the co-pay amount, capped at a maximum of $100 per class member, rather than up to the full amount.
Can the Claim Form be emailed to the administrator?
No. The notice states that claims sent by email will not be accepted, because the Claim Form and its supporting documents contain Protected Health Information under HIPAA. The only two accepted methods are the online portal on the official settlement website and a paper form returned by mail, and a claimant may use one method or the other but not both.
Does this settlement get rid of the $15 Senior Care co-pays?
No. The $15 co-pays were reinstated on January 1, 2025 after the Court's preliminary injunction was vacated, and they remain in effect as implemented. Under the settlement the co-pays currently in effect for Senior Care will not be increased beyond $15 before December 31, 2027.
What happens to settlement money that nobody claims?
It goes back to the defendants. The settlement agreement describes a reversionary settlement: any portion of the $53 million cap not paid out under the agreement reverts to the defendants, as do the amounts behind checks that are not cashed or deposited within 120 days of distribution and payments returned as undeliverable.
Who decides how many co-pays I was charged?
EmblemHealth's medical provider claims data does. The settlement agreement states that data is conclusive as to the identity of class members and the amount of co-pay exposure, and the mailed Claim Form arrives pre-populated with the date of service, the provider name and the co-pay amount for each visit. Any proof of payment submitted must be substantially consistent with that data.
Official Settlement Notice
For more class actions keep scrolling below.
Settlement Amount
Up to $53,000,000
Reversionary — anything not paid out returns to the defendants
Case Title
Bianculli, et al. v. City of New York Office of Labor Relations, et al.
Case Number
Index No. 160234/2022
Court
Supreme Court of the State of New York, New York County
Final Approval Hearing
March 24, 2027 at 2:15 PM
New York County · attendance is not required
Administrator
Atticus Administration LLC
Official Website
Senior Care Copay Settlement.com
