Medicare-eligible New York City retirees and dependents may be able to recover $15 medical copays through a proposed settlement with the City of New York, EmblemHealth and GHI. Only class members who received customized Claim Forms identifying potential copay exposure can seek reimbursement, and they must submit signed forms by October 30, 2026.
The lawsuit alleges that copays imposed on the EmblemHealth-administered medical portion of the GHI Senior Care Plan from January 1, 2022 through January 31, 2023 violated the governing plan terms and other law. The defendants deny every claim, the court has not decided which side is right, and no payment will be issued unless the settlement receives final approval.
Who can submit a reimbursement claim?
The broader settlement class includes Medicare-eligible retired New York City employees and their Medicare-eligible dependents who were enrolled in the medical GHI Senior Care Plan at any time from January 1, 2022 through January 31, 2023. The case concerns the $15 copays applied to the medical component administered by EmblemHealth. It does not concern the hospital component administered by Anthem.
That class definition does not mean every class member can receive money. According to the official notice, EmblemHealth used its claims data to identify members potentially exposed to one or more eligible copays. Those people receive customized Claim Forms listing the copays for which they may seek reimbursement. A class member who did not receive a Claim Form remains bound by the settlement unless they opt out, but is not eligible to claim reimbursement.
Documentation controls how much may be reimbursed
A claimant who submits acceptable proof of paying a listed $15 copay may be eligible for up to full reimbursement of that copay. Examples in the notice include a receipt, canceled check, credit-card statement or provider letter. Submitted proof must be substantially consistent with the copay information in EmblemHealth's data.
Claimants without payment documents are not necessarily excluded. They may sign an affirmation that they paid the listed copay and seek partial reimbursement. Each undocumented copay is limited to up to 40% of its amount, and all undocumented copay reimbursements are capped at $100 per class member. Proof of a legal name change or authority to act for another person is mandatory when applicable.
The $53 million settlement amount represents the approximate maximum potential copays in EmblemHealth's data, not a guaranteed payout to the class. Fees of $9.9 million, costs up to $100,000 and service awards up to $25,000 come out first. If approved claims exceed the remaining net amount, reimbursements will be reduced pro rata. Any money left after approved claims will return to the defendants.
How and when to file the customized form
The completed and signed customized Claim Form and all supporting materials must be submitted online or mailed by October 30, 2026. Email submission is not permitted. Online claimants use the settlement portal and the member information provided with their forms; mailed claimants send the materials to the settlement administrator at the address in the notice.
The administrator reviews forms for timeliness, completeness and documentation. A cure letter may provide an opportunity to correct some deficiencies, but missing the claim deadline results in denial. A valid claim is required even for partial reimbursement without payment documents.
Online claimants may choose PayPal, Venmo, Zelle, direct deposit or a mailed check. Mail claimants receive checks. Distribution will occur only after final approval and the resolution of any appeals.
Opting out and objecting have separate deadlines
The deadline to request exclusion is October 15, 2026. Excluding yourself gives up any settlement reimbursement but preserves the ability to pursue the released claims separately. A request must be mailed and comply with the official notice.
The objection deadline is November 30, 2026. Objecting does not remove a person from the class and does not replace filing a Claim Form. A class member can submit a claim and also object, but cannot object after validly excluding themselves.
Court approval is still pending
The final approval hearing is scheduled for March 24, 2027 at 2:15 p.m. in Room 412 of the Supreme Court of the State of New York, County of New York, 60 Centre Street, New York, New York. The official notice does not state a timezone.
At the hearing, the court will consider the proposed settlement, requested fees, costs, service awards and plan of allocation. The court may change the hearing details. Claimants should use the official settlement website for current information and submit their forms by October 30 rather than waiting for the hearing.