NYC and EmblemHealth Settle Senior Care Co-Pay Class Action for $53 Million

The Senior Care copay matter has been settled. Anyone who was enrolled in Senior Care from January 1, 2022 to January 31, 2023, and paid $15 copays is eligible to receive a refund. You are automatically part of the class. But to get a refund, you have to fill out a claim form. You can do this either on the special  online portal, or via a paper version which is being sent to you, at the address Emblem has on file for you 

If you haven’t received a paper claim form, please contact the Settlement Administrator Atticus Administration: 1-800-814-2610

Please participate; do not “opt out”

We encourage you to participate in this process. Any money that is not claimed will be returned to the City and Emblem. If you want to bring your own lawsuit with your own lawyer, you need to opt-out. If you just don’t want to participate, or don’t want to to ask for a refund, there is no need for you to do anything., there is no need to opt out.

If you have questions or need help

For any questions or concerns, please call Atticus Administration at 1-800-814-2610 or email SeniorCareCopaySettlement@AtticusAdmin.com. Do not email any attachments or screenshots; Atticus is not able to open these emails in case they contain your Personal Health Information (PHI).

Please note that paper class action notices will soon arrive in the mail. If you are eligible for reimbursement, you will also receive a claim form in the mailing.

Using the Online Portal

A special  settlement website has been set up. The web address is:: www.seniorcarecopaysettlement.com.

To log in to the settlement website you will need two pieces of information, (1) the Claimant ID that is on the top left of the email you received; and (2) your most recent Emblem Member ID, located on your ID card. If you do not have your Emblem Member ID, please contact Emblem.

If you are having issues logging in to the online dashboard:

• Make sure you are typing the Claimant ID and Member ID into the correct boxes.
• Distinguish between 1, I, and L.
• Type the Member ID in the correct case (upper case or lower case).

Documentation Needed for Full Reimbursement

To get a full reimbursement of any co-pays you paid during the class period, the settlement requires that you provide some proof that you actually paid the co-pays. (Some doctors actually refused to accept the co-pays until the litigation was resolved.) You can also get a partial reimbursement even if you don’t have documentation.

Any document that shows that you actually paid the copays for which you are eligible for reimbursement is acceptable. Explanations of Benefits and other bills are not acceptable because they do not show actual payment.

What is acceptable:

• Cancelled checks, paper receipts,  bank statements, and credit card statements  are all acceptable as proof.
• If iyou have a different kind of document that clearly shows payment, it may also be accepted.
• A letter from the provider. If you do not have any of these documents, a letter from the provider is also acceptable. You can download an acceptable sample of a medical provider letter from the the Atticus website (linked here). A sample will also be sent to you in the mail. Please ask the relevant providers to attest to your payment of copays on the dates listed on the claim form.
• If the proof of payment you submit is insufficient, Atticus will inform you, and you will have a chance to correct it.

Missing Dates of Care

Your claim form contains the dates of medical services you received – according to Emblem’s records.  If claim form does not reflect certain medical services that you believe you paid copays from January 1, 2022 through January 31, 2023, please contact Emblem or Atticus.

More Help

The NYC Organization has posted videos about the process and some common issues:

Video about How to Fill Out the Claim Form here.

Video with Q&A here.

About the Settlement: On July 31, 2026, New York City and EmblemHealth agreed to pay $53 million to settle a class action lawsuit on behalf of more than 250,000 elderly and disabled retired City workers enrolled in EmblemHealth’s GHI Senior Care Plan. The suit was brought by the NYC Organization of Public Service Retirees and a handful of retirees. The signed settlement papers were sent to New York County Supreme Court Justice Lyle E. Frank for the Court’s approval. Walden Haran Williams LLP was co-counsel with Pollock Cohen in representing the retirees.

The settlement refunds co-pays that retirees were unlawfully charged for medical visits between January 1, 2022 through January 31, 2023. The $53 million represents 100 percent of the co-pays retirees had been charged. In addition to the monetary settlement, the City and EmblemHealth also agreed not to increase the existing $15 Senior Care co-pays through at least December 31, 2027. 

The $53 million settlement amount is one of the largest class action settlements in New York City history. In addition, the lawsuit saved retirees an estimated $110 million through a temporary injunction, which halted the co-pays for two years.

Settlement documents are here.