EmblemHealth & NYC Senior Care Co-Pay Class Action Settlement

Critical gate: being in the GHI Senior Care class does not mean you can claim money. Only people EmblemHealth's data flagged as potentially exposed to at least one $15 co-pay were mailed a customized Claim Form, and only those people can file. If you never received a Claim Form, you cannot submit one and you get nothing — but you are still bound by the release unless you opt out by October 15, 2026. The fund is up to $53 million and is reversionary (unclaimed money goes back to the defendants). Claim deadline: October 30, 2026.

Do I Qualify?

You may be eligible if:

• You are a Medicare-eligible retired NYC employee, or a Medicare-eligible dependent, enrolled in EmblemHealth-administered GHI Senior Care between January 1, 2022 and January 31, 2023
• You actually received a mailed customized Claim Form — without that form you cannot file and you get nothing
• EmblemHealth's claims data flagged you as potentially exposed to at least one $15 co-pay
• You have the Claimant ID from the mailed form and the GHI Senior Care member ID from the insurance card
• You file by October 30, 2026 (opt-out deadline is earlier: October 15, 2026)

You must have the mailed Claim Form. There is no blank form for people who never received one. Documented claims need a receipt, cancelled check, bank/credit card statement, or provider letter. Undocumented claims use a signed affirmation only (up to 40%, capped at $100). Email is not accepted.

What Happened?

Plaintiffs alleged that Medicare-eligible NYC retirees in the EmblemHealth-administered GHI Senior Care plan were charged a $15 co-pay they should not have paid. Defendants deny wrongdoing and agreed to settle.

The settlement has a $53 million cap and is reversionary: money that is not claimed reverts to the defendants instead of being redistributed. After about $9.9 million in attorney fees, $100,000 in costs, and up to $25,000 in service awards, the net fund pays documented co-pay claims at up to 100% and undocumented claims at up to 40% capped at $100 per person.

The $15 co-pay itself remains in effect and, under the settlement, will not be increased above $15 before December 31, 2027. Claims cannot be emailed because the form contains HIPAA-protected health information.

How to File Your Claim

1. Online portal requires the Claimant ID from the mailed Claim Form plus the GHI Senior Care member ID from the insurance card — no blank or generic form exists for people without one
2. Paper route is the same pre-populated form mailed out, returned by mail
3. Claims cannot be emailed (HIPAA)
4. Choose documented (up to 100% reimbursement with proof: receipt, cancelled check, bank/credit card statement, or provider letter) or undocumented (signed affirmation only, capped at 40% / $100)
5. Visit the official claim form: https://www.seniorcarecopaysettlement.com/dashboard-login/

How Much Will I Actually Get?

$53 million cap, reversionary — anything unclaimed reverts to the defendants, not redistributed to other class members. After about $9.9 million in attorney fees, $100,000 in costs, and up to $25,000 in service awards, the remaining Net Settlement Amount pays claims: documented co-pays up to 100%, undocumented up to 40% capped at $100 per person. Pro-rata reduction if approved claims exceed the net fund.

Last reviewed: September 7, 2026 | Information verified from court records and official settlement documents.

Frequently Asked Questions