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.

Please contact us and/or Atticus to let us know if you have copays from January 1, 2022 to January 31, 2023, that you paid and are not listed on the claim form.

Please go to your online Emblem portal and download the Explanations of Benefits. Do not send any attachments or screenshots to Atticus via email. You can either email Atticus at SeniorCareCopaySettlement@AtticusAdmin.com with your Emblem Member ID and Claimant ID and ask for a secure link to upload your EOBs and proof of payment, or mail the documents to Senior Care Co-Pay Settlement c/o Atticus Administration PO Box 64053 St. Paul, MN 55164. Only send photocopies by mail. We cannot guarantee these claims will be paid.

3. What if the provider name on the claim sheet is not the same as the billing provider (i.e., the claim says Dr. John Doe by I was billed by and paid Doe Healthcare)?
As long as the payment matches up, that is sufficient. Please leave a note explaining the situation.

4. What if the amounts I paid are different from the amount of claim listed (i.e., I paid multiple copays in one receipt)?
If you are submitting online, please leave a note explaining the situation, and submit the receipt for each of the relevant claims. If you are submitting the claim form by paper, you only have to submit the receipt once, but please leave a note explaining the situation.

5.   What if the date of my proof paid is different from the date listed on the claim sheet?
As long as the payment matches up, that is sufficient. Please leave a note explaining the situation.

6.   Do I need to use the Medical Provider List if I have proof of payment (receipts, check, bank statement, credit card statement)?
You only need to submit the Confirmation of Payment of Copays letter if you do not have any other proof of payment.

7.   What if I can't find any proof I paid the copays?
If you cannot find any proof that you paid the copays, you can ask your provider to fill out the Confirmation of Payment of Copays letter. If you are not able to get that form filled out for any reason, please let us know. If you do not want to ask your providers for the letter, you can opt to get 40% of your copays, up to $100.

8.   If I have a dependent, should we each be getting separate claim forms?
You and your dependents should each get a separate claim form.

9.   Can you complete some of the claims online and also some on the paper form?
No. Please only submit your claims online or on the paper form.

10. Is the EOB proof that we paid?
No. An explanation of benefits is proof that you were charged a copay, but not that you paid.

11.  Can I send any proof of payment to Atticus by e-mail?
No. Do not send any proof of payment to Atticus by e-mail. If you have any questions for Atticus that you will ask via e-mail, please do not include any attachments or screenshots in the e-mail. You can email Atticus to ask for a link to securely upload the documents.

12. Should I send originals of my proof of payment to Atticus?
No. Please only send photocopies of your proof of payment.

13. Is a statement or ledger from the providers office showing paid adequate proof (even if it shows different amounts)?
If the statement shows that you actually paid the copays, it is sufficient.

14.  What if I messed up the claim sheet, can I get another?
You can print out a list of your claims from the Atticus portal, or use another sheet of paper. Please make sure you submit the signed affirmation. You can also email Atticus at SeniorCareCopaySettlement@AtticusAdmin.com with your Claimant ID and full address.

15. If you don’t want to file for at least the minimum $100 refund do not opt out; just do nothing. Opting out means you want to bring your own lawsuit with your own lawyers.

16. What kind of documents do I need to submit to show that I am the representative of a deceased spouse or family member?
To submit a claim on behalf of a deceased individual, please provide a copy of the death certificate along with documentation showing that you have legal authority to act for the estate, such as Letters Testamentary, Letters of Administration, or another court-issued document establishing your authority.

17. What kind of documents do I need to submit to show that I am authorized to act on behalf of an incapacitated individual?
To submit a claim on behalf of an incapacitated individual, please provide documentation showing that you are authorized to act on their behalf, such as a power of attorney, letter of authority, or similar legal documentation.

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.