EmblemHealth Senior Care Co-Pay Settlement, Check If You Qualify — Bianculli v. City of New York, Index No. 160234/2022

October 30, 2026. That’s the deadline to file a claim in the EmblemHealth Senior Care co-pay settlement, and it’s closer than it looks. EmblemHealth and the City of New York have agreed to pay up to $53,000,000 to resolve claims that $15 co-pays were improperly added to the Emblem-administered GHI Senior Care Plan for retired city workers. Filing, if you got a claim form, takes about ten minutes.

EmblemHealth Senior Care Settlement — Key Facts

Field	Detail
Settlement Amount	Up to $53,000,000 (a cap on Defendants’ liability, not a guaranteed payout pool)
Claim Deadline	October 30, 2026
Who Qualifies	Medicare-eligible retired NYC employees and dependents enrolled in the Emblem-administered GHI Senior Care Plan, Jan. 1, 2022 – Jan. 31, 2023 (~246,000 Class Members)
Estimated Payout	Full or partial reimbursement of $15 co-pays with proof; up to 40% of the co-pay (max $100 per person) without proof; reduced pro rata if total claims exceed what’s available
Proof Required (Yes/No)	Not required, but it’s the difference between full reimbursement and a capped partial one
Settlement Status	Preliminarily approved August 10, 2026; Final Approval Hearing set for March 24, 2027
Court & Case Number	Supreme Court of the State of New York, County of New York — Index No. 160234/2022
Law Alleged	Breach of contract (the Certificate of Insurance was silent on co-pays) and relief under CPLR Article 7803(3)
Administrator	Atticus Administration
Official Claim Site	seniorcarecopaysettlement.com/dashboard-login
Last Updated	September 5, 2026

Who Are EmblemHealth and the City of New York, and Why Are They Being Sued Over Co-Pays?

EmblemHealth, through its Group Health Incorporated (GHI) subsidiary, administers the medical side of the Senior Care Plan that covers Medicare-eligible retired New York City workers, under a contract with the City’s Office of Labor Relations. Retirees say that starting January 1, 2022, Emblem began charging $15 co-pays for medical visits even though the plan’s own Certificate of Insurance never mentioned co-pays — it only said Medicare covers 80% of a charge and Emblem covers the rest. That gap between the contract and the bill is the whole case.

What Did EmblemHealth and the City Do Between 2022 and 2023?

In November 2022, retired city workers Margaretann Bianculli, Janet Kobren, Merri Lasky, Phyllis Lipman, and Barry Skolnick sued on behalf of themselves and roughly 246,000 fellow retirees. Two months later, a state court judge issued a preliminary injunction — Emblem had to stop the co-pays. That’s a fast win, and it stuck for two years.

The pause ended January 1, 2025, when Emblem filed a revised Certificate of Insurance that spelled out $15 co-pays in writing. The charge came back that same day and is still in effect now. Under this Settlement, though, Emblem can’t raise it above $15 before December 31, 2027.

Here’s the honest math on the money: of the $53 million cap, $9,900,000 goes to Class Counsel as fees, up to $100,000 covers their costs, and up to $25,000 splits across the five named retirees as service awards. That’s roughly $10 million off the top before a single retiree gets a dollar back. Whatever’s left is what actually pays claims — and if the total valid claims run higher than that remaining amount, every payment gets cut down proportionally. Anything left over after claims are paid doesn’t go to a charity or get redistributed. It goes back to EmblemHealth and the City.

Are You Part of the EmblemHealth Senior Care Settlement?

Here’s exactly how to know if this one includes you.

You’re a Class Member if you were:

• A Medicare-eligible retired New York City employee, or their Medicare-eligible dependent
• Enrolled in the Emblem-administered GHI Senior Care Plan
• Covered at any point between January 1, 2022 and January 31, 2023

This settlement does not cover the hospital side of Senior Care, which Anthem/Empire Blue Cross Blue Shield administers separately — only the Emblem-administered medical co-pays are at issue here.

There’s a wrinkle most settlement notices don’t have: only Class Members that Emblem’s own claims data flagged as having actually been charged a co-pay received a pre-filled Claim Form in the mail. If you didn’t get one, you’re still bound by the settlement, but you generally have no reimbursement claim to file — Emblem’s records are treated as conclusive.

Related article: LiveHealth Online Privacy Settlement, Check If You Qualify, Polk v. American Well Corp., Case No. 25CV026746

EmblemHealth Retirees Outside New York — Are You Still Covered?

Yes. Eligibility runs on your City employment history and Senior Care enrollment, not on where you live today. Retirees who moved to Florida, North Carolina, or anywhere else after leaving city service are still covered if they meet the enrollment criteria above.

Not sure if you qualify, or think your Claim Form’s pre-filled co-pay history is wrong? A free consultation with a consumer rights attorney can help you sort it out before October 30.

How Much Can EmblemHealth Settlement Class Members Get? Up to Full Reimbursement Per Co-Pay

With Proof of Payment — Up to Full Reimbursement

A receipt, cancelled check, bank statement, credit card statement, or signed provider letter gets you in line for full reimbursement of each $15 co-pay you can document.

Without Proof of Payment — Up to 40%, Capped at $100

No paperwork? You can still sign the affirmation on the Claim Form saying you paid it. That gets you up to 40% of the co-pay amount — capped at $100 total across all your undocumented co-pays.

Payment goes out by PayPal, Venmo, Zelle, direct deposit, or check if you file online; mail-in claims get a check. This is reimbursement of money you already spent, not new income, and the settlement site doesn’t address 1099 reporting one way or the other — check with a tax professional if you’re unsure how this affects your return.

How to File Your EmblemHealth Senior Care Co-Pay Claim — Step by Step

1. Find your pre-filled Claim Form, mailed with your Notice, and your Claimant ID number
2. Go to seniorcarecopaysettlement.com/dashboard-login and log in with your Claimant ID and Senior Care member ID
3. Confirm or correct your name and address, and confirm each co-pay listed as actually paid
4. Upload proof of payment for each co-pay if you have it — or leave it blank and sign the affirmation for a partial reimbursement instead
5. Choose your payment method and submit
6. Watch for a “cure letter” by email if anything’s missing — respond before the cure deadline or the claim is denied

Takes about 10 minutes online. ⚠️ 55 days left as of today — file at seniorcarecopaysettlement.com/dashboard-login, or by mail postmarked by October 30, 2026.

Should EmblemHealth Class Members Opt Out or Object Before the Deadlines?

What Opting Out of the EmblemHealth Settlement Actually Means

Opting out means no reimbursement from this settlement, but you keep the right to sue over these same co-pays on your own. Most people shouldn’t opt out without legal advice first. Here’s the catch: the opt-out deadline is October 15, 2026 — fifteen days earlier than the claim deadline. Miss it while you’re still deciding, and the decision gets made for you.

How to Object to the EmblemHealth Settlement

Objecting keeps you in the class and eligible for a payment, while telling the court you disagree with some part of the deal. Objections are due by November 30, 2026, filed with the Supreme Court of the State of New York, 60 Centre Street, Room 412, New York, NY 10007, and sent to both Class Counsel and the defendants’ attorneys.

Talk to a consumer rights attorney before October 15 if opting out is even on the table — that date moves faster than people expect.

EmblemHealth Senior Care Co-Pay Settlement — Key Dates, 2026

Milestone	Date
Preliminary Approval Order Entered	August 10, 2026
Opt-Out Deadline	October 15, 2026
Claim Filing Deadline	October 30, 2026
Objection Deadline	November 30, 2026
Deadline to Submit Cure Documents	December 30, 2026
Final Approval Hearing	March 24, 2027, 2:15 p.m.
Expected Payment Date	UNVERIFIED — payments won’t issue until final approval and any appeals resolve; no fixed date given

EmblemHealth Senior Care Settlement — Frequently Asked Questions, Index No. 160234/2022

Do I need a lawyer to file an EmblemHealth Senior Care co-pay claim?

 No. Class Counsel — Pollock Cohen LLP and Walden Macht Haran & Williams LLP — already represents the class. You can hire your own consumer rights lawyer at your own expense if you want a second opinion.

Is the EmblemHealth Senior Care settlement legitimate?

 Yes. It’s overseen by Hon. Lyle E. Frank of the Supreme Court of the State of New York, County of New York, and the only official site is seniorcarecopaysettlement.com.

When will EmblemHealth settlement payments be sent? 

Not before the March 24, 2027 Final Approval Hearing, and not until any appeals of that approval are resolved. No fixed payment date exists yet.

What if I missed the EmblemHealth claim deadline? 

Claims submitted or postmarked after October 30, 2026 will be denied. Contact the Claims Administrator, Atticus Administration, to ask about your specific circumstances.

Will my EmblemHealth settlement payment go on a 1099?

 Unclear from the settlement materials. This reimburses co-pays you already paid out of pocket rather than issuing new income, but the site doesn’t state a tax position. Ask a tax professional.

I never got a Claim Form in the mail — can I still file?

 Generally, no. Emblem’s own claims data determined who received a pre-filled form, and that data is treated as conclusive. You remain a Class Member either way and will be bound by the settlement.

Why is the opt-out deadline earlier than the claim deadline? 

That’s how this settlement was structured — October 15, 2026 for opting out, October 30, 2026 for filing a claim. Don’t wait on one while assuming you have until the other.

Will my Senior Care co-pays go up again after this settlement? 

Not before December 31, 2027. The settlement holds the co-pay at $15 until then; what happens after that date isn’t addressed in the settlement.

Sources Used in This EmblemHealth Senior Care Article

• Official Settlement Website — Bianculli, et al. v. City of New York, et al., homepage, accessed Sept. 5, 2026: https://www.seniorcarecopaysettlement.com/
• Official Settlement FAQ — seniorcarecopaysettlement.com, accessed Sept. 5, 2026: https://www.seniorcarecopaysettlement.com/faqs-2/
• Official Notice of Class Action Lawsuit and Proposed Settlement — Atticus Administration, August 2026: https://www.seniorcarecopaysettlement.com/wp-content/uploads/2026/08/Bianculli_Notice-of-Class-Action-Lawsuit-and-Proposed-Settlement.pdf
• Official Important Dates Page — seniorcarecopaysettlement.com, accessed Sept. 5, 2026: https://www.seniorcarecopaysettlement.com/important-dates/

Researched and written by Israr Ahmad, legal content researcher and founder of AllAboutLawyer.com. All facts verified against the official settlement website (seniorcarecopaysettlement.com), its FAQ page, the court-authorized Notice of Class Action Lawsuit, and the Important Dates page, as of September 5, 2026. Last Updated: September 5, 2026.

This article is for informational purposes only and does not constitute legal advice. Laws vary by state and individual circumstances differ. For advice about your specific situation, consult a qualified attorney.