A New York state court settlement now open for claims addresses $15 co-pays that the City of New York and EmblemHealth imposed on retired municipal employees enrolled in the Senior Care Medicare plan beginning January 1, 2022. The case, filed by five retirees and a retiree advocacy organization, argued the co-pays violated the insurance contract between the city and Emblem. A settlement capping the city and Emblem’s liability at $53 million now lets eligible retirees seek reimbursement, but only those who were mailed a personalized claim form tied to their own medical records can file one.
How $15 Co-Pays Became a Class Action Over a Silent Contract
The lawsuit, Bianculli, et al. v. City of New York, et al., was filed in November 2022 in the Supreme Court of the State of New York, County of New York, under Index No. 160234/2022. The named plaintiffs argued that the Certificate of Insurance governing the Emblem-administered Senior Care plan was silent on co-pays and instead stated that Medicare would cover 80% of a reasonable charge for covered services while Emblem covered the remaining 20% — meaning the $15 co-pay imposed starting January 1, 2022 had no contractual basis. The City and Emblem denied the claims.
The court sided with the retirees enough to act before resolving the case on the merits. A judge granted a preliminary injunction on January 11, 2023, barring further co-pays while the litigation proceeded, after co-pays had already been charged for more than a year. That injunction held until January 1, 2025, when it was vacated after Emblem filed a revised insurance certificate that expressly authorized the $15 co-pay; the charge has applied continuously since then, and the settlement caps it at $15 through December 31, 2027 rather than eliminating it.
Class certification, covering roughly 246,000 Medicare-eligible retirees and dependents enrolled in the plan between January 1, 2022 and January 31, 2023, was granted on October 20, 2023. Emblem has calculated that while the disputed co-pays were in effect, members of that class incurred a maximum of approximately $53 million in total potential co-pay charges, a figure that became the settlement’s liability cap rather than an estimate of what any individual retiree can expect to receive. A judge entered the Preliminary Approval Order on August 10, 2026, the step that started the claim window now open.
Only a Mailed Claim Form With a Claimant ID Can Be Filed
Reimbursement under this settlement is not open to every eligible retiree who wants to file one. Only class members Emblem’s own claims data identified as having been charged at least one qualifying co-pay receive a customized claim form attached to their notice, pre-populated with the visits and charges Emblem’s records show. A retiree who believes they paid a $15 co-pay but never received that customized form is not eligible to submit a claim under the settlement’s terms, even though they remain bound by it as a class member…