EmblemHealth

Alleged improper $15 copays charged to Medicare-eligible retirees and dependents in the EmblemHealth GHI Senior Care plan.

EmblemHealth and the City of New York have agreed to a $53 million settlement to resolve a class action lawsuit alleging improper implementation of $15 copays for medical services under the GHI Senior Care plan between January 1, 2022, and January 31, 2023. The lawsuit claimed these copays were not authorized by the plan's contract and were not properly disclosed. Eligible class members are Medicare-eligible retired New York City employees or their Medicare-eligible dependents enrolled in the GHI Senior Care plan during the class period. Those who received a claim form can seek reimbursement for listed copays, with full reimbursement possible if proof of payment is provided. Those without proof can receive up to 40% of the copay amount (up to $100 total) by attesting to payment. Payments may be reduced pro rata if total valid claims exceed the net settlement fund.

• Medicare-eligible retired New York City employees or Medicare-eligible dependents enrolled in the EmblemHealth-administered GHI Senior Care plan at any time between Jan. 1, 2022,...