The $53 Million NYC Retiree Copay Settlement Has One Sentence Most Coverage Skipped: Whatever Nobody Claims Goes Back to the City and EmblemHealth. Claims Close October 30.

The Notice of Class Action Lawsuit and Proposed Settlement runs twelve pages and is published on SeniorCareCopaySettlement.com, the court-authorised site built and managed by Atticus Administration LLC. Question 4 asks what the settlement amount is and how it will be distributed. Its last operative sentence, before the closing pointer to the settlement website, reads:

Any Net Settlement Amount remaining after payment of Approved Claims will be returned to the Defendants.

That is a reversionary settlement, and it is what gives the October 30 deadline its weight. In a non-reversionary common fund, money nobody claims is redistributed to the people who did claim, or given to a charity under a cy pres clause. Here it stays with the Defendants: the City of New York Office of Labor Relations, the City of New York, EmblemHealth, Inc. and Group Health Incorporated.

The practical consequence is blunt. An unclaimed copay is not money sitting in a pot for other retirees. It is money that is never paid out at all.

The notice is careful with the headline figure in a way that press releases are not. “Under the terms of the proposed Settlement, Defendants' liability is limited to an amount that shall not exceed $53,000,000 (the ‘Settlement Amount').” And immediately after: the $53 million “represents the approximate amount of total co-pays for eligible services that Class Members could have incurred during the period January 1, 2022 through January 31, 2023, based on Emblem's medical provider claims data; it does not necessarily represent the amount of co-pays actually paid by Class Members.”

So $53 million is Emblem's own estimate of maximum exposure, not a cheque anybody wrote. Payments then come in a stated order:

• “$9,900,000 will be paid to Class Counsel as their Fees” — a fixed figure;
• “up to $100,000.00 will be paid to Class Counsel for Costs”;
• “up to $5,000 in Service Awards to each of the five individually named Plaintiffs”, for “a total of up to $25,000 in Service Awards.”

Only the first of those three is certain; the other two are ceilings. Taken at their maximum, $10,025,000 comes off before any retiree is paid, and the Net Settlement Amount — “the remainder of the Settlement Amount” after those deductions — is at least $42,975,000. Fees alone are 18.7 per cent of the cap, modest for a class action, and paid regardless of how many retirees file.

One protection does run the other way. If approved claims come in above the net amount, “payments will be reduced and distributed on a pro rata basis,” and total payments “shall not exceed the Settlement Amount of $53 million.” That is the scenario in which the ceiling binds — and, given how the two claim routes are priced, it is not the likely one.

There are two ways to claim, and they pay very differently.

With proof of payment, a class member “will be eligible to receive up to full reimbursement of all co-pays for which proof of payment is submitted.” Proof means cancelled cheques, receipts, bank or credit card statements, or a letter from the medical provider — the settlement site publishes a sample provider letter for exactly this.

Without proof, you can still claim by affirming that you paid: “If you submit a valid claim for a co-pay but do not submit proof of payment for that co-pay, you may still be eligible for a partial reimbursement of such an ‘undocumented' co-pay, if you simply affirm that you actually paid the co-pay. Any partial reimbursement for undocumented co-pays will be limited to up to 40% of the co-pay amounts incurred, up to a maximum of $100 per Class Member.”

Put numbers on that. Forty per cent of a $15 copay is $6. A retiree who saw a doctor four times in that thirteen-month window and kept nothing gets $24; the same four visits with receipts are worth $60. To reach the $100 undocumented ceiling at all you would need 17 qualifying copays — roughly a visit every three weeks for over a year.

Which is why the reversion clause has teeth. The notice puts the class at “approximately 246,000 Class Members.” Even if every one of them filed the undocumented claim and every one hit the full $100 cap — which almost nobody will, because it takes 17 visits — that comes to $24,600,000 against a Net Settlement Amount of at least $42,975,000. The undocumented route cannot exhaust this settlement. The documented one is the only route that can, and it is the one that requires digging through four-year-old bank statements.

The class is defined broadly and the claim form is not sent to all of it. The class is “All Medicare-eligible retired New York City employees and their Medicare-eligible dependents who were enrolled in the EmblemHealth, Inc. (‘Emblem') administered medical GHI Senior Care Plan at any time during the period of January 1, 2022 through January 31, 2023.”

A customised claim form went only to those “identified by Emblem's records as being potentially exposed to one or more co-pays for eligible medical services” in that window. For everyone else the notice is explicit, and this is the part to read carefully:

If you did not receive a Claim Form attached to this Notice, it is because you are not eligible to claim any reimbursement for the co-pays at issue in this lawsuit (see below); however, you remain a member of the Settlement Class and will be bound by the terms of the Settlement Agreement unless you choose to opt out.

Bound without being paid is the default here. The only way out is a written exclusion request by October 15, 2026 — a full fifteen days before the claim deadline, which is an easy pair of dates to transpose.

The notice also warns that receiving the form is not the same as being paid: “Simply receiving or returning a Claim Form does not make you eligible for an automatic payment.” And it rules out one route entirely: “Claim Form Submission – Online or By Mail ONLY (There is no email submission)”, and “you cannot send in a claim via email.” The settlement website repeats the point in bold. Post, or the online portal — which needs the Claimant ID printed on the form together with the member ID from the front of the GHI Senior Care card.

First, the copays are not gone. The notice sets out the history: “The Plaintiffs obtained a preliminary injunction from the Court on January 11, 2023, prohibiting the further imposition of co-pays.” That injunction “was vacated (ended) effective January 1, 2025, after Emblem filed a revised COI to expressly provide for $15 co-pays. The $15 co-pays were reinstated starting January 1, 2025”, and under the settlement the copay “will not be increased beyond the current $15 prior to December 31, 2027.” This case buys back thirteen months of copays and a price cap. It does not end the copay.

Second, only half the plan is in it. “Emblem co-administers the Senior Care Plan with Anthem/Empire Blue Cross Blue Shield (‘Anthem'). Emblem administers the medical component (e.g., primary physician care), while Empire administers the hospital component.” And then the boundary: “This Litigation does not involve the co-pays for the hospital component administered by Anthem. This litigation only involves the $15 co-pays implemented on January 1, 2022 in the Emblem-administered medical portion of the Senior Care Plan.”

Emblem's own conclusion about scale is quoted in the same passage: “while the co-pays were in effect, most, but not all, Senior Care members received medical services that would have been subject to a co-pay.” Most, not all — which is why a large share of the class received a notice with no claim form attached.

The settlement site publishes a Summary of Important Dates. In order:

• August 10, 2026 — Preliminary Approval Order entered.
• October 15, 2026 — deadline to opt out (“Request for Exclusion”).
• October 30, 2026 — claim filing deadline, by post or online. “If you do not file a Claim Form by October 30, 2026, you will not be eligible to receive any reimbursement.”
• November 30, 2026 — objection deadline; also the date deficiency notices and second-level review notices are sent.
• December 30, 2026 — deadline to submit cure documents.
• March 24, 2027 — Final Approval Hearing, 2:15 p.m., Room 412, New York Supreme Court, 60 Centre Street, New York, NY 10007.

The gap between the last claim date and the hearing is nearly five months, and payment comes after the hearing, not after the deadline. Anyone filing in October should expect to wait into 2027 at the earliest.

The deficiency and cure dates are the quiet mercy in this schedule: a claim that is short a document does not simply fail on October 30. The administrator writes on November 30 and there is a month to fix it. That only works if the claim went in at all.

The Claims Administrator is Atticus Administration LLC, reachable on 1-800-814-2610 and at SeniorCareCopaySettlement@AtticusAdmin.com — for questions, not for claims. Class counsel, appointed by the court on October 20, 2023, are Walden Macht Haran & Williams LLP and Pollock Cohen LLP. The plaintiffs are five individually named retirees — Margaretann Bianculli, Janet Kobren, Merri Lasky, Phyllis Lipman and Barry Skolnick — together with the NYC Organization of Public Service Retirees, Inc.

One figure in circulation is not the notice's. Class counsel's own announcement of the settlement describes “more than 250,000” class members; the court-authorised notice says “approximately 246,000 Class Members.” We have used the notice's figure throughout.