EmblemHealth and New York City have agreed to settle a class action over $15 copays the city imposed on Medicare-eligible retirees enrolled in its GHI Senior Care plan. The proposed settlement, filed July 30, caps the defendants’ liability at $53 million and locks in the copays at $15 through 2027.
Five retirees and the NYC Organization of Public Service Retirees originally filed the lawsuit in November 2022 in New York County Supreme Court, arguing the copays were never authorized under the original contract between the city and its workers. The class covers roughly 246,000 retirees and their Medicare-eligible dependents.
The $53 million represents the maximum copays that class members could have incurred during the class period based on Emblem’s claims data, not what retirees actually paid out of pocket. Any money left over after valid claims are paid will revert to the city and Emblem, and $10 million will go to legal fees and costs, pending court approval.
The agreement said the defendants “specifically deny any and all wrongdoing, liability, or damages and have concluded this matter strictly to avoid protracted litigation.”
“We are pleased that a settlement has been reached that avoids litigation,” an EmblemHealth spokesperson told Becker’s. “From this agreement, a process has been established to assist members with reimbursement and provide information on next steps.”
New York City has pushed since 2021 to shift its Medicare-eligible retirees into a Medicare Advantage plan to cut costs, an effort retirees fought in court for years before the state’s highest court cleared the path in 2025.
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