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NYC Health Benefits Program
Information and Update: Preliminary Approval of Class Action Settlement of lawsuit involving $15 medical copays during the period January 1, 2022 through January 31, 2023 under the Emblem-administered medical portion of the Senior Care Plan.
This Update Applies Only To The "Class" Certified By The Court (see below).
Class Members should have or will be receiving communication from Atticus Administration LLC, the court-appointed neutral Claims Administrator. Please make sure to open it.
Who to Contact About the Settlement:
- FIRST, Please visit the Settlement Website at www.SeniorCareCopaySettlement.com
The settlement website contains important information and documents regarding the settlement and claims process, including a Frequently Asked Questions (FAQ) section that may answer your questions. - SECOND, if you cannot find the information or answer(s) you are looking for on the settlement website or in the FAQs, please contact ATTICUS ADMINISTRATION LLC directly (see below contact information).
- THIRD, for questions regarding claim eligibility (only eligible class members that Emblem's records show as having paid a copay any time from January 1, 2022 through January 31, 2023 will receive a claim form), claim evaluation, or eligibility for any settlement payment, please contact Atticus Administration LLC directly.
- FOURTH, please note that the Mayor’s Office of Labor Relations (OLR) is NOT handling the settlement claims process and has no information to answer questions concerning the claims process including claim eligibility, claim forms, claim evaluations, or timing and eligibility for settlement payments, please contact Atticus Administration LLC directly.
Atticus Administration LLC Contact Information:
By Telephone: 1-800-814-2610
By Mail:
Senior Care Co-Pay Settlement
c/o Atticus Administration
PO Box 64053
St. Paul, MN 55164
The Class Certified By The Court:
Who Is Included in the Class?
All Medicare-Eligible City Retirees and Their Medicare-Eligible Dependents Who Were Enrolled in the Emblem-administered Medical Portion of the GHI/Anthem Senior Care Plan At Any Time From January 1, 2022 Through January 31, 2023 (the “Class”). This Update Does Not Apply to Those Who First Enrolled In The GHI/Anthem Senior Care Plan after January 31, 2023 Because You Are Not Included In The Class.
Information and Update: $15 copays resumed January 1, 2025 for the EmblemHealth-GHI portion of the GHI/Anthem Senior Care Plan
As of January 1, 2025, Senior Care members are required to pay a $15 copayment each time they use the health services listed below:
- Primary Care Physician Office Visits: $15 Copayment per visit
- Specialist Office Visit: $15 Copayment per visit
- Allergy testing/injections: $15 Copayment per visit
- X-rays: $15 Copayment per visit
- Laboratory tests: $15 Copayment per test
- Complex diagnostic and radiology services: $15 Copayment per visit
- Radiation therapy: $15 Copayment per visit
- Urgent Care Services: $15 Copayment per visit
- Emergency Care (Professional Component): $15 Copayment per visit
- Mental Health Care (Outpatient): $15 Copayment per visit
- Substance Use Disorder Services (Outpatient): $15 Copayment per visit
- Physical, Occupational, and Speech Therapy: $15 Copayment per visit
- Cardiac Rehabilitation: $15 Copayment per visit
- Pulmonary Rehabilitation: $15 Copayment per visit
- Chiropractic Care: $15 Copayment per visit
- Podiatry Care: $15 Copayment per visit
- Vision Care: $15 Copayment per visit
Please note, that Senior Care members are responsible for the annual Medicare Part B deductible and $50 GHI Senior Care deductible.
For questions, please call the EmblemHealth Customer Service phone number on the Senior Care member ID card.
Visit the Plans & Rates page of the Health Benefits Program wesbite to review other City’s health plan options for Medicare eligible retirees and their Medicare eligible dependents.
Information Regarding the Medicare GLP-1 Bridge for Part D Plans
Starting July 1, 2026, Medicare will begin a short-term demonstration, called the Medicare GLP-1 Bridge, that will provide eligible Medicare Part D beneficiaries with access to certain GLP-1 drugs. For more information, visit CMS.gov.
Retiree Responsibilities and Assistance
Medicare Part B and IRMAA Reimbursement
Information about Medicare and IRMAA Reimbursement Learn More
Medicare Part B Reimbursement
The City reimburses retirees and their eligible dependents for Medicare Part B premiums paid, excluding any penalties. You must be receiving a City pension check and be enrolled as the contract holder for City health benefits in order to receive reimbursement for Part B premiums.
For most retirees, the refund is issued automatically by the Health Benefits Program. The reimbursement amount is based on the standard Medicare Part B premiums.
Medicare Part B reimbursements are issued to eligible retirees annually during the month of April. If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement will be deposited directly into your bank account. This will be separate from your pension payment. If you don’t have EFT or direct deposit, you will receive a check in the mail.
What is IRMAA?
The Income-Related Monthly Adjustment Amount (IRMAA) is an additional amount that you are required to pay for your monthly Medicare premiums if you have higher annual earnings.
Medicare-eligible retirees and their Medicare-eligible dependents can submit an IRMAA application if they paid above the standard amount per month. If you did not pay more than the standard amount then you are not eligible for IRMAA. Please do NOT submit an IRMAA application if you are not eligible for reimbursement.
IRMAA reimbursements are issued to eligible retirees annually during the 3rd week of October. If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement is deposited directly into your bank account. This is separate from your pension payment. If you don’t have EFT or direct deposit, you will receive a check in the mail.
The Medicare Part B Reimbursement Program video provides information about the different types of Medicare Part B reimbursements that the City provides, as well as information to help you to see whether you qualify to receive these payments, and how to apply.
Your Responsibilities
It is important that you know how your health plan works and what is required of you. Learn More
Here are some important things that you need to remember:
- Complete an enrollment form to add new dependents (newborn, adoption, marriage) within 30 days after the event;
- Notify the NYC Health Benefits Program and your health plan in writing when your address changes;
- Review your pension check to ensure appropriate premiums are deducted;
- Know your rights and responsibilities under COBRA continuation coverage.
If You Need Assistance
Who you should contact for assistance and when you should contact them Learn More
Retirees with questions about benefits, services, or claims should write or call their health plan.
When writing to the plan, give your certificate number, name and address.
The Health Benefits Program is also available to provide service and information to City retirees who have questions about or problems with their health benefits or pension check deductions.
Retirees contacting the Health Benefits Program should always include the following information (please print clearly):
Name, Address and Telephone Number
Complete Social Security Number
Pension Number
Inquiries and questions can be emailed to: healthbenefits@olr.nyc.gov
Who Do I Contact After Retirement?
Find out who you should contact after retirement. Learn More
Retirees can contact the Health Benefits Program:
- For questions concerning eligibility and enrollment
- For questions regarding deductions for health benefits taken from your pension check
- For Transfer Period information
- To obtain applications to make changes to your coverage such as adding/dropping dependents, adding/dropping the optional rider, waiving health coverage and to change plans (excluding Medicare HMOs, which require a special application from the health plan).
- For notification of enrollment in Medicare
- For questions regarding Medicare Part B premium reimbursements
- To obtain information and an application for COBRA benefits
- To change your address
- If health coverage has been terminated for you and/or your dependents
When Should I Contact My Health Plan?
Find out when you should contact your Health Plan. Learn More
(Refer to your health plan identification card or plan booklet for telephone numbers.)
- If you have questions regarding covered services
- To obtain written information about covered services
- For information about the status of pending claims or claim disputes
- For claim allowances (How much will a plan pay towards a claim?)
- For health plan service areas
When writing to a health plan, include your name and address, certificate number, date(s) of service, and claim number(s), if applicable. Some plans also allow inquiries through their web sites.
When Should I Contact My Union/Welfare Fund?
Find out when you should contact your Union/Welfare Fund. Learn More
For information about:
- Prescription drug coverage (if applicable)
- Vision benefits
- Dental benefits
- Life Insurance (if applicable)
The Health Benefits Program is also available to provide service and information to City retirees who have questions about or problems with their health benefits or pension check deductions.
Retirees contacting the Health Benefits Program should always include the following information (please print clearly):
Name, Address and Telephone Number
Complete Social Security Number
Pension Number
Inquiries and questions can be emailed to healthbenefits@olr.nyc.gov
