A settlement on GHI Senior Care copays
The following information was emailed to retired Medicare-eligible members enrolled in GHI Senior Care on Aug. 4, 2026.
A recent class action settlement with the city and EmblemHealth will give Medicare-eligible retirees in GHI Senior Care a reimbursement for copays they paid between January 2022 and February 2023.
What happened?
A claim was brought alleging that from January 2022 to February 2023, EmblemHealth did not have proper state authorization to charge copays. A recent settlement of this claim requires that the city reimburse retirees in GHI Senior Care for copays they made during that time.
What is in the settlement?
The settlement includes the following provisions:
- Retirees may receive up to 40% of paid copays (up to $100) without providing receipts, provided Emblem can verify they actually saw a doctor on those dates. Reimbursement beyond that requires receipts for the copayments.
- Senior Care copays will not be increased through Dec. 31, 2027.
The UFT’s position is that copays should not increase at any time. We will oppose any increase to retiree copays and will remain firm in that position regardless of this settlement.
How can you get reimbursed?
The city will be using a third-party administrator to ensure that reimbursements are distributed correctly. We will be in touch with EmblemHealth, the Municipal Labor Committee and the city to provide you with information on how that process will work and what documentation you will need for reimbursement. We will contact you with that information once we have it.
What about other copays?
Any copays that were paid outside of the January 2022 to February 2023 timeframe are not covered by this settlement and are not subject to reimbursement from the city. However, if you are a member of the UFT’s Supplemental Health Insurance Program (SHIP), you can receive up to $105 annually in copay reimbursements. The UFT started the SHIP copay reimbursement plan in January 2025 to help our retirees with copayments. You can learn about the many benefits of SHIP enrollment on our website.
We will keep you updated on this situation as it continues so that you have the information you need to be reimbursed.