Member
Providers
Shop For a Plan

Giving Back to Our Communities

Fidelis Care and the Centene Foundation Award $1.1 Million to The Jed Foundation to Protect the Mental Health of New York’s Youth

Funding will help expand emotional well-being resources, educational workshops, and training programs for community-based organizations that foster communities of care statewide

September 20, 2024, NEW YORK CITY —  Fidelis Care, a leading health insurer providing quality, affordable coverage to New Yorkers, and the Centene Foundation, the philanthropic arm of Centene Corporation, announced today a $1.1 million grant to The Jed Foundation (JED), a national nonprofit that protects emotional health and prevents suicide for teens and young adults.

With this grant, JED will expand its current services, providing at least five youth-serving community-based organizations (CBOs) with consultation or strategic planning services, including expert guidance, educational workshops, and training programs, equipping young people with life skills and connecting them to mental health care when they are in distress.

“We are thrilled to support the vital work of The Jed Foundation with this grant,” said Vincent Marchello, Chief Medical Officer at Fidelis Care. “At Fidelis Care, we recognize the importance of mental health services in creating healthier communities. This investment underscores our commitment to ensuring youth and adolescents have access to the critical support they need to thrive.”

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), it is currently estimated that nearly one in five 12- to 17-year-olds in the United States experience a major depressive episode every year, and almost half of teens 13 to 17 say they would seek out professional help only as a last resort. In New York State, the need for enhanced mental health support for school-aged youth is critical: in 2021, 57% of New York 12- to 17-year-olds with depression had not received any care in the last year.

“JED is grateful to Fidelis Care and the Centene Foundation for their commitment to supporting the emotional well-being of New York youth and for providing the resources to help them thrive,” said John MacPhee, JED Chief Executive Officer. “This partnership will allow us to bring JED’s lifesaving work to community-based organizations across the state and help them build on their mental health safety nets and approaches, while positively impacting the lives of thousands of young people.”

The inaugural group of CBOs includes Bottom Line, an organization that partners with degree-aspiring students from first-generation and low-income backgrounds as they get into and through college and launch mobilizing first careers; Hetrick-Martin Institute, which provides free, year-round programs and services for LGBTQIA+ youth and allies aged 13 to 24 in New York City; and Prep for Prep, which provides first-rate educational, leadership development and professional advancement opportunities for young people of color in New York City.

"Through decades of experience at Bottom Line, we have seen that the condition of a student's mental health plays a significant role in their overall journey to becoming a college graduate and professional,” said Sheneita R. Graham, Director of Culturally Responsive Programming at Bottom Line. “Our role at Bottom Line is to build strong relationships that assist us in determining need and connecting students to resources that will help them thrive personally to persist academically. Partnering with The Jed Foundation grants us the opportunity to expertly assess our mental health policies, processes, and resources to ensure we provide our students with thoughtful, high-quality support."

"Hetrick-Martin Institute is pleased to be working with The Jed Foundation to improve our ability to recognize young people in distress and conduct suicide risk assessments," said Bridget Hughes, Chief Program Officer at Hetrick-Martin Institute.

"We are so grateful to The Jed Foundation for hosting two workshops for our incoming college freshmen as part of our annual College Transition Retreat,” said Corey Rhoades, Director of Undergraduate Affairs at Prep for Prep. “The presenters shared their expertise and tailored the sessions in a way that was uniquely relevant and engaging for our students."

To learn more about ways to provide community-based organizations with consulting, evidence-based best practices, and data-driven guidance to protect youth mental health and prevent suicide, visit JED’s website.

Fidelis-JED-Social


Screener Program Provides Support to Families Impacted by Social Determinants of Health

SDoH-chart

Fidelis Care’s innovative SDoH screener program was launched two years ago as a grassroots health equity initiative to address conditions in the environments where people are born, live, work, and play that affect their health, well-being, and quality of life. Social Determinants of Health can affect a wide range of health risks and outcomes – particularly among vulnerable populations and in underserved areas.

The screener enables trained Fidelis Care representatives to assess an individual’s immediate needs and challenges related to SDoH through a brief series of questions covering areas such as access to transportation, food, and secure and safe housing. More than 450,000 Fidelis Care members have participated to date.


Click 
here to learn more about the different Social Determinants of Health and find available resources.


More News:


Reminder: Ambetter From Fidelis Care and Essential Plan - Diabetes and Maternity Services Cost-Share Changes as of January 1, 2025
3/10/2025 • Posted by Provider Relations in Provider News

Fidelis Care would like to remind our providers of plan changes effective January 1, 2025, for Ambetter From Fidelis Care and Essential Plans. In order for members to obtain the in-network cost share benefit for Diabetes and Maternity Services, providers should follow the below guidance when sending prescriptions to pharmacies for applicable members.

 

As a reminder, members who become pregnant are required to report their pregnancy to the New York State of Health Marketplace Phone Number below to be eligible for the Pregnancy Cost-Share Waiver.

  • New York State of Health Marketplace Phone: (855) 355-5777 TTY: (800) 662-1220.

 

 

Ambetter From Fidelis Care (Metal-Level Products)

 

Diabetes Services

 

Effective January 1, 2025, most Fidelis Marketplace members will not be responsible for the in-network cost share for some services related to the diagnosis and management of diabetes, inclusive of diabetic medications and diabetic supplies covered under the Pharmacy Benefit. Cost sharing will be waived for the following services for members whose primary diagnosis is diabetes.

  • Primary Care Visits
  • Dilated Retinal Exam (once per year)
  • Diabetic Foot Exam (once per year)
  • Nutritional Counseling

 

REMINDER: For cost sharing to be waived on Pharmacy Benefit claims, members’ diabetes prescriptions sent to their pharmacy of choice must include an ICD-10 diagnosis for diabetes.

Maternity Services

Effective January 1, 2025, there will be no cost-sharing obligations for most members who become pregnant for most services. Cost sharing will be waived from the onset of pregnancy to the 12-month postpartum period following delivery, inclusive of medications and supplies covered under the Pharmacy Benefit.

Cost sharing will apply to the following services.

  • Ambulance Services
  • All Inpatient Services (hospital, rehabilitation, mental health/substance use disorder, hospice)
  • Emergency Care in a Hospital
  • Physician, Nurse Practitioner and Midwife Services for Delivery
  • Inpatient Hospital and Birthing Center Services for Delivery
  • Pediatric Vision and Dental

 

To ensure cost-shares are appropriately waived on Pharmacy Benefit claims for all pregnant members, it is highly recommended to include an ICD-10 diagnosis for pregnancy OR post-partum care on pregnant members’ prescriptions sent to their pharmacy of choice.

 

 

 

Essential Plans

 

Diabetes Services

 

Effective January 1, 2025, most Fidelis Marketplace members will not be responsible for the in-network cost share for some services related to the diagnosis and management of diabetes, inclusive of diabetic medications and diabetic supplies covered under the Pharmacy Benefit. Cost sharing will be waived for the following services for members whose primary diagnosis is diabetes.

  • Primary Care Visits
  • 1 Dilated Retinal Exam per year
  • Diabetic Foot Exam (once per year)
  • Nutritional Counseling

 

REMINDER: For cost sharing to be waived on Pharmacy Benefit claims, members’ diabetes prescriptions sent to their pharmacy of choice must include an ICD-10 diagnosis for diabetes.

 

If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.

Thank you for partnering with us to support the health and wellness of our members!


Reminder: Ambetter From Fidelis Care and Essential Plan - Diabetes and Maternity Services Cost-Share Changes as of January 1, 2025
3/10/2025 • Posted by Provider Relations in Provider News

Fidelis Care would like to remind our providers of plan changes effective January 1, 2025, for Ambetter From Fidelis Care and Essential Plans. In order for members to obtain the in-network cost share benefit for Diabetes and Maternity Services, providers should follow the below guidance when sending prescriptions to pharmacies for applicable members.

 

As a reminder, members who become pregnant are required to report their pregnancy to the New York State of Health Marketplace Phone Number below to be eligible for the Pregnancy Cost-Share Waiver.

  • New York State of Health Marketplace Phone: (855) 355-5777 TTY: (800) 662-1220.

 

 

Ambetter From Fidelis Care (Metal-Level Products)

 

Diabetes Services

 

Effective January 1, 2025, most Fidelis Marketplace members will not be responsible for the in-network cost share for some services related to the diagnosis and management of diabetes, inclusive of diabetic medications and diabetic supplies covered under the Pharmacy Benefit. Cost sharing will be waived for the following services for members whose primary diagnosis is diabetes.

  • Primary Care Visits
  • Dilated Retinal Exam (once per year)
  • Diabetic Foot Exam (once per year)
  • Nutritional Counseling

 

REMINDER: For cost sharing to be waived on Pharmacy Benefit claims, members’ diabetes prescriptions sent to their pharmacy of choice must include an ICD-10 diagnosis for diabetes.

Maternity Services

Effective January 1, 2025, there will be no cost-sharing obligations for most members who become pregnant for most services. Cost sharing will be waived from the onset of pregnancy to the 12-month postpartum period following delivery, inclusive of medications and supplies covered under the Pharmacy Benefit.

Cost sharing will apply to the following services.

  • Ambulance Services
  • All Inpatient Services (hospital, rehabilitation, mental health/substance use disorder, hospice)
  • Emergency Care in a Hospital
  • Physician, Nurse Practitioner and Midwife Services for Delivery
  • Inpatient Hospital and Birthing Center Services for Delivery
  • Pediatric Vision and Dental

 

To ensure cost-shares are appropriately waived on Pharmacy Benefit claims for all pregnant members, it is highly recommended to include an ICD-10 diagnosis for pregnancy OR post-partum care on pregnant members’ prescriptions sent to their pharmacy of choice.

 

 

 

Essential Plans

 

Diabetes Services

 

Effective January 1, 2025, most Fidelis Marketplace members will not be responsible for the in-network cost share for some services related to the diagnosis and management of diabetes, inclusive of diabetic medications and diabetic supplies covered under the Pharmacy Benefit. Cost sharing will be waived for the following services for members whose primary diagnosis is diabetes.

  • Primary Care Visits
  • 1 Dilated Retinal Exam per year
  • Diabetic Foot Exam (once per year)
  • Nutritional Counseling

 

REMINDER: For cost sharing to be waived on Pharmacy Benefit claims, members’ diabetes prescriptions sent to their pharmacy of choice must include an ICD-10 diagnosis for diabetes.

 

If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.

Thank you for partnering with us to support the health and wellness of our members!