Plan Basics

Medicaid Managed Care offers comprehensive coverage for children and adults who meet income, resource, age, and/or disability requirements.

There are no copays for covered services and no monthly premiums. Always check with your Primary Care Provider to find out if a referral is required for any additional health services you might need.

Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. For more information regarding the pharmacy benefit transition, please visit NYRx, the Medicaid Pharmacy Program. Please note, members will continue to receive their medical benefits through Fidelis Care.

Child Health Plus offers comprehensive coverage for children under the age of 19.

There are no copays or deductibles. Almost every child is eligible, regardless of income or immigration status. Monthly premiums vary based on income. Always check with your Primary Care Provider to find out if a referral is required for any additional health services you might need.

Child Health Plus covers prescription or non-prescription drugs listed in the formulary with no cost-sharing as long as they are ordered by a provider within the Fidelis Care network. 

Fidelis Care offers five “tiers” of the Essential Plan. The plan tier you qualify for will depend on your income eligibility. 

How Cost-Sharing Works

Fidelis Care Essential Plans do not have deductibles. Depending on your plan, you may be required to pay a copayment or coinsurance. For example, you may have a copay of up to $35 for medical services and prescription drugs.

In-Network Coverage

Fidelis Care Essential Plans have in-network only benefits, meaning that services from providers not in the Fidelis Care Network might not be covered. You should always check to make sure your provider participates in our network before receiving services -- even if you were referred by a participating provider. 

Emergency services are always covered. However, it's still important to avoid surprise bills in these situations. Learn more about Surprise Bills.

Treatment Cost Calculator

The Treatment Cost Calculator is available in the Member Portal. After January 1, 2023, if you have any questions about this information, please call Member Services at 1-888-343-3547 (TTY: 711).

Smoking Cessation

Fidelis Care is here to help you access the care and services you need to quit smoking. Your plan includes coverage of smoking cessation counseling, prescription and non-prescription smoking cessation products such as nasal sprays, inhalers, over-the-counter nicotine patches, and gum.

Flu shots

Remember that you are eligible for a FREE annual flu shot from August 1 to April 30, which you can receive at your doctor’s office or any pharmacy. Check the formulary for a full listing of covered flu vaccinations.

For a full list of preventive services for adults, women, and children, please visit healthcare.gov.

We’re here to help you understand the cost of your care. If you need help, please call us at 1-888-FIDELIS (1-888-343-3547). 

How Cost-Sharing Works

Your Qualified Health Plan will have some combination of cost-sharing, such as copays, deductibles, coinsurance, and an out-of-pocket maximum.

Say your plan has a $1,000 deductible, 20 percent coinsurance, and an out-of-pocket maximum. Here's how your costs will stack up:

1. You'll pay for any health services you need in full (if you stay in network, you will pay the rate at which Fidelis Care would reimburse your doctor for the service, which will help you save money). You pay for your services until you have spent $1,000 on health care. 
2. Once you meet your deductible, you'll continue to pay 20 percent coinsurance for any health services you need. This means you'll pay 20 percent of the cost of the health services you need, while Fidelis Care will pay 80 percent.
3. You'll pay a portion of the cost for your health services until you reach an out-of-pocket maximum. This means your plan has a limit for how much you will spend out of pocket on health services in a given year. Once you reach that out-of-pocket maximum, any health services you need after that are covered by Fidelis Care in full. 

In-Network Coverage

Fidelis Care Qualified Health Plans have in-network only benefits, meaning that services from providers not in the Fidelis Care Network might not be covered. You should always check to make sure your provider participates in our network before receiving services -- even if you were referred by a participating provider. 

Emergency services are always covered. However, it's still important to avoid surprise bills in these situations. Learn more about Surprise Bills. 

Treatment Cost Calculator

The Treatment Cost Calculator is available in the Member Portal. After January 1, 2023, if you have any questions about this information, please call Member Services at 1-888-343-3547 (TTY: 711).

Smoking Cessation

Fidelis Care is here to help you access the care and services you need quit smoking. Your plan includes coverage of smoking cessation counseling, prescription and non-prescription smoking cessation products such as nasal sprays, inhalers, over-the-counter nicotine patches, and gum.

Flu shots

Remember that you are eligible for a FREE annual flu shot from August 1 to April 30^, which you can receive at your doctor’s office or any pharmacy. Check the formulary for a full listing of covered flu vaccinations.

For a full list of preventive services for adults, women, and children, please visit healthcare.gov.

We’re here to help you understand the cost of your care. If you need help, please call us at 1-888-FIDELIS (1-888-343-3547).