11/12/2024
•
Posted by Provider Relations
Fidelis Care would like to inform our providers of plan changes that will be effective January 1, 2025.
| Wellcare By Fidelis Care |
| Wellcare Fidelis Dual Plus (HMO D-SNP) - Plan 008 | Effective January 1, 2025, Fidelis Care members currently in this plan will be enrolled in Wellcare Fidelis Dual Plus (HMO D-SNP) – Plan 003, unless the member chooses another plan. |
| Wellcare Fidelis No Premium (HMO) – Plan 004 | Effective January 1, 2025, the plan name will change from Wellcare Fidelis No Premium (HMO) to Wellcare Fidelis Simple (HMO-POS). The service areas for this plan will expand to: Columbia, Franklin, Genesee, Greene, Livingston, Madison, Ontario, Putnam, Suffolk, and Sullivan Counties. |
| Wellcare Fidelis Dual Access (HMO D-SNP) Plan 001 | Effective January 1, 2025, the service areas for this plan will expand to: Genesee, Jefferson, Livingston, Madison, Monroe, Ontario, and Wayne Counties. |
| Wellcare Fidelis Assist (HMO-POS) – Plan 002 | Effective January 1, 2025, the service areas for this plan will expand to: Columbia, Franklin, Genesee, Greene, Livingston, Madison, Ontario, Putnam, Suffolk, and Sullivan Counties. |
| Wellcare Fidelis Dual Plus (HMO D-SNP) – Plan 003 | Effective January 1, 2025, the service areas for this plan will expand to: Genesee, Jefferson, Livingston, Madison, Monroe, Ontario, and Wayne Counties. |
| 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 (PCP office visits, annual dilated retinal examination, annual diabetic foot exam, diabetic self-management education services, laboratory procedures tests, equipment and supplies, and prescription drugs). In order for cost sharing to be waived, the claim must be submitted with a primary diagnosis of 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. Services are covered in full with the exception of: emergency services, inpatient mental health services, inpatient substance use services, ambulance and pre-hospital emergency medical services, inpatient services, dental care, and vision care. |
| Essential Plans |
| Diabetes Services | Effective January 1, 2025, Fidelis Essential Plan members will not be responsible for the in-network cost share for some services related to the diagnosis and management of diabetes (PCP office visits, annual dilated retinal examination, annual diabetic foot exam, diabetic self-management education services, laboratory procedures tests, equipment and supplies, and prescription drugs). In order for cost sharing to be waived, the claim must be submitted with a primary diagnosis of diabetes. |
| Primary Care Provider Assignments | Starting November 1, 2024, newly enrolled members and members who renew their coverage will have 30 days to self-select a PCP. If a member does not designate a PCP within the 30 days following renewal or enrollment, Fidelis Care will assign the member a PCP, similar to the Medicaid assignment process. Members will receive a letter from Fidelis Care with the PCP they are assigned. |
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!