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 on the Medical Benefit, the claim must be submitted with a primary diagnosis of diabetes.

In order for cost sharing to be waived on the Pharmacy Benefit, the prescription sent to the member must include a 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 on the Medical Benefit, the claim must be submitted with a primary diagnosis of diabetes.

In order for cost sharing to be waived on the Pharmacy Benefit, the prescription sent to the member must include a 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.