Learn more about NY State of Health (.mp3)
Enrolling in the NY State of Health is as easy as 1 - 2 - 3!
1. Get Started
NY State of Health: The Official Health Plan Marketplace provides consumers more of a choice of insurance products at a lower price. Products are standardized in the Marketplace and fall into various "metal" levels based on their design and the level of cost sharing required of individuals in the product: Platinum, Gold, Silver and Bronze. There are also Child-Only plans, plans that cover young adults in the home until age 26, and Catastrophic plans. Within each metal level and product there are price (monthly premium) and product (co-insurance, copays and deductible) levels.
Fidelis Care products offered through the NY State of Health give members the freedom to see any doctor in the Fidelis Care network--no referrals required. View our products
To make an appointment with a Fidelis Care representative, call 1-888-FIDELIS (1-888-343-3547); TTY: 1-800-421-1220
2. Estimate Your Rates
The Fidelis Affordable Care Advisor is an online calculator that can help you plan for and estimate the costs of new insurance options offered through NY State of Health, as well as find out if you may qualify for Child Health Plus, Medicaid, Medicare Advantage, or Dual Advantage. By entering a zip code, date of birth, number of family members, and household income, the Fidelis Affordable Care Advisor presents insurance options at prices that include subsidies or tax credits, if they apply. It also allows users to schedule an appointment with a representative who can assist with enrollment.
For 2016 coverage, open enrollment runs from November 1, 2015 through January 31, 2016. Missed the deadline? Learn about Special Enrollment Periods below.
(Clicking this link will cause you to leave the Fidelis Care website)
Before You Enroll: Estimate Your Cost for Treatment
With our Treatment Cost Calculator, you can estimate your share of costs based on the product you have selected, for many common conditions and services.
Using the calculator is two-step process:
- Choose a medical treatment, service, or condition.
- Review a general estimate of your costs, based on your location, potential benefits, and historical costs.
Missed the open enrollment deadline?
Learn about Special Enrollment Periods
You may still be eligible for coverage if you apply within 60 days of the date of one of these qualifying events. Additionally, this year, there is a one-time Special Enrollment Period for people who learn that they have a federal tax penalty for 2014. This Special Enrollment Period is only available from March 1 through April 30, 2015.
|Change in legal marital status
Examples: Getting married, death of a spouse, divorce, separation, annulment, etc.
|Change in the number of dependents
Examples: Having a child; adopting; child ceasing to meet age, student status, or marital status requirements; etc.
|Change in employment status
Examples: Termination of employment; start or return from an unpaid leave of absence; changing from part-time to full-time; etc.
|Change in the place of residence
Examples: Moving to a state or county where the current plan isn't available, obtaining a green card or permanent resident status, etc.
|Change in eligibility
Examples: Becoming eligible for Medicare or Medicaid, gaining or losing eligibility for tax credits or cost-sharing reductions, etc.
|Change in employer-sponsored plan
Examples: A change in coverage of a spouse or dependent under an employer's plan, open enrollment under the plan of another employer, loss of benefits under an employer's plan, etc.
|Errors or Violations through NY State of Health
Examples: Chosen product does not provide minimum required coverage, enrolled in a plan or product you did not select, delays in processing, etc.
|Loss of coverage under a group health plan of a governmental or educational institution
Examples: A state's children's health insurance program, medical care program of an Indian tribal government, etc.
|*If you have questions, need additional information, or want to schedule a meeting with a Fidelis Care representative, please call 1-888-FIDELIS (1-888-343-3547) or call your local broker.
What's covered under these new products?
Discover our Essential Health Benefits
Regardless of the plan you choose, you’ll be covered for these:
|Preventive and Wellness Services
What benefits are covered?
|Chronic Disease Management
|Pediatric Services, including Oral and Vision Care
|Maternity and Newborn Care
|Ambulatory Patient Services
|Emergency Room Care
|Rehabilitative and HabilitationServices and Devices
|Ambulatory Patient Services
||Mental Health and SubstanceAbuse Disorders
NY State of Health Preferred Drug List (Formulary)
(.pdf) | A drug formulary is a list of both generic and brand name prescription drugs that are covered by your prescription drug benefit. The formulary is managed by our Pharmacy and Therapeutics Committee, qualified pharmacists and doctors whose primary focus is offering safe, high-quality and cost-effective drugs. New drugs are added to the formulary periodically based on the latest medical research and some drugs may be removed periodically based on the findings and recommendations of the Pharmacy and Therapeutics Committee.