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Important Information on the Expansion of the Essential Plan

With expanded coverage for the Essential Plan through the NY State of Health Marketplace, more New Yorkers qualify than ever before!
The Essential Plan is designed for lower-income adults under the age of 65 who don’t qualify for Medicaid or Child Health Plus.

Why did I receive a letter about switching to the Essential Plan?

New York State has expanded the eligibility of the Essential Plan. Individuals with an annual income between $30,121 to $37,650 are now eligible for Essential Plan 200-250. Essential Plan 200-250 is a low-cost alternative to your Ambetter from Fidelis Care Qualified Health Plan and has a $0 monthly premium.

What are my choices?

Carefully read any communications from New York State to understand your options. You have choices. You can:

  • Switch to Essential Plan 200-250: New York State will automatically move you to Fidelis Care's Essential Plan 200-250 unless you opt out of the change.
  • Stay in your Ambetter from Fidelis Care Qualified Health Plan: You can choose to stay in your current plan by opting out of the Essential Plan 200-250. Follow the directions in the letter from New York State by the provided deadline. If you opt out of the Essential Plan 200-250, you will lose any subsidies that you receive to lower the cost of your premium.
What are the benefits of switching to the Essential Plan?

The Essential Plan 200-250 is a quality, low-cost health plan from Fidelis Care - the same health plan you know and trust. The plan features a $0 monthly premium, $0 deductible, and no or low out-of pocket costs. 

The Essential Plan 200-250 includes a full range of benefits to support your health and wellness, including: 

  • FREE preventive care like checkups with your primary care provider and routine screenings 
  • Dental and vision care with $0 copay 
  • Hospital care 
  • Prenatal care 
  • Prescription drugs 
  • Lab tests, X-rays, and more 
  • $400 fitness reimbursement each year 
  • And much more!
I want to move to the Essential Plan 200-250. What happens next?

New York State will determine the date that you are moved to the Essential Plan 200-250. The dates are either April 1, 2024, or May 1, 2024. Read the communication from New York State. Fidelis Care will also communicate this information to you. You will receive a Welcome Kit from Fidelis Care in the mail 6-10 days after your enrollment date. It will contain your ID card and other important information.

Your Essential Plan 200-250 member ID card will say Fidelis Care instead of Ambetter from Fidelis Care. While the cards look different, both plans are from Fidelis Care. You are still getting the same care from the company you know and trust. You will still use the Fidelis Care Member Portal, visit the Fidelis Care website, and call Fidelis Care Member Services. For your convenience, you can use the Essential Plan Member page. You can call 1-888-FIDELIS (1-888-343-3547) when you need to contact Member Services. 

Once I join EP, do I need to do anything else?

If you don't already have a primary care provider (PCP), you will need to choose one. If you already have a PCP or see a regular doctor, then the doctor can probably be your PCP. Use our Find a Doctor tool to make sure your provider is in the Essential Plan. If the provider is in the Essential Plan, call Member Services at 1-888-FIDELIS (1-888-343-3547) and ask your Representative to assign the provider as your PCP.

You should also check to see if other providers that you see are in our Essential Plan network. If they aren't and you are currently receiving treatment, then you will be notified by Fidelis Care about your options to maintain care. We want to make sure there are no gaps in your care. 

Member Portal

Log in or register to view and print ID cards, check your claims history, access your pharmacy benefit, and much more.

Essential Plan Member Resources

Log in to the Member Portal to view your contract and benefits. Essential Plan members can also visit our Essential Plan Member page for information about benefits.

Ambetter from Fidelis Care to Essential Plan 200-250
What’s Changing? *

Ambetter from Fidelis Care
Qualified Health Plan

Fidelis Care Essential Plan 200-250

Monthly Premium Cost varies depending on plan $0
Deductible Cost varies depending on plan $0
Preventive Care Covered Covered
Annual Physical Exam $0 $0
Dental Adults not covered under Standard QHP plans Covered with $0 copay
Vision Adults not covered under Standard QHP plans Covered with $0 copay
Hospital Care Covered Covered
Prenatal Care Covered Covered
Lab Tests and X-Rays Covered Covered
Primary Care Provider (PCP) Selection Recommended to assist you in managing your health Required; you will not need a referral from your PCP to see a specialist
Fitness Reimbursement Program $200/$100 reimbursement every six months for member/spouse who complete 50 visits in six months $200 reimbursement every six months for member who complete 50 visits in six months
Prescription Drugs Cost varies depending on plan and drug tier $6/$15/$30
Brand Incomm-Convey-Fidelis-Care-Health-Insurance-Partner Incomm-Convey-Fidelis-Care-Health-Insurance-Partner
Member Portal members.fideliscare.org members.fideliscare.org
Website fideliscare.org fideliscare.org
Phone 1-888-FIDELIS (1-888-343-3547), TTY: 711 1-888-FIDELIS (1-888-343-3547), TTY: 711

* Please refer to your plan materials for complete benefit information.


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