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HomeMemberManage Your PlanEssential Plan Resources

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Essential Plan Members

Welcome! Fidelis Care is proud to be your healthcare partner.

Get Started

Take charge of your health! Get the care and services you need to stay as healthy as possible.
  • Important Information Regarding Pregnancies for Essential Plan Members

    • Step 1: Sign Up for Our Member Portal

    The Member Portal is the easiest way to get information about your plan. You will have 24/7 access to your account. You can:

  • View and print new ID cards
  • Check your claims
  • Access your plan documents

    • If you need help creating your Member Portal account, watch this video.

    Step 2: Fill Out Your Health Risk Assessment
    The Health Risk Assessment is a brief survey. It helps us understand your healthcare needs and get you connected to services. Complete the survey that came in your welcome materials which is mailed within 14 days of coverage. Then mail it to us in the postage-paid envelope.
    Step 3: Get to Know Your Benefits

    Fidelis Care's Essential Plan offers a wide range of services. They include:

  • No-cost annual checkups
  • Immunizations
  • Preventive care
  • Routine screenings
  • Hospital and emergency care
  • Mental health and substance use services (no PCP referral needed)
  • Transportation to doctor visits
  • Eye exams
  • Dental care
  • Family planning


    • You can learn more about your benefits by reading your subscriber contract. To request a paper copy, call Fidelis Care at 1-888-FIDELIS (1-888-343-3547); TTY: 711. 

    Fidelis Care offers Care Management services to help members who need extra health support with scheduling healthcare appointments or arranging transportation to your doctor's visit. To see if you are eligible for Care Management Services or to enroll in our texting program, call 1-800-247-1441 (TTY: 711) from 8:30 AM to 5 PM Monday through Friday.

    Here are some additional benefits to support your health.

    Fitness Reimbursement
    Prenatal Care Program
    Step 4: Choose a Primary Care Provider

    Fidelis Care wants to make sure you get the best care. A primary care provider (PCP) helps keep you healthy. If you already have a PCP who is in the Fidelis Care network, then that provider should have been automatically assigned as your PCP. You can view, confirm or change your PCP from your Member Portal account. If you need help changing your PCP through the member portal, watch this video.

    Find PCPs near you by using our Find a Doctor tool. Watch this video if you need help with the Find a Doctor tool.

    Step 5: Schedule Your Annual Checkup
    It’s important to get a checkup every year to see if there are any changes to your health. Your PCP can help you stay well and take control of your health. There is no copay for your annual checkup.


    Here are some questions you might ask your PCP:

  • Do I need any vaccinations?
  • Do I need any health screenings or blood tests?
  • Do I need any changes to my prescriptions?
  • What lifestyle changes can I make to improve my health?
  • When should I schedule my next visit?


    • Follow your PCP’s advice. Listen to your PCP and ask questions if you don't understand. Be sure to keep all follow-up visits. Also, take medications as prescribed.

    Member Portal


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


    Log In

    Member Resources

    Click below to view reference documents. If you’re a member, log in to the Member Portal to view your contract and benefits

    Plan Basics

    There are no copays for covered services, including preventive services. Always check with your primary care provider to find out if a referral is required for any additional health services you might need.

    Your coverage also helps:

  • Get high quality care. Access to high quality in-network care for little to no out of pocket costs.
  • Stay healthy. Health insurance helps you get preventive care that keeps you healthy and in touch with a doctor.
  • Prepare for the unexpected. If you have an emergency or become seriously ill, health insurance helps give you peace of mind knowing your healthcare needs will be met.


    • You can also review common health insurance terms to help you better understand your plan.

    Prescription Drug Information

    Your pharmacy benefits are covered by Express Scripts (by clicking on this link, you will leave the Fidelis Care website). Log in to your Member Portal account to easily access your pharmacy benefits.

    Formularies 

    Mail Order Pharmacy

    For additional resources, visit our pharmacy webpage.

    Summaries of Benefits and Coverage

    The Summary of Benefits and Coverage outlines some of your plan’s key benefits, and explains how much they could cost. The cost examples are estimates only, and serve as a guide for how your particular plan might cover different conditions; not the exact dollar amount you will pay.

    2025

    Essential Plan 1
    Essential Plan 2 
    Essential Plan 3
    Essential Plan 4
    Essential Plan 200-250
    Subscriber Contracts

    Your Subscriber Contract provides a full description of the services included in your benefit package, as well as cost information for those services.

    2025

    Essential Plan 1
    Essential Plan 2
    Essential Plan 3
    Essential Plan 4
    Essential Plan 200-250

    Renew Your Coverage

    You need to renew your health insurance every year. We can help answer all your questions so you stay covered. 

    Get Help


    Connect with a Primary Care Provider (PCP)

    Having a PCP can improve your healthcare and overall well-being. Our videos can guide you through:
    • Finding a PCP near you
    • Changing your PCP through the member portal 

    Schedule your annual checkup.

    Need help? Call 1-888-FIDELIS (1-888-343-3547), TTY: 711.


    Dental-Icon

    Visit a Dentist

    Essential Plan members receive dental coverage as part of their plan. Your benefits are covered through DentaQuest. Visit our DentaQuest Resource Page for more information on getting started, and preventive dental care best practices.

    Vision-Icon

    Schedule an Eye Exam

    Vision coverage is included as part of the Essential Plan. Your benefits are covered through Davis Vision. Visit our Davis Vision Resource Page (by clicking on this link, you will leave the Fidelis Care website) for information on getting started. 

    To review Fidelis Care's best practice guidelines for healthy vision, click HERE

    Shot-Icon

    Get Your Immunizations

    Fidelis Care encourages you to get the flu vaccine every year. The vaccine is free as part of your Essential Plan coverage. Learn more about other important immunizations and talk to your primary care provider about the vaccines that are right for you. 

    We're here to help!

    Contact Fidelis Care with any questions you may have.

     

    Find a Doctor

    Search for a medical professional, service, or facility in the Fidelis Care Network.
    Search

    Member Newsletter

    Read our latest member newsletter (HealthyNOW) and browse the archives.

    Read

    Your Health Information is Protected

    The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provides national standards to protect individuals’ medical records and other personal health information. The Privacy Rule applies to all forms of your protected health information, whether electronic, written, or oral. 

    To learn more about HIPAA and your privacy rights, visit the U.S. Department of Health and Human Services. By clicking this link, you will leave the Fidelis Care website.

    Authorization to Use and Disclose Health Information (PDF)

    Revocation of Authorization to Use and/or Disclose Health Information (PDF)

    Member Rights and Responsibilities

    As a Fidelis Care member, you have a right to participate with practitioners in making decisions about your healthcare. You also have the right to be treated with respect and with recognition of your dignity and your right to privacy.

    General Statement of Member Rights and Responsibilities (PDF)

    Language Assistance Services (PDF)

    Notice of Non-Discrimination (PDF)

    Patient Bill of Rights (PDF)

    Important Information on Coverage Decisions

    Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on many health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

    Fidelis Care does not reward providers or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff based on decisions that promote underutilization of services. 

    Fidelis Care is committed to ensuring that members have the care and services they need.