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Member Resources

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

Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. For more information regarding the pharmacy benefit transition, please visit NYRx, the Medicaid Pharmacy Program. Please note, members will continue to receive their medical benefits through Fidelis Care.

Medicaid Managed Care
Formularies

Effective April 1, 2023, members enrolled in Medicaid Managed Care plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program.

Medicaid List of Covered Drugs and Over the Counter (OTC) Products (NYRx)

Search for a Pharmacy or Medical Equipment Supplier (NYRx)

Virtual Support

Telemedicine Benefits

Member Handbook

Medicaid Managed Care Member Handbook

Member Handbook Insert - Medicaid NYRx, the Medicaid Pharmacy Program (Effective April 1, 2023)

Member Notices

Applied Behavior Analysis (ABA) Therapy  (Effective January 1, 2023)

Gambling Disorder Treatment  (Effective January 1, 2023) 

Subscriber and Renewal Documents

Renewal Information Checklist

Appeal and Informal Review Process

Essential Plan
Formularies 
Essential Plan Resources
Virtual Support


2023 Summaries of Benefits and Coverage & Subscriber Contracts

Essential Plan 1 

 

Essential Plan 2 

Essential Plan 3 

 

Essential Plan 4 
Child Health Plus
Formularies

2023 Drug Formulary

Virtual Support

Telemedicine Benefits

Member Notices

Member Notice - Expanded Coverage  (Effective January 1, 2023)

Member Notice - Family Planning

Subscriber Contract and Renewals

Subscriber Contract

Subscriber Contract Rider

Additional Information for CHPlus Members

Renewal Information Checklist

Appeal and Informal Review Process

Qualified Health Plans

Benefits 

Formularies

QHP Resources

Summaries of Benefits and Coverage

2023

     

    Subscriber Contracts

    2023

  • Catastrophic
  • Child Only
  • Individual and Family
  • Off-Exchange: Catastrophic
  • Off-Exchange: Children
  • Off-Exchange: Individual and Family
  • Off-Exchange: Silver and Gold: Enhanced
  • Off-Exchange: Silver One, and Gold Wellness
  • Silver and Gold: Enhanced
  • Silver One, and Gold Wellness

    •  

  • Narrative Summary of Requested Rate Changes Effective January 1, 2024
    • HealthierLife Health and Recovery Plan (HARP)
    Formularies

    Effective April 1, 2023, members enrolled in HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program.

    HARP List of Covered Drugs and Over the Counter (OTC) Products (NYRx)

    Search for a Pharmacy or Medical Equipment Supplier (NYRx)

    Virtual Support

    Telemedicine Benefits

    Member Handbook Materials

    Member Handbook

    Member Handbook Insert - Medicaid NYRx, the Medicaid Pharmacy Program (Effective April 1, 2023)

    Member Handbook Insert – Behavioral Health Community Oriented Recovery and Empowerment (CORE) Services

    Member Handbook Insert - Children and Family Treatment and Support Services (CFTSS)

    Member Handbook Insert - Family Planning Coverage

    Member Handbook Insert - Interoperability and Patient Access rule

    Member Handbook Insert - Maximum Pharmacy Copay

    Member Handbook Insert - National Diabetes Prevention Program (NDPP)

    Member Handbook Insert - Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST)

    Member Notices

    Member Notice - Smoking Cessation Counseling

    Subscriber and Renewal Documents

    Appeal and Informal Review Process

    Renewal Information Checklist

    Fidelis Care at Home (Managed Long Term Care)
    Member Handbook Materials

    Member Handbook

    Member Handbook Insert - Important Updates Regarding Coronavirus COVID-19

    Member Handbook Insert - New York Independent Assessor - Initial Assessment Process

    Member Handbook Insert - Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST)

    Member Handbook Insert - Plan Transfers

    Subscriber and Renewal Documents 

    Annual Disenrollment Notice

    Appeal and Informal Review Process

    SSBCI (Special Supplemental Benefits for the Chronically Ill)

    Medicare and Dual Advantage (Wellcare By Fidelis Care)

    Wellcare By Fidelis Care Medicare and Dual Advantage Plan Information ⇒

     

    Get Ready to Renew

    Automatic renewals will end soon, and you will need to take action to renew your health insurance. Stay connected and update your information today.
    Learn More

    Connecting Your Healthcare

    The Interoperability and Patient Access rule (CMS-9115-F) puts patients first by giving you control and easy access to your health information when you need it most. 
    Resources

    Member How To Videos

    Get the most from your Fidelis Care plan and our Member Portal by watching our videos, including how to change your PCP, requesting new ID cards, and more.

    Videos

     

     

    View and download document plans

     

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    Medicare Resources

    Exhausted Benefits

    Fidelis Care offers case management services to members by phone. Our Case Managers can provide support and assistance in identifying alternatives and resources when benefits have been exhausted. 

    Case Managers are health professionals available to assist you in managing your health, learning more about your health or conditions, coordinating care with providers and receiving necessary services. To receive more information, please call Fidelis Care Clinical Services at 1-800-247-1441.

    Language Assistance

    Free language assistance services are available to you, such as:

    • Qualified interpreters
    • Information written in other languages

    If you need these services, call Fidelis Care at 1-888-343-3547. For TTY/TDD services, call 711.

    Language Assistance Services (PDF)

     

     

    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

    General Statement of Member Rights and Responsibilities (PDF)

    Notice of Privacy Practices

    Fidelis Care Notice of Privacy Practices


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