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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 January 1, 2024, members enrolled in Child Health Plus, Essential Plan, Wellcare By Fidelis Care Medicare and Dual Advantage, and Ambetter from Fidelis Care Qualified Health Plans will have their pharmacy benefit managed by Express Scripts. Members will receive new ID cards with updated pharmacy information. Learn more.

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 - Children and Family Treatment and Support Services (CFTSS)

Member Handbook Insert - Children's Home and Community Based Services (Effective July 1, 2024)

Member Handbook Insert - Chronic Disease Self-Management Program (CDSMP) for Arthritis (Effective June 1, 2025)

Member Handbook Insert - Dental Services (Effective January 31, 2024)

Member Handbook Insert - Doula Services (Effective April 1, 2025)

Member Handbook Insert - Electronic Notice Option

Member Handbook Insert - Family Planning  (Effective January 1, 2025)

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

Member Handbook Insert - Mobile Crisis Telephonic Triage Response Service (Effective March 1, 2024)

Member Handbook Insert - School-Based Health Center Services  (Effective May 1, 2025)

Member Handbook Insert - Social Care Network (SCN) (Effective January 1, 2025)

Member Handbook Insert - Undocumented Non-Citizens Age 65 and Over

Member Notices

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

Gambling Disorder Treatment  (Effective January 1, 2023) 

Social Care Network (SCN)  (Effective January 1, 2025) 

Subscriber and Renewal Documents

Renewal Information Checklist

Appeal and Informal Review Process

Essential Plan

Essential Plan Information ⇒

Child Health Plus
Formularies

2025 Drug Formulary

Virtual Support

Telemedicine Benefits

Member Notices

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

Member Notice - Family Planning

Member Notice - Home and Community Based Services (Effective January 1, 2025)

Subscriber Contract and Additional Information

Subscriber Contract

Subscriber Contract Rider

Additional Information for CHPlus Members

Ambetter from Fidelis Care | Qualified Health Plans (QHP)

Ambetter from Fidelis Care Qualified Health Plans Information ⇒

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 - Chronic Disease Self-Management Program (CDSMP) for Arthritis (Effective June 1, 2025)

Member Handlbook Insert - Dental Services (Effective January 31, 2024)

Member Handbook Insert - Doula Services (Effective April 1, 2025)

Member Handbook Insert - Electronic Notice Option

Member Handbook Insert - Interoperability and Patient Access rule

Member Handlbook Insert - Mobile Crisis Telephonic Triage Response Service (Effective March 1, 2024)

Member Handbook Insert - National Diabetes Prevention Program (NDPP)

Member Handbook Insert - Social Care Network (SCN) (Effective January 1, 2025)

Member Notices

Member Notice - Smoking Cessation Counseling

Social Care Network (SCN)  (Effective January 1, 2025) 

Subscriber and Renewal Documents

Appeal and Informal Review Process

Renewal Information Checklist

Fidelis Care at Home | Managed Long Term Care (MLTC)

Fidelis Care at Home (MLTC) Health Plan Information ⇒

Wellcare By Fidelis Care | Medicare and Dual Advantage

Wellcare By Fidelis Care Medicare and Dual Advantage Plan Information ⇒

 

Renew Your Coverage

Health insurance is no longer being automatically renewed for members in our Medicaid Managed Care, Essential Plan, Child Health Plus, or HealthierLife (HARP) plans. Members will need to renew their health insurance to keep their coverage.
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

As a Fidelis Care member, you have a right to participate with practitioners in making decisions about your health care. 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)

Notice of Non-Discrimination (PDF)

Patient Bill of Rights (PDF)

Notice of Privacy Practices

Fidelis Care Notice of Privacy Practices


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