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.
Medicaid Managed Care
Formularies 

2023 Formulary

2022 Formulary


Virtual Support

Telemedicine Benefits


Member Handbook

Medicaid Managed Care Member Handbook


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 


2022 Summaries of Benefits and Coverage & Subscriber Contracts

Essential Plan 1 

 

Essential Plan 2 

Essential Plan 3 

 

Essential Plan 4 

Qualified Health Plans

Benefits 


Formularies


QHP Resources


Summaries of Benefits and Coverage

2023


     

    2022


       

      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

    •  

      2022

    • 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 and Gold: Wellness
    • Silver and Gold: Enhanced
    • Silver and Gold: Wellness

    •  

    • Narrative Summary of Requested Rate Changes Effective January 1, 2023
    •  

      Pharmacy Benefits

      Your pharmacy benefits are covered through CVS Caremark.  Navigate to CVS Caremark for more information or to register today.

      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. 

      Medication Not Covered?

      Click HERE to request coverage for a medication that is not on your plan’s drug list or restricted in some way.  Approval is not guaranteed.  

       

       

      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 ServicesBy clicking this link, you will leave the Fidelis Care website.


      Notice of Privacy Practices

      Fidelis Care Notice of Privacy Practices


      Find a Doctor

      Search for a Doctor in your area.