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Welcome, Fidelis Care Members!

We are proud to be your healthcare partner and want to help you access essential health benefits and services to keep you as healthy as possible.

Here’s how to get started:

Step 1: Sign Up for Our Member Portal

The Member Portal is the easiest and most secure way to access information about your plan. With 24/7 access to your Fidelis Care account, you can pay your monthly premium, request and print new ID cards, and access your plan documents. To create a secure online member account, visit members.fideliscare.org and click “Register.”

Step 2: Fill Out Your Health Risk Assessment

You can complete this brief survey on the Member Portal. The answers you provide will help us serve you better and get you connected to whatever services you may need.

Step 3: Review Your Plan Documents

You can access your Summary of Benefits and Coverage,Subscriber Contract, Formulary, and other important plan documents by logging into the Member Portal. 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. Visit fideliscare.org/costcalculator to find a treatment cost calculator, providing you with estimates that cover other conditions and services (for Qualified Health Plans and Essential Plan members; after January 1, 2023, if you have any questions about this information, please call Member Services at 1-888-343-3547). Your Subscriber Contract provides a full description of the services included in your benefit package, as well as cost information for those services. 

Step 4: Choose a Primary Care Provider
Fidelis Care is committed to ensuring you have access to the preventive care and screenings you need to stay healthy. To ensure that access, we recommend you select a Primary Care Provider (PCP), even if your plan does not require one. 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 review, select, or change your PCP from your Member Portal account. Your PCP will work with you to make sure you get the care you need.

To find PCPs near you, use our Find a Doctor tool. If you need help finding a doctor or choosing your PCP, call Member Services at 1-888-FIDELIS (1-888-343-3547); TTY: 711.

Pharmacy Benefit Change for Medicaid and HealthierLife Members

NYRx logo

  • Starting April 1, 2023, the Fidelis Care Pharmacy Benefit has been carved out and will now be managed by NYRx, the New York State Medicaid Pharmacy program. The list of preferred medications under NYRx may potentially differ from that of Fidelis Care. The list of NYRx preferred medications may be found HERE by clicking the 'Preferred Drug List' option. The NYRx OTC and Prescription Drug Member Search tool can also provide information about medication(s) covered under NYRx.
  • Your doctor has been made aware of this potential change and may switch you to a preferred medication or submit a prior authorization request to NYRx. Please speak with your provider to discuss any potential impact to your current medications.
  • Information about the transition of the pharmacy benefit from Fidelis Care Medicaid to NYRx, the Medicaid Pharmacy Program can be found HERE. 
  • General information about NYRx, the Medicaid Pharmacy Program can be found HERE, along with information for Members and Providers.
  • Do you have questions or need help? Call the NY State Medicaid Helpline at 1-855-648-1909 (TTY: 1-800-662-1220) or email NYRx@health.ny.gov.
            Frequently Asked Questions (FAQ)       

Pharmacy Benefits

Members in Medicaid and HARP receive prescription drugs through NYRx, the Medicaid Pharmacy Program effective April 1, 2023. 

For all other members with pharmacy coverage, your benefits are covered by CVS Caremark. (by clicking on this link, you will leave the Fidelis Care website)

Dental Benefits

For members with dental coverage, your benefits are covered through DentaQuest. Visit our DentaQuest Resource Page (by clicking on this link, you will leave the Fidelis Care website) for more information on getting started, and preventive dental care best practices.

Vision Benefits

For members with vision coverage, 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

 

Find a Doctor

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Understand Your Benefits

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Member Resources

View and download documents for your Fidelis Care health plan. 

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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)

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. 

Member Portal

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Renew Your Coverage

Questions about renewing health insurance? Fidelis Care can help.

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Make A Payment

Need to pay your premium? Start here.

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HealthyNOW

Read the latest member newsletter and browse the archives.

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