The Essential Plan is for New Yorkers who do not qualify for Medicaid or Child Health Plus, but still need access to high quality health care. Fidelis Care offers four different income-based "tiers" of the Essential Plan.
Who can apply?
The Essential Plan is for individuals who meet certain income requirements. It's a good option for young adults who no longer qualify for Child Health Plus. It’s also great for people who can’t get health coverage through their employer.
Contact a Representative Today to Determine your Eligibility for EP
Fidelis Care offers four types of Essential Plans: Essential Plan 1, 2, 3, and 4. Your income will determine which plan you are eligible for.
Costs vary between tiers depending on your eligibility:
- Monthly premium is $0 or $20
- Office visits are $0, $15 for a PCP and $25 for a specialist.
- Inpatient hospital stays are $0 or $150.
- There is no deductible for any of the plans.
- All plans offer in-network only coverage (except for emergency services which are covered at any provider). Always check if your provider is in network before receiving care. Your costs will be higher if you receive care out of network.
Treatment Cost Calculator
Enroll at any time. You can sign up today!
The Essential Plan offers access to essential health benefits, such as:
- Preventive care and chronic disease management
- Emergency Services and hospitalization
- Maternity and newborn care
- Prescription drugs
Essential Plan members can elect dental and vision coverage for an additional cost.
Essential Plan members are also eligible for Fidelis Care's Fitness Reimbursement Program, as well as our Mail Order Pharmacy Program.
Essential Plan members don’t need referrals. Prior authorization is needed for certain services, and if you need to see an out of network provider.
2021 Benefit Comparisons
Compare 2021 Essential Plans (PDF)
Compare 2021 Dental and Vision Essential Plans (PDF)