Essential Plan

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. Open enrollment is available year-round.  If eligible, you can sign-up today!

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Cost

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
  • Office visits are $0 or $15 for a PCP, and $0 or $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.

 

Benefits

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 also have dental and vision coverage at no additional cost. Essential Plan members do not have to make any copayments or coinsurance when they receive a covered dental or vision care service from a network provider.

Essential Plan members are also eligible for Fidelis Care's Fitness Reimbursement Programas well as our Mail Order Pharmacy ProgramEssential Plan members don’t need referrals.

Prior authorization is needed for certain services, and if you need to see an out of network provider. 

 

How to Enroll

Once you know the health coverage you qualify for, there are four ways you can enroll:

  • Enroll Online via NY State of Health
    Visit 
    NYSOH and click on "Start Enrollment."
  • Select 'Get Started' in the next box to contact a certified representative. 

Get Coverage Today

Tell us more about yourself to find qualifying plans and estimate costs.