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. 

Contact a Representative Today to Determine your Eligibility for EP


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, $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


Availability

Enroll at any time. You can sign up today! 


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 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)


 

How to Enroll

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

  • Call 1-888-FIDELIS (1-888-343-3547), TTY: 711
  • Find a Fidelis Care office near you. Make an appointment, or visit during regular business hours!
  • Enroll Online via NY State of Health. Visit www.nystateofhealth.ny.gov and click on "Start Enrollment."
  • Select the 'Get Started' button below to contact a certified representative at Fidelis Care.

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

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