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. 

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 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


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 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. 

View details for our Essential Plans. (PDF)

How to Enroll

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

How can we help?

Fidelis Care is here to help you live your healthiest life and make informed health insurance decisions:

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