Essential coverage. $0 monthly premium

Essential Plan (EP)

The Essential Plan is for New Yorkers who do not qualify for Medicaid or Child Health Plus, but still need access to quality health care. Fidelis Care offers five income-based tiers of the Essential Plan – all with $0 premium. 


Essential Plan benefits include:

  • FREE preventive care like routine doctor exams and screenings 
  • Dental and vision coverage 
  • Inpatient and outpatient hospital care 
  • Prescription drugs 
  • Prenatal care, including free BabyCare program
  • Lab tests, X-rays, and more
  • Fitness reimbursement
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Who can apply for EP?

The Essential Plan is for individuals who meet certain income requirements. You can use the 2024 Income Guidelines chart to see if you may qualify. 

The Essential Plan is 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!  

2024 Income Guidelines

Household Size

Maximum Yearly Income

1

$37,650

2

$51,100

3

$64,550

4

$78,000

 

 

Low or No Costs

Fidelis Care offers five types of Essential Plans: Essential Plan 1, 2, 3, 4, and 200-250. 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.

Find a Doctor

Check to see if your medical professional, service, or facility is in the Fidelis Care Essential Plan Network.

 

Essential Plan 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. 

To review our 2024 Benefit Summaries and Subscriber Contracts for Essential Plan 1, 2, 3, 4, and 200-250, please visit our EP Member webpage.

To learm more about the Essential Plan expansion, please visit our EP Expansion webpage.

 


What are the differences between Essential Plans 1, 2, 3 and 4?

To review the benefits and eligibility requirements for each plan, view and/or download our 2024 Essential Plan (EP) Comparison Chart.


 

How to Enroll in an Essential Plan

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.