Qualified Health Plan Products
Fidelis Care Qualified Health Plan Products are standardized plans offered by Fidelis Care via NY State of Health, the Official Health Plan Marketplace.
Plans fall into various "metal" levels based on their design and the level of cost sharing required: Platinum, Gold, Silver, Bronze, and Catastrophic Coverage. It is also possible to purchase these plans "off-exchange," or directly from Fidelis Care.
Availability
Qualified Health Plans are available during Open Enrollment.
Contact a Representative Today to Determine your Eligibility for QHP
Cost
Premiums, copays, coinsurance, and deductibles vary by plan type.
Treatment Cost Calculator
After January 1, 2023, if you have any questions about this information, please call Member Services at 1-888-343-3547 (TTY: 711).
Benefits
Our Qualified Health Plans either fully or partially cover a comprehensive list of benefits, including:
- Dental and vision coverage options for the entire family*
- Telemedicine benefit with 24/7 doctor visits with $0 copay
- Preventive services and chronic disease management
- Outpatient services
- Emergency services
- Hospitalization
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Laboratory services
- HSA-Compatible Bronze option to help cover and even lower healthcare costs
- Fitness Reimbursement Program
- Mail Order Pharmacy Program
- Wellness and Silver One options that include acupuncture**
*Gold and Silver Plan members can elect dental and vision coverage for an additional cost.
** In NYC, Westchester, and Rockland, Wellness and Silver One plans will include acupuncture visits.
Click here for copies of our Qualified Health Plans' benefit and coverage summaries, drug formulary, and Subscriber Contracts. They have information about pharmacy and utilization management procedures, specific benefit inclusions and exclusions, and our provider network. To request paper copies,call Fidelis Care at 1-888-FIDELIS (1-888-343-3547); TTY: 711.
Formularies
How to Enroll
Once you know the health coverage you qualify for, there are four ways you can enroll: