Essential health benefits are covered by your plan. Depending on your plan, you may have deductibles, copayments, and other out-of-pocket costs that apply to most covered services. Please refer to your Subscriber Contract or call Ambetter from Fidelis Care if you have any questions. Always check with your provider to find out if a referral is required for any additional health services you might need.
Preventive services covered at no cost to you follow recommendations from the US Preventive Services Task Force, the Health Resources & Services Administration, and Bright Futures, a national health promotion initiative lead by the American Academy of Pediatrics.
Your coverage also helps:
Get high quality care. Access to high quality in-network care for little to no out of pocket costs.Stay healthy. Health insurance helps you get preventive care that keeps you healthy and in touch with a doctor.Prepare for the unexpected. If you have an emergency or become seriously ill, health insurance helps give you peace of mind knowing your healthcare needs will be met.
You can also review common health insurance terms to help you better understand your plan.
Monthly Premiums
You will receive a billing statement in the mail to pay your monthly premium payment. You may also receive an email to pay your premium. Please make your payment by the due date indicated on your billing statement to avoid possible loss of coverage.
How Cost-Sharing Works
Your Qualified Health Plan will have some combination of cost-sharing, such as copays, deductibles, coinsurance, and an out-of-pocket maximum.
Say your plan has a $1,000 deductible, 20 percent coinsurance, and an out-of-pocket maximum. Here's how your costs will stack up:
- You'll pay for any health services you need in full (if you stay in network, you will pay the rate at which Ambetter from Fidelis Care would reimburse your doctor for the service, which will help you save money). You pay for your services until you have spent $1,000 on health care.
- Once you meet your deductible, you'll continue to pay 20 percent coinsurance for any health services you need. This means you'll pay 20 percent of the cost of the health services you need, while Ambetter from Fidelis Care will pay 80 percent.
- You'll pay a portion of the cost for your health services until you reach an out-of-pocket maximum. This means your plan has a limit for how much you will spend out of pocket on health services in a given year. Once you reach that out-of-pocket maximum, any health services you need after that are covered by Ambetter from Fidelis Care in full.
We’re here to help you understand the cost of your care. If you need help, please call us at 1-888-FIDELIS (1-888-343-3547).
In-Network Coverage
Ambetter from Fidelis Care Qualified Health Plans have in-network only benefits, meaning that services from providers not in the Ambetter from Fidelis Care Network might not be covered. You should always check to make sure your provider participates in our network before receiving services – even if you were referred by a participating provider.
Emergency services are always covered. However, it's still important to avoid surprise bills in these situations. Learn more about Surprise Bills.