Important Medicare Information
Important information about your Fidelis Medicare coverage.
Multi Language Insert
Enrollment applications are available in both English and Spanish versions. We have free interpreter services to answer any questions you may have about our health or drug plan. Learn more: Multi-Language Insert (.pdf)
Fidelis Care must honor you rights as a member of our Plan.
We must provide information in a way that works for you (in languages other than English, in Braille, in large print, or other alternate formats, etc.)
To get information from us in a way that works for you, please call Member Services department at 1-800-247-1447 (TTY 1-800-695-8544). From October 1st through February 14th, we are open seven (7) days a week from 8:00 a.m. to 8:00 p.m. and from February 15th through September 30th, we are open Monday through Friday from 8:00 a.m. to 8:00 p.m.
Our plan has non-English speaking representatives and free language interpreter services available to answer questions from non-English speaking members. We can also give you information in Spanish, in an audio format, in large print, or other alternate formats if you need it. If you are eligible for Medicare because of a disability, we are required to give you information about the plan’s benefits that is accessible and appropriate for you.
If you have any trouble getting information from our plan because of problems related to language or a disability, please call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week, and tell them that you want to file a complaint. TTY users call 1-877-486-2048.
Para obtener información sobre nosotros de una manera que conveniente para usted, por favor llame a Servicios al Socio (los números telefónicos están en el reverso de este folleto).
Nuestro plan tiene personas y servicios de intérprete de idiomas disponibles para responder las preguntas de miembros que no hablan inglés. También le podemos dar la información en español, en un formato de audio, en una impresión grande o en otros formatos alternativos si usted lo necesita. Si usted es elegible para Medicare debido a una discapacidad, debemos ofrecerle información sobre los beneficios del plan que son accesibles y apropiados para usted.
Si tiene alguna dificultad para obtener información de nuestro plan debido a problemas relacionados con el idioma o una discapacidad, por favor llame a Medicare al 1-800-MEDICARE (1-800-633-4227), 24 horas al día, 7 días a la semana, y dígales que quiere presentar una queja. Los usuarios de TTY deberán llamar al 1-877-486-2048.
We must treat you with fairness and respect at all times
Our plan must obey laws that protect you from discrimination or unfair treatment. We do not discriminate based on a person’s race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability, or geographic location within the service area.
If you want more information or have concerns about discrimination or unfair treatment, please call the Department of Health and Human Services’ Office for Civil Rights 1-800-368-1019 (TTY 1-800-537-7697) or your local Office for Civil Rights.
If you have a disability and need help with access to care, please call our Member Services department. If you have a complaint, such as a problem with wheelchair access, Member Services can help.
We must ensure that you get timely access to your covered services and drugs
As a member of our plan, you have the right to choose a primary care provider (PCP) in the plan’s network to provide and arrange for your covered services (Chapter 3 of your Evidence of Coverage explains more about this). Call Member Services to learn which doctors are accepting new patients. We do not require you to get referrals.
As a plan member, you have the right to get appointments and covered services from the plan’s network of providers within a reasonable amount of time. This includes the right to get timely services from specialists when you need that care. You also have the right to get your prescriptions filled or refilled at any of our network pharmacies without long delays.
If you think that you are not getting your medical care or Part D drugs within a reasonable amount of time, Chapter 9, Section 10 of your Evidence of Coverage tells what you can do. (If we have denied coverage for your medical care or drugs and you don’t agree with our decision, Chapter 9, Section 4 of your Evidence of Coverage tells what you can do.)
We must protect the privacy of your personal health information
Federal and state laws protect the privacy of your medical records and personal health information. We protect your personal health information as required by these laws.
How do we protect the privacy of your health information?
You can see the information in your records and know how it has been shared with others
You have the right to look at your medical records held at the plan, and to get a copy of your records. We are allowed to charge you a fee for making copies. You also have the right to ask us to make additions or corrections to your medical records. If you ask us to do this, we will work with your healthcare provider to decide whether the changes should be made.
You have the right to know how your health information has been shared with others for any purposes that are not routine.
If you have questions or concerns about the privacy of your personal health information, please call our Member Services department.
We must give you information about the plan, its network of providers, and your covered services.
As a member of Fidelis Care, you have the right to get several kinds of information from us.
If you want any of the following kinds of information, please call Member Services:
We must support your right to make decisions about your care. You have the right to know your treatment options and participate in decisions about your health care
You have the right to get full information from your doctors and other health care providers when you go for medical care. Your providers must explain your medical condition and your treatment choices in a way that you can understand.
You also have the right to participate fully in decisions about your health care. To help you make decisions with your doctors about what treatment is best for you, your rights include the following:
You have the right to give instructions about what is to be done if you are not able to make medical decisions for yourself
Sometimes people become unable to make health care decisions for themselves due to accidents or serious illness. You have the right to say what you want to happen if you are in this situation. This means that, if you want to, you can:
The legal documents that you can use to give your directions in advance in these situations are called “advance directives.” There are different types of advance directives and different names for them. Documents called “living will” and “power of attorney for health care” are examples of advance directives.
If you want to use an “advance directive” to give your instructions, here is what to do:
If you know ahead of time that you are going to be hospitalized, and you have signed an advance directive, take a copy with you to the hospital.
Remember, it is your choice whether you want to fill out an advance directive (including whether you want to sign one if you are in the hospital). According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive.
What if your instructions are not followed?
If you have signed an advance directive, and you believe that a doctor or hospital did not follow the instructions in it, you may file a complaint with the New York State Department of Health.
You have the right to make complaints and to ask us to reconsider decisions we have made.
If you have any problems or concerns about your covered services or care, Chapter 9 of your Evidence of Coverage tells what you can do. It gives the details about how to deal with all types of problems and complaints.
What you need to do to follow up on a problem or concern depends on the situation. You might need to ask our plan to make a coverage decision for you, make an appeal to us to change a coverage decision, or make a complaint. Whatever you do – ask for a coverage decision, make an appeal, or make a complaint – we are required to treat you fairly.
You have the right to get a summary of information about the appeals and complaints that other members have filed against our plan in the past. To get this information, please call Member Services.
What can you do if you believe you are being treated unfairly or your rights are not being respected?
If it is about discrimination, call the Office for Civil Rights
If you believe you have been treated unfairly or your rights have not been respected due to your race, disability, religion, sex, health, ethnicity, creed (beliefs), age, or national origin, you should call the Department of Health and Human Services’ Office for Civil Rights at 1-800-368-1019 or TTY 1-800-537-7697, or call your local Office for Civil Rights.
Is it about something else?
If you believe you have been treated unfairly or your rights have not been respected, and it’s not about discrimination, you can get help dealing with the problem you are having:
How to get more information about your rights
There are several places where you can get more information about your rights:
You have some responsibilities as a member of the plan. What are your responsibilities?
Things you need to do as a member of the plan are listed below. If you have any questions, please call Member Services. We’re here to help.
Get familiar with your covered services and the rules you must follow to get these covered services. Use this Evidence of Coverage booklet to learn what is covered for you and the rules you need to follow to get your covered services.
If you have any other health insurance coverage or prescription drug coverage in addition to our plan, you are required to tell us. Please call Member Services to let us know.
Tell your doctor and other health care providers that you are enrolled in our plan. Show your plan membership card whenever you get your medical care or Part D prescription drugs.
Help your doctors and other providers help you by giving them information, asking questions, and following through on your care.
Be considerate. We expect all our members to respect the rights of other patients. We also expect you to act in a way that helps the smooth running of your doctor’s office, hospitals, and other offices.
Pay what you owe. As a plan member, you are responsible for these payments:
Tell us if you move. If you are going to move, it’s important to tell us right away. Call Member Services.
Call Member Services for help if you have questions or concerns. We also welcome any suggestions you may have for improving our plan.
Fidelis Care Medicare 2017 Star Ratings
Ending your membership in Fidelis may be voluntary (your own choice) or involuntary (not your own choice):
If you are leaving our plan, you must continue to get your medical care through our plan until your membership ends.
Note: If you disenroll from Medicare prescription drug coverage and go without “creditable” prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. (“Creditable” coverage means the coverage is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.)
Contact your State Medicaid Office to learn about your Medicaid plan options (telephone numbers are in your Evidence of Coverage Chapter 2, Section 6).
If you have any questions or would like more information on when you can end your membership:
Usually, to end your membership in our plan, you simply enroll in another Medicare plan. However, if you want to switch from our plan to Original Medicare but you have not selected a separate Medicare prescription drug plan, you must ask to be disenrolled from our plan. There are two ways you can ask to be disenrolled:
If you would like to switch from our plan to:
This is what you should do:
If you leave Fidelis, it may take time before your membership ends and your new Medicare coverage goes into effect. (See Section 2 for information on when your new coverage begins.) During this time, you must continue to get your medical care and prescription drugs through our plan.
Fidelis must end your membership in the plan if any of the following happen:
Where can you get more information?
If you have questions or would like more information on when we can end your membership:
Fidelis is not allowed to ask you to leave our plan for any reason related to your health.
What should you do if this happens?
If you feel that you are being asked to leave our plan because of a health-related reason, you should call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may call 24 hours a day, 7 days a week.
If we end your membership in our plan, we must tell you our reasons in writing for ending your membership. We must also explain how you can make a complaint about our decision to end your membership. You can also look in your Evidence of Coverage Chapter 9, Section 11 for information about how to make a complaint.
Questions? Call our Member Services Department at 1-800-247-1447 (TTY: 1-800-695-8544). From October 1 to February 14, our office hours are 8:00 a.m. to 8:00 p.m. seven days a week and from February 15 through September 30, our office hours are Monday through Friday, 8:00 a.m. to 8:00 p.m.
Fidelis Care is an HMO plan with a Medicare contract. Enrollment in Fidelis Care depends on contract renewal.
Fidelis Care is a Coordinated Care plan with a Medicare contract and a contract with the New York State Department of Health Medicaid program. Enrollment in Fidelis Care depends on contract renewal.
(Updated 10/12/2016) H3328_FC 16153 Approved