Участник
Провайдер

Войдите в свою учетную запись, загрузите формы, просмотрите таблицы требований, и многое другое.

Поставщики услуг
Поставщики услуг
Поиск плана

Ресурсы Medicare

Просмотреть и загрузить материалы плана.


Документы плана на 2021 год

Fidelis Dual Advantage Flex (HMO SNP) Plan 001

Annual Notice of Changes

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

Ежегодное уведомление об изменениях (PDF)

年度改變通知 (PDF)

 

Evidence of Coverage

This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

Границы страховой ответственности (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Fidelis Care Programs and the Original Medicare Program. The charts in this booklet list important health benefits. For each benefit, you can see what our program covers and what the Original Medicare Program covers. Our members receive all of the benefits that the Original Medicare Program offers but we also offer additional benefits to help you stay healthy.

Summary of Benefits (PDF)

Resumen de Beneficios (PDF)

Краткий обзор страховых выплат (PDF)

福利介紹 (PDF)


Информация, отпускаемая без рецепта

2021 Medicare, части A и B Премии и франшизы


Out of Network Coverage Rules

It is important to know which providers are part of our network because, with limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which Fidelis Care authorizes use of out-of-network providers. See Chapter 3 (Using the plan’s coverage for your medical services) for more specific information about emergency, out-of-network, and out-of-area coverage.

2021 Medicare, части A и B Премии и франшизы

Fidelis Medicare Advantage Flex (HMO POS) Plan 002
Medicaid Advantage Plus (HMO SNP) Plan 003

Annual Notice of Changes

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

Ежегодное уведомление об изменениях (PDF)

年度改變通知


Evidence of Coverage

This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

Границы страховой ответственности (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Fidelis Care programs and the Original Medicare Program. The charts in this booklet list important health benefits. For each benefit, you can see what our program covers and what the Original Medicare Program covers. Our members receive all of the benefits that the Original Medicare Program offers but we also offer additional benefits to help you stay healthy.

Summary of Benefits (PDF)

Resumen de Beneficios (PDF)

Краткий обзор страховых выплат (PDF)

福利介紹 (PDF)


Over-the-Counter Benefit Information


Out-of-Network Coverage Rules

It is important to know which providers are part of our network because, with limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which Fidelis Care authorizes use of out-of-network providers. See Chapter 3 (Using the plan’s coverage for your medical services) for more specific information about emergency, out-of-network, and out-of-area coverage.
Fidelis Medicare Advantage $0 Premium (HMO) Plan 004

Annual Notice of Changes

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

Ежегодное уведомление об изменениях (PDF)

年度改變通知


Evidence of Coverage

This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

Границы страховой ответственности (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Fidelis Care programs and the Original Medicare Program. The charts in this booklet list important health benefits. For each benefit, you can see what our program covers and what the Original Medicare Program covers. Our members receive all of the benefits that the Original Medicare Program offers but we also offer additional benefits to help you stay healthy.

Summary of Benefits (PDF)

Resumen de Beneficios 2021 (PDF)

Краткий обзор страховых выплат на 2021 год (PDF)

2021年度福利介紹 (PDF)


Out-of-Network Coverage Rules

It is important to know which providers are part of our network because, with limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which Fidelis Care authorizes use of out-of-network providers. See Chapter 3 (Using the plan’s coverage for your medical services) for more specific information about emergency, out-of-network, and out-of-area coverage.

Fidelis Medicare Advantage Without Rx (HMO POS) Plan 005

Annual Notice of Changes

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

Ежегодное уведомление об изменениях (PDF)

年度改變通知


Evidence of Coverage

This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

Границы страховой ответственности (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Fidelis Care programs and the Original Medicare Program. The charts in this booklet list important health benefits. For each benefit, you can see what our program covers and what the Original Medicare Program covers. Our members receive all of the benefits that the Original Medicare Program offers but we also offer additional benefits to help you stay healthy.

Summary of Benefits (PDF)

Resumen de Beneficios 2021 (PDF)

Краткий обзор страховых выплат на 2021 год (PDF)

2021年度福利介紹 (PDF)


Out-of-Network Coverage Rules

Under a Point-of-Service (POS) option, you may use non-plan providers to get your some covered services (see Section 2.4 for the definition of Point-of-Service in your Evidence of Coverage). However, your out of pocket costs may be higher if you use non-plan providers (for more information about this, see Section 2 in your Evidence of Coverage). The exception is if you use non-plan providers for emergency care.
Medicare requires that we have or arrange for enough providers to give you medically necessary plan covered services at the in-network cost-sharing level. This is called our "network" of providers. When you get services from non-plan providers, we call these "out-of-network" services. 
You don't need to get a referral when you get care from non-plan providers. However, before getting these services you may want to confirm with us that the services you are receiving are covered by us and are medically necessary. If we later determine that the services are not covered or were not medically necessary, we may deny coverage and you will be responsible for the costs.
You will be allowed $10,000 worth of out-of-network services.  Your cost-sharing amount for these services is $5,000. We will pay the other $5,000. Once the $10,000 maximum is met, you will be responsible for all costs associated with out-of-network care you receive.
The following services are not covered out-of-network and you will be responsible for all of the costs if you obtain these services:
  • Inpatient Acute Care
  • Inpatient Mental Health Care
  • Skilled Nursing Facility Care
  • Primary Care Physicians
  • Home Health
  • X-rays
  • Part B Prescription Drugs
  • Durable Medicare Equipment & Prosthetic Devices
  • Dialysis
  • Outpatient Services including Surgery, X-rays, Outpatient Diagnostic Radiology (e.g. CT scans, PET scans, MRI's, nuclear medicine) and Therapeutic Radiology (e.g. radiation therapy, chemotherapy)
  • Diabetic Supplies

If you need medical care that Medicare requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out-of-network provider. You will need to obtain “prior authorization” from us to get this care. In this situation, you will pay the same as you would pay if you got the care from a network provider.

The plan covers emergency care or urgently needed care that you get from an out-of-network provider. For more information about this, and to see what emergency or urgently needed care means, see Section 3 of your Evidence of Coverage.

Fidelis Dual Advantage (HMO SNP) Plan 006

Annual Notice of Changes

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

Ежегодное уведомление об изменениях (PDF)

年度改變通知


Evidence of Coverage

This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

Границы страховой ответственности (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Fidelis Care Programs and the Original Medicare Program. The charts in this booklet list important health benefits. For each benefit, you can see what our program covers and what the Original Medicare Program covers. Our members receive all of the benefits that the Original Medicare Program offers but we also offer additional benefits to help you stay healthy.

Summary of Benefits (PDF)

Resumen de Beneficios (PDF)

Краткий обзор страховых выплат (PDF)

福利介紹 (PDF)


Over-the-Counter Benefit Information


Out of Network Coverage Rules

It is important to know which providers are part of our network because, with limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which Fidelis Care authorizes use of out-of-network providers. See Chapter 3 (Using the plan’s coverage for your medical services) for more specific information about emergency, out-of-network, and out-of-area coverage.
Fidelis Medicare Advantage Flex (HMO POS) Plan 007

Annual Notice of Changes

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

Ежегодное уведомление об изменениях (PDF)

年度改變通知 (PDF)

 

Evidence of Coverage

This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

Границы страховой ответственности (Evidence of Coverage) (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Fidelis Care programs and the Original Medicare Program. The charts in this booklet list important health benefits. For each benefit, you can see what our program covers and what the Original Medicare Program covers. Our members receive all of the benefits that the Original Medicare Program offers but we also offer additional benefits to help you stay healthy.

Summary of Benefits (PDF)

Resumen de Beneficios 2021 (PDF)

Краткий обзор страховых выплат на 2021 год (PDF)

2021年度福利介紹 (PDF)


Flex Reimbursement

Flex Reimbursement Account Information


Out of Network Coverage Rules:

The following services are not covered out-of-network and you will be responsible for all of the costs if you obtain these services: 

Inpatient Acute Care 

Inpatient Mental Health Care 

Skilled Nursing Facility Care 

Primary Care Physicians 

Home Health 

X-rays 

Part B Prescription Drugs 

Durable Medicare Equipment & Prosthetic Devices 

Dialysis 

Outpatient Services including Surgery, X-rays, Outpatient Diagnostic Radiology (e.g. CT scans, PET scans, MRI's, nuclear medicine) and Therapeutic Radiology (e.g. radiation therapy, chemotherapy) 

Diabetic Supplies 

If you need medical care that Medicare requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out-of-network provider. You will need to obtain “prior authorization” from us to get this care. In this situation, you will pay the same as you would pay if you got the care from a network provider. 

The plan covers emergency care or urgently needed care that you get from an out-of-network provider. For more information about this, and to see what emergency or urgently needed care means, see Section 3 of your Evidence of Coverage.

Medicaid Advantage Plus (HMO SNP) Plan 008

Annual Notice of Changes

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

Ежегодное уведомление об изменениях (PDF)

年度改變通知


Evidence of Coverage

This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

Границы страховой ответственности (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Fidelis Care programs and the Original Medicare Program. The charts in this booklet list important health benefits. For each benefit, you can see what our program covers and what the Original Medicare Program covers. Our members receive all of the benefits that the Original Medicare Program offers but we also offer additional benefits to help you stay healthy.

Summary of Benefits (PDF)

Resumen de Beneficios (PDF)

Краткий обзор страховых выплат (PDF)

福利介紹 (PDF)


Over-the-Counter Benefit Information


Out-of-Network Coverage Rules

It is important to know which providers are part of our network because, with limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which Fidelis Care authorizes use of out-of-network providers. See Chapter 3 (Using the plan’s coverage for your medical services) for more specific information about emergency, out-of-network, and out-of-area coverage.
Fidelis Medicare Advantage $0 Premium (HMO) Plan 009

Annual Notice of Changes

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

Ежегодное уведомление об изменениях (PDF)

年度改變通知 (PDF)

 

Evidence of Coverage

This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

Границы страховой ответственности (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Fidelis Care programs and the Original Medicare Program. The charts in this booklet list important health benefits. For each benefit, you can see what our program covers and what the Original Medicare Program covers. Our members receive all of the benefits that the Original Medicare Program offers but we also offer additional benefits to help you stay healthy.

Summary of Benefits (PDF)

Resumen de Beneficios 2021 (PDF)

Краткий обзор страховых выплат на 2021 год (PDF)

2021年度福利介紹 (PDF)


Out-of-Network Coverage Rules

It is important to know which providers are part of our network because, with limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which Fidelis Care authorizes use of out-of-network providers. See Chapter 3 (Using the plan’s coverage for your medical services) for more specific information about emergency, out-of-network, and out-of-area coverage.

 

 

Услуги телемедицины

Есть 2 способа использования телездравоохранения, обеспечивающих безопасность, комфорт и удобство вашего дома:

  • Запланируйте телемедицинский визит к вашему сетевому поставщику медицинских услуг или специалисту. Многие поставщики услуг Fidelis Care могут записаться на прием по телефону или видео. 
  • Через Teladoc вы можете получать онлайн-услуги от сертифицированных врачей, имеющих лицензию штата Нью-Йорк, 24 часа в сутки, 7 дней в неделю.

    Лучше всего начать перед вашим первым виртуальным посещением врача с загрузки приложения Teladoc (доступного в App Store или Google Play) или начать работу в Интернете, перейдя по ссылке на веб-сайт ниже.

    Расширенные преимущества

    Fidelis Care также предлагает своим участникам ведение дел по телефону:


    • Менеджеры, ведущие дела, могут оказать поддержку и помощь в определении альтернатив и ресурсов, когда преимущества исчерпаны.

    • Специалисты по ведению дел - это медицинские работники, которые помогут вам управлять своим здоровьем, узнать больше о вашем здоровье или условиях, координировать уход с поставщиками и получать необходимые услуги.

     

    Чтобы получить дополнительную информацию, позвоните в отдел клинической службы Fidelis Care по указанному ниже номеру:

     

     

    Преимущества аптек

    Ваши льготы в аптеке покрываются через CVS Caremark. 
    Посетите веб-сайт CVS Caremark.

    Для вашего удобства Fidelis Care также предоставляет онлайн-форму для предварительного разрешения (PA) и запросов на дополнительные лекарства:

    Ваша информация защищена

    Правило конфиденциальности Закона о переносимости и подотчетности медицинского страхования (HIPAA) применяется ко всем формам вашей защищенной медицинской информации, будь то электронная, письменная или устная.

    Чтобы узнать больше о HIPAA и ваших правах на конфиденциальность, посетите Министерство здравоохранения и социальных служб США

     

     

     Чтобы получить полный список планов в вашей зоне обслуживания, свяжитесь с планом. Fidelis Care заключила договор с Medicare на планы HMO, HMO D-SNP и HMO-POS, а также с программой Medicaid штата. Участие в программе Fidelis Care зависит от продления контракта.

    С 1 октября по 31 марта вы можете звонить нам 7 дней в неделю с 8:00 до 20:00. С 1 апреля по 30 сентября вы можете звонить нам с понедельника по пятницу с 8:00 до 20:00. Система обмена сообщениями используется в нерабочее время, в выходные и праздничные дни.

    Многоязычная вставка (PDF)

    Уведомление о недопущении дискриминации (PDF)

    политика конфиденциальности

    H5599_22019WEB_2021_Accepted_12262020

    Информационные бюллетени

    Прочтите последний информационный бюллетень для участников Medicare под названием «YourAdvantage» и просмотрите архивы.

    Поиск врача

    Поиск медицинского специалиста, поставщика услуг или медицинского учреждения в сети Fidelis Care.

    Портал участников

    Войдите или зарегистрируйтесь, чтобы совершать платежи, распечатывать удостоверения личности, менять PCP и многое другое.