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Member Resources

Click a plan below to view reference documents. If you’re a member, log in to the Member Portal to view your contract and benefits.
Effective January 1, 2024, members enrolled in Child Health Plus, Essential Plan, Wellcare By Fidelis Care Medicare and Dual Advantage, and Ambetter from Fidelis Care Qualified Health Plans will have their pharmacy benefit managed by Express Scripts. Members will receive new ID cards with updated pharmacy information. Learn more.

Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. For more information regarding the pharmacy benefit transition, please visit NYRx, the Medicaid Pharmacy Program. Please note, members will continue to receive their medical benefits through Fidelis Care.

Medicaid Managed Care
Formularies

Effective April 1, 2023, members enrolled in Medicaid Managed Care plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program.

Medicaid List of Covered Drugs and Over the Counter (OTC) Products (NYRx)

Search for a Pharmacy or Medical Equipment Supplier (NYRx)

Virtual Support

Telemedicine Benefits

Member Handbook

Medicaid Managed Care Member Handbook

Member Handbook Insert - Dental Services

Member Handbook Insert - Medicaid NYRx, the Medicaid Pharmacy Program (Effective April 1, 2023)

Member Handbook Insert - Mobile Crisis Telephonic Triage Response Service

Member Handbook Insert - Undocumented Non-Citizens Age 65 and Over

Member Notices

Applied Behavior Analysis (ABA) Therapy  (Effective January 1, 2023)

Gambling Disorder Treatment  (Effective January 1, 2023) 

Subscriber and Renewal Documents

Renewal Information Checklist

Appeal and Informal Review Process

Essential Plan

Essential Plan Information ⇒

Child Health Plus
Formularies

2024 Drug Formulary

Virtual Support

Telemedicine Benefits

Member Notices

Member Notice - Expanded Coverage  (Effective January 1, 2023)

Member Notice - Family Planning

Subscriber Contract and Additional Information

Subscriber Contract

Subscriber Contract Rider

Additional Information for CHPlus Members

Ambetter from Fidelis Care | Qualified Health Plans (QHP)

Ambetter from Fidelis Care Qualified Health Plans Information ⇒

HealthierLife | Health and Recovery Plan (HARP)
Formularies

Effective April 1, 2023, members enrolled in HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program.

HARP List of Covered Drugs and Over the Counter (OTC) Products (NYRx)

Search for a Pharmacy or Medical Equipment Supplier (NYRx)

Virtual Support

Telemedicine Benefits

Member Handbook Materials

Member Handbook

Member Handbook Insert - Medicaid NYRx, the Medicaid Pharmacy Program (Effective April 1, 2023)

Member Handbook Insert – Behavioral Health Community Oriented Recovery and Empowerment (CORE) Services

Member Handbook Insert - Children and Family Treatment and Support Services (CFTSS)

Member Handlbook Insert - Dental Services

Member Handbook Insert - Family Planning Coverage

Member Handbook Insert - Interoperability and Patient Access rule

Member Handbook Insert - Maximum Pharmacy Copay

Member Handlbook Insert - Mobile Crisis Telephonic Triage Response Service

Member Handbook Insert - National Diabetes Prevention Program (NDPP)

Member Handbook Insert - Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST)

Member Notices

Member Notice - Smoking Cessation Counseling

Subscriber and Renewal Documents

Appeal and Informal Review Process

Renewal Information Checklist

Fidelis Care at Home | Managed Long Term Care (MLTC)
Member Handbook Materials

Member Handbook

Member Handbook Insert - Dental Services

Member Handbook Insert - Important Updates Regarding Coronavirus COVID-19

Member Handbook Insert - New York Independent Assessor - Initial Assessment Process

Member Handbook Insert – Non-Emergency Medical Transportation

Member Handbook Insert - Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST)

Member Handbook Insert - Plan Transfers

Subscriber and Renewal Documents 

Annual Disenrollment Notice

Appeal and Informal Review Process

SSBCI (Special Supplemental Benefits for the Chronically Ill)

Wellcare By Fidelis Care | Medicare and Dual Advantage

Wellcare By Fidelis Care Medicare and Dual Advantage Plan Information ⇒

 

Get Ready to Renew

Automatic renewals will end soon, and you will need to take action to renew your health insurance. Stay connected and update your information today.
Learn More

Connecting Your Healthcare

The Interoperability and Patient Access rule (CMS-9115-F) puts patients first by giving you control and easy access to your health information when you need it most. 
Resources

Member How To Videos

Get the most from your Fidelis Care plan and our Member Portal by watching our videos, including how to change your PCP, requesting new ID cards, and more.

Videos

 

 

View and download document plans

 

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Medicare Resources

Exhausted Benefits

Fidelis Care offers case management services to members by phone. Our Case Managers can provide support and assistance in identifying alternatives and resources when benefits have been exhausted. 

Case Managers are health professionals available to assist you in managing your health, learning more about your health or conditions, coordinating care with providers and receiving necessary services. To receive more information, please call Fidelis Care Clinical Services at 1-800-247-1441.

Language Assistance

Free language assistance services are available to you, such as:

  • Qualified interpreters
  • Information written in other languages

If you need these services, call Fidelis Care at 1-888-343-3547. For TTY/TDD services, call 711.

Language Assistance Services (PDF)

 

 

Your Health Information is Protected

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provides national standards to protect individuals’ medical records and other personal health information. The Privacy Rule applies to all forms of your protected health information, whether electronic, written, or oral. 

To learn more about HIPAA and your privacy rights, visit the U.S. Department of Health and Human Services. By clicking this link, you will leave the Fidelis Care website.

Authorization to Use and Disclose Health Information (PDF)

Revocation of Authorization to Use and/or Disclose Health Information (PDF)

Member Rights and Responsibilities

As a Fidelis Care member, you have a right to participate with practitioners in making decisions about your health care. You also have the right to be treated with respect and with recognition of your dignity and your right to privacy.

General Statement of Member Rights and Responsibilities (PDF)

Patient Bill of Rights (PDF)

Notice of Privacy Practices

Fidelis Care Notice of Privacy Practices


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