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Member Resources

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Medicaid Managed Care

Appeals and Fair Hearing Rights (PDF)

Drug Formulary (PDF)

Member Handbook (PDF)

Renewal Information Checklist (PDF)

Essential Plan

Treatment Cost Calculator


Essential Plan 1 

Benefit Summary (PDF)

Drug Formulary (PDF)

Subscriber Contract (PDF)


Essential Plan 2 

Benefit Summary (PDF)

Drug Formulary (PDF)

Subscriber Contract (PDF)


Essential Plan 3 

Benefit Summary (PDF)

Drug Formulary (PDF)

Subscriber Contract (PDF)


Essential Plan 4 

Benefit Summary (PDF)

Drug Formulary (PDF)

Subscriber Contract (PDF)

Child Health Plus

Additional Information for Child Health Plus Members (PDF)

Drug Formulary (PDF)

Renewal Information Checklist (PDF)

Subscriber Contract (PDF)

Metal-Level Products (Qualified Health Plans and Off-Exchange)

Treatment Cost Calculator

Drug Formulary (PDF)


Summaries of Benefits and Coverage

Platinum (PDF)

Gold (PDF)

Silver (PDF)

Silver 250 (PDF)

Silver 200 (PDF)

Silver 150 (PDF)

Bronze (PDF)

Catastrophic (PDF)


Subscriber Contracts

Catastrophic (PDF)

Child Only (PDF)

Individual and Family (PDF)

Off-Exchange: Catastrophic (PDF)

Off Exchange: Children (PDF)

Off Exchange: Individual and Family (PDF)


Narrative Summary of Requested Rate Changes Effective January 1, 2020 (PDF)

HealthierLife Health and Recovery Plan (HARP)

Appeals and Fair Hearing Rights (PDF)

Member Handbook (PDF)

Drug Formulary (PDF)

Renewal Information Checklist (PDF)

Summary of Benefits (PDF)

Fidelis Care at Home (Managed Long Term Care)

Appeals and Fair Hearing Rights (PDF)

Drug Formulary (PDF)

Free Interpreter Services are Available (PDF)

Member Handbook (PDF)

Non-discrimination Notice (PDF)

Pharmacy Benefits

Your pharmacy benefits are covered through CVS Caremark. Visit the CVS Caremark website (by clicking on this link, you will leave the Fidelis Care website) for more information or to register. 

Fidelis Care also provides an online form for your convenience:

 

Resources for Medicare Advantage 
and Dual Advantage Members

View and download plan materials.

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.

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. 

The HIPAA Security Rule protects health information in electronic form and requires providers and others covered under HIPAA to ensure that electronic protected health information is secure. 

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.


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