Medicare Resources

2022 Plan Documents

Wellcare Fidelis Dual Access (HMO D-SNP) Plan 001

Formulary

2022 Formulary (PDF)

Formulario 2022 (PDF)

2022 처방집 (PDF)

2022年处方集 (PDF)

 

Annual Notice of Changes

For Members Enrolled in Fidelis Dual Advantage Flex (Plan 001) in 2021

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

연간 변경 공지 (PDF)

年度改變通知 (PDF)

 

Annual Notice of Changes

For Members Enrolled in Fidelis Dual Advantage (Plan 006) in 2021

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

연간 변경 공지 (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, 2022. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

보장의 증거 (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Wellcare By 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)

혜택 요약 (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 Wellcare By 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.
Wellcare Fidelis Assist (HMO-POS) Plan 002

Formulary

2022 Formulary (PDF)

Formulario 2022 (PDF)

2022 처방집 (PDF)

2022年处方集 (PDF)

 

Annual Notice of Changes

For Members Enrolled in Fidelis Dual Advantage Flex (Plan 002) in 2021

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

연간 변경 공지 (PDF)

年度改變通知


Annual Notice of Changes

For Members Enrolled in Fidelis Dual Advantage Flex (Plan 007) in 2021

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

연간 변경 공지 (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, 2022. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

보장의 증거 (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Wellcare By 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 2022 (PDF)

2022년 혜택 요약 (PDF)

2022年度福利介紹 (PDF)


Over-the-Counter Benefit 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.

Wellcare Fidelis Dual Plus Metro (HMO D-SNP) Plan 003

Formulary

2022 Formulary (PDF)

Formulario 2022 (PDF)

2022 처방집 (PDF)

2022年处方集 (PDF)

 

Annual Notice of Changes

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

연간 변경 공지 (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, 2022. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

보장의 증거 (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Wellcare By 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)

혜택 요약 (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 Wellcare By 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.
Wellcare Fidelis No Premium (HMO) Plan 004

Formulary

2022 Formulary (PDF)

Formulario 2022 (PDF)

2022 처방집 (PDF)

2022年处方集 (PDF)

 

Annual Notice of Changes

For Members Enrolled in Fidelis Medicare $0 Premium (Plan 004) in 2021

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

연간 변경 공지 (PDF)

年度改變通知


Annual Notice of Changes

For Members Enrolled in Fidelis Medicare Advantage $0 Premium (Plan 009) in 2021

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

연간 변경 공지 (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, 2022. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

보장의 증거 (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Wellcare By 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)

2022년 혜택 요약 (PDF)

2021年度福利介紹 (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 Wellcare By 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.

Wellcare Fidelis Patriot No Premium (HMO-POS) Plan 005

Formulary

2022 Formulary (PDF)

Formulario 2022 (PDF)

2022 처방집 (PDF)

2022年处方集 (PDF)

 

Annual Notice of Changes

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

연간 변경 공지 (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, 2022. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

보장의 증거 (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Wellcare By 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 2022 (PDF)

혜택 요약 (PDF)

2022年度福利介紹 (PDF)


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.

Wellcare Fidelis Dual Plus (HMO D-SNP) Plan 008

Formulary

2022 Formulary (PDF)

Formulario 2022 (PDF)

2022 처방집 (PDF)

2022年处方集 (PDF)

 

Annual Notice of Changes

Annual Notice of Changes (PDF)

Aviso anual de cambios (PDF)

연간 변경 공지 (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, 2022. It explains how to get coverage for the health care services and prescription drugs you need.

Evidence of Coverage (PDF)

Evidencia de cobertura (PDF)

보장의 증거 (PDF)

承保福利說明 (PDF)


Summary of Benefits

You can use this document to compare Wellcare By 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)

혜택 요약 (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 Wellcare By 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.

 

Pharmacy Benefits

Your pharmacy benefits are covered through CVS Caremark. 
Visit the CVS Caremark website.
(By clicking this link, you will leave the Fidelis Care website.) 

Wellcare By Fidelis Care also provides an online form for Prior Authorization (PA) and supplemental medication requests:

 

Free 24/7 Nurse Advice Line

Health concerns don't always follow a 9-to-5 schedule.  Thankfully, neither does our 24-hour Nurseline, free of charge for members.  

Medical professionals can answer your health questions and help set up doctor appointments.

Call us toll-free: 1-800-247-1447 (TTY 711).

 

Telehealth Services

There are 2 ways for you to use your telehealth benefit from the safety, comfort and convenience of your home:

  • Schedule a telehealth visit with your network primary care provider or specialist. Many Wellcare By Fidelis Care providers can make an appointment for a visit by phone or video. 
  • Through Teladoc, you can receive online care from board-certified, NY State-licensed doctors, 24 hours a day, 7 days a week.

    Before your first virtual care visit, download the Teladoc app or get started online by following the website link below.
    (By clicking this link, you will leave the Fidelis Care website.) 

    Extended Benefits

    Wellcare By Fidelis Care also offers case management to members by phone:

    • 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 our Clinical Services at the number below:

    Your Information is Protected

    The Health Insurance Portability and Accountability Act (HIPAA) 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.) 


    Disaster and Emergency Policy

    In the event of an emergency or natural disaster, WellCare By Fidelis Care is committed to helping you continue to access care easily.

    View Policy

     

    Additional Information

    Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.

    From October 1 to March 31, you can call us 7 days a week from 8 a.m. to 8 p.m. From April 1 to September 30, you can call us Monday through Friday from 8 a.m. to 8 p.m. A messaging system is used after hours, weekends and on federal holidays.

    Non-Discrimination Notice and Language Assistance (PDF)

    Privacy Policy

    H5599_22060_2022

     


    Last Updated 9.24.2021