Preventive Services | Fidelis Care (2024)

From immunizations, to cancer screenings, to tests for chronic diseases, Medicaid Managed Care gives you access to the healthservices you need to help stop disease before it starts.

Preventive services are free when provided by a doctor in the Fidelis Care network.

Services Child Health Plus covers include:*

• Well-child care.
• Immunizations.
• Treatment for illness or injury.
• Prescription and non-prescription drugs if ordered by a physician.
• Emergency, preventative and routine dental care. Limited orthodontic services are available for children with a severe medical condition such as cleft lip or cleft palate.
• Preventive and routine vision care (including eyeglasses).
• Speech and hearing services (with limits).
• Durable medical equipment.

*Source: New York State Department of Health

Preventive Care Billing Explained

ALL PLANS fully cover ONE preventive office visit per year, usually called a “well visit” or “annual physical.”

“Sick appointments,” or doctor visits you request because of illness or other health concerns, will carry a cost depending on the specifics of your plan.

Do you have to pay? Yes - but NOT for the flu shot. In this case, the flu shot is free, but you will still have to pay for the office visit because it was not preventive.

Do you have to pay? If you have Essential Plan 2, 3, or 4, no. If you have Essential Plan 1, yes. The first colonoscopy will be free because it is considered a preventive screening. The second colonoscopy is a follow-up and thus NOT preventive, and you will need to pay for it according to the specifics of your plan.

Prescription drugs are covered differently depending on the type of coverage you carry. Please refer to your plan’s specific drug coverage information for guidance.

Preventive Care Billing Explained

ALL METAL-LEVEL PLANS PLANS fully cover ONE preventive office visit per year, usually called a “well visit” or “annual physical.”

“Sick appointments,” or doctor visits you request because of illness or other health concerns, will carry a cost depending on the specifics of your plan.

Sometimes the preventive service is free, but the doctor visit isn’t. For example: you visit the doctor because you feel ill or are experiencing pain. At the appointment, the doctor notices you haven’t received your annual flu shot. So, you opt to also receive the flu shot at your appointment.

Do you have to pay? Yes - but NOT for the flu shot. In this case, the flu shot is free, but you will still have to pay for the office visit because it was not preventive.

Sometimes preventive services are free the first time you receive them in a plan year. If you need the same service more than once within your plan year, that service will cost money. For example: you receive a routine colonoscopy, and based on the results, your doctor wants you to have a follow-up colonoscopy six months later.

Do you have to pay? Yes. The first colonoscopy will be free because it is considered a preventive screening. The second colonoscopy is a follow-up and thus NOT preventive, and you will need to pay for it according to the specifics of your plan.

Prescription drugs are covered differently depending on the type of coverage you carry. Please refer to your plan’s specific drug coverage information for guidance.