Our plan will help you find the right mix of care and services to live the life you choose.


 

Summary of Benefits

PHP Care Complete FIDA-IDD Plan offers all medical, dental, behavioral health, and long-term supports and services covered by Medicare and Medicaid, including OPWDD services. The actual benefits and services that a participant receives is based on his or her assessed needs and personal preferences.

 


This is not a complete list. The benefit information is a brief summary, not a comprehensive description of benefits. For more information contact the plan or read the Participant Handbook.

Limitations and restrictions may apply. For more information, call PHP Care Complete FIDA-IDD Plan Participant Services or read the PHP Care Complete FIDA-IDD Plan Participant Handbook.

Benefits may change on January 1 of each year.

Prescription Drug Coverage

Medicare Part D prescription drugs covered by Partners Health Plan Care Complete FIDA-IDD Plan are listed in the Medicare three-tier formulary, which includes all generic drugs covered under the Part D program as well as many brand-name drugs, non-preferred brands, and specialty drugs. In addition, NYS Medicaid provides coverage for certain drugs excluded from the Medicare Part D benefit such as some prescription vitamins, and a number of non-prescription drugs. You can view a complete copy of the formulary here. Some of these drugs have prior authorization or step-therapy requirements or quantity limits. Participants should obtain covered drugs from a network pharmacy.

If you have any questions about PHP Care Complete’s FIDA-IDD drug benefit, please contact our Participant Services at 1-855-747-5483 or TTY/TDD: 711 or PerformRx by calling the number on the back of your Participant ID Card.

Pharmacy claims are processed by PerformRx, PHP’s pharmacy benefit vendor. PerformRx services also include home infusion, specialty pharmacy, and mail-order pharmacy.

To learn more about Prescription Drug Coverage, click here.

 


The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.

This is not a complete list. The benefit information is a brief summary, not a comprehensive description of benefits. For more information contact the plan or read the Participant Handbook.

Limitations and restrictions may apply. For more information, call PHP Care Complete FIDA-IDD Plan Participant Services or read the PHP Care Complete FIDA-IDD Plan Participant Handbook.

Benefits may change on January 1 of each year.

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