Member Portal Initial Payment Form

NY State of Health First Payment

Please enter the following information to complete your first payment with Fidelis Care. Have your confirmation ID and your head of household information ready before starting.

Confirmation Information

Please be sure to enter all 14 letters and numbers of your Confirmation ID, including the two letters at the beginning.

Head of Household Information

Member Information

Premium Information

Note: Once your payment is received, we will send your Member ID Card and Subscriber Contract.