Does your child need health insurance?Please fill out the information below and mail to: Fidelis Care, 5010 Campuswood Dr., Syracuse, NY 13057.

NAME (please print): ____________________________________________CHILD’S AGE(s): ___________

ADDRESS: _____________________________________________ CITY: ____________________________

COUNTY: ______________________________________ STATE: ___________ ZIP Code: ______________

PHONE NUMBER: (H) ___________________ (W) ___________________ (C): ______________________

WHAT IS THE BEST TIME TO REACH YOU?: ___________________________________________________

NAME OF YOUR CHILD’S SCHOOL: ________________________________________________________

Covering kids with quality, affordable care.

Please tear off and return to:Fidelis Care

5010 Campuswood Dr.Syracuse, NY 13057

or fax to (315) 437-4875

Dear Parent:

Fidelis Care wants to make sure that every student has access to quality, affordable health coverage. We’re working with schools to tell parents like you about Child Health Plus with Fidelis Care.

It is a special program that is part of New York State’s Child Health Plus program for children under 19.

Covered benefits include:

• Doctor visits • Checkups • Dental and eye exams • Immunizations

• Hospital care • Emergency care • Prescription drugs

Depending on your income, Child Health Plus with Fidelis Care may cost very little, or nothing at all. You can choose your child’s own doctor from the Fidelis Care network – a healthcare professional in your neighborhood you know and trust. A happy, healthy child is life’s greatest gift.

If your child needs health insurance, please fill out the card below or call 1-888-FIDELIS (1-888-343-3547) • TTY: 1-800-421-1220. Fidelis Care is here to help.

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