COMPASS ROSE HEALTH PLAN - PROTECTING OUR MEMBERS SINCE 1948 - PLAN YEAR 2018
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PLAN YEAR 2018
COMPASS ROSE
HEALTH PLAN
PROTECTING OUR MEMBERS SINCE 1948
POWERED BY
compassrosebenefits.com | 1WELCOME
WE AR E H ERE TO H ELP YO U
SOLVE THE CO M P L EX I T I E S O F I N S U R A N C E
PLAN HIGHLIGHTS 3
COMPASS ROSE HEALTH PLAN 4
CUSTOMER SERVICE 5
NETWORK + COVERAGE 6
HEALTH BENEFITS 7
PRESCRIPTIONS 8-9
MEDICARE 10
ADDITIONAL RESOURCES 11
RATES + ENROLLMENT 12
compassrosebenefits.com | 2COMPASS ROSE HEALTH PLAN Using the UnitedHealthcare Choice Plus Network:
$15 $15 $25 $5
PRIMARY CARE TELEHEALTH SPECIALIST GENERIC
DOCTOR VISITS VISITS PRESCRIPTIONS
Lab Work Preventive Care Maternity
100% 100% 100%
*LabCorp
WORLDWIDE COVERAGE — NO REFERRALS NEEDED
EXCLUSIVE MEMBERSHIP
Intelligence Department Department
Community of Defense of State
compassrosebenefits.com | 3YOUR HEALTH, OUR PLAN WE ARE CO M M I T T ED TO S E R V I N G OUR MEMB ERS WHO WE ARE The Compass Rose Health Plan offers a nationwide PPO — giving you and your family access to high-quality health care. We work with the Office of Personnel Management to bring you our Federal Employees Health Benefits (FEHB) Plan. We strive to keep your out-of-pocket expenses low and are committed to providing you with exceptional service. We raise the bar on what you can expect from a health care company. We originated in 1948 as the preferred plan for employees of the Central Intelligence Agency (CIA). Over the years, we have expanded our eligibility to include Active and Retired civilian employees of the Intelligence Community, the Department of Defense and the Department of State. To see if you are eligible, visit compassrosebenefits.com/Eligibility SERVICE. STABILITY. SECURITY. We pride ourselves on offering individual attention to each insured employee and their family. Our mission is to provide you with a health plan that best meets your personal needs. compassrosebenefits.com | 4
WE ARE HERE FOR YOU
OUR MEMB ER A D V OC ATES H E LP
SIMPLIFY T HE CO M P L EXI T I E S O F I N S U R A N C E
CUSTOMER SERVICE
We understand that insurance can be complicated and overwhelming.
When you select the Compass Rose Health Plan as your insurance provider,
you will find your needs anticipated and your questions answered.
Providing strong customer service is vital to what we do.
Our promise is to provide exceptional customer service and the best
member experience to satisfy your needs fully.
OPEN SEASON
Don’t let your questions go unanswered. If you need assistance during
Open Season, please contact our customer service information center
Monday - Friday.
Open Season is November 13th - December 11th — don’t miss your
chance to enroll.
CALL:
(888) 438-9135 from 8:00am - 8:00pm (EST)
E-MAIL:
askCRBG@compassrosebenefits.com
ONLINE:
compassrosebenefits.com/OpenSeason
compassrosebenefits.com | 5HOW OUR PLAN WORKS
YOU CHOO S E YOU R O W N H E A LT H C A R E P R O V I D E R S
OUR NETWORK
The Compass Rose Health Plan is a nationwide Preferred Provider
Organization (PPO). When you visit a network provider, you receive HEL PF UL T I P
covered services at a reduced cost.
Providers may
not recognize
The Plan is powered by the UnitedHealthcare (UHC) Choice Plus
our Plan name,
network in all states. The UHC network consists of over 840,000 doctors
be sure to ask
and more than 5,700 hospitals. Our health plan gives you the freedom to if your provider
choose ANY doctor or hospital, in- or out-of-network, and we never participates in the
require a referral. UnitedHealthcare
Choice Plus
network.
FIND THE RIGHT DOCTOR
Our online Provider Directory allows you to search our large network of
doctors, hospitals, labs and facilities – 24 hours a day, seven days a week.
Visit compassrosebenefits.com/UHC.
COVERAGE
In-Network Coverage: covered at 90%
Out-of-Network Coverage: covered at 70%
Overseas Coverage*: no networks, covered at 90%
* Members are required to pay 100% at the time of service, and submit a claim for reimbursement at 90%.
ANNUAL DEDUCTIBLE
In-Network Annual Deductible: Out-of-Network Annual Deductible:
Self - $350 Self - $400
Self Plus One - $700 Self Plus One - $800
Self and Family - $700 Self and Family - $800
CATASTROPHIC PROTECTION
Catastrophic Medical PPO & Pharmacy Network Coverage: $4,000
Catastrophic Medical Non-PPO Coverage: $7,000
compassrosebenefits.com | 6BENEFITS
G E T THE MOST F R OM YOU R P LA N TO
H E LP YOU S AVE M O NE Y
Your cost when you use in-network providers for covered services:
BENEFIT STATESIDE AND OVERSEAS
ROUTINE PREVENTIVE CARE
$0
(ADULT AND CHILDREN)
DOCTOR OFFICE VISITS - PRIMARY PHYSICIAN $15 copayment (No Deductible*)
DOCTOR OFFICE VISITS - SPECIALIST $25 copayment (No Deductible)
TELEHEALTH: DOCTOR ON DEMAND $15 copayment (No Deductible)
LABWORK PROGRAM THROUGH LABCORP $0
X-RAY & OTHER DIAGNOSTIC SERVICES 10% of the Plan Allowance
URGENT CARE FACILITY $50 copayment, waived if admitted (No Deductible)
EMERGENCY ROOM $100 copayment, waived if admitted (No Deductible)
INPATIENT HOSPITAL CARE1 $200 copayment per hospital stay (No Deductible)
SURGICAL SERVICES1 10% of the Plan Allowance (No Deductible)
ROUTINE MATERNITY CARE $0
BASIC CHIROPRACTIC CARE $20 copayment (No Deductible, 20 visits max)
ACUPUNCTURE CARE 10% of the Plan Allowance (24 visits max)
OUTPATIENT THERAPY1,2 10% of the Plan Allowance (90 visits max)
$15 co-pay in Primary Physician’s office (No Deductible)
ALLERGY CARE
$25 co-pay for Specialists (No Deductible)
$350 Self Only
ANNUAL DEDUCTIBLE
$700 Self Plus One or Self and Family
OUT-OF-POCKET MAXIMUM $4,000 Self Only, Self Plus One or Self and Family
1) Precertification is required.
2) Combined 90 visits for Physical, Occupational and Speech therapy services.
* A deductible is the annual amount you pay for medical bills before the Plan pays. It is not required for some covered services.
For details, see Brochure.
Please refer to the 2018 FEHB Plan Brochure for complete benefit information at
compassrosebenefits.com/Brochure.
compassrosebenefits.com | 7PRESCRIPTION DRUG PROGRAM
CONVENIENT O P T I ONS TO F I LL P R E S C R I P T I O N S
PHARMACY BENEFITS
Express Scripts, a leader in pharmaceutical care and services, is the
Pharmacy Benefit Manager for the Compass Rose Health Plan.
For more information, or to find out if your prescription is covered,
please call (877) 438-4449.
To access our list of preferred medications and exclusions, visit
compassrosebenefits.com/Formulary. HEL PF UL TI P
With the
RETAIL PHARMACY IN-NETWORK Home Delivery
Program,
You may fill your prescription at a network pharmacy. To locate members receive
a pharmacy in your area, please call (877) 438-4449 or visit a 3-month
express-scripts.com/Pharmacy. supply of their
prescription for
the cost of 2
HOME DELIVERY PROGRAM months.
Eliminate the trip to the pharmacy and consider home delivery for
maintenance drugs — drugs that can be prescribed for at least 90
days.
Prescriptions are delivered to your front door at no additional
shipping cost, with an option for automatic refills — making it easy
and convenient.
SPECIALTY PHARMACY BENEFIT
Specialty medications used to treat severe, chronic medical conditions
(usually administered by injection or infusion), are obtained through
Accredo. Specialty medications are NOT eligible for the home delivery
benefit, nor can they be filled at retail pharmacies.
If you have questions regarding Specialty medications, please contact
Accredo at (800) 803-2523.
compassrosebenefits.com | 8PRESCRIPTION DRUG CO-PAYS
CONVENIENT O P T I ONS TO F I LL P R E S C R I P T I O N S
BENEFIT YOUR COST
Level 1 (Generics): $5 copayment (no deductible)
IN-NETWORK RETAIL Level 2 (Preferred brand name): $35 copayment (no deductible)
30-day supply Level 3 (Non-preferred brand name): $50 copayment or 30%, whichever is
greater (no deductible)
Level 1 (Generics): $3 copayment (no deductible)
IN-NETWORK RETAIL
Level 2 (Preferred brand name): $18 copayment (no deductible)
MEDICARE PART B PRIMARY
Level 3 (Non-preferred brand name): $35 copayment or 30%, whichever is
30-day supply
greater (no deductible)
Level 1 (Generics): $10 copayment (no deductible)
HOME DELIVERY
Level 2 (Preferred brand name): $70 copayment (no deductible)
90-day supply
Level 3 (Non-preferred brand name): $100 copayment or 30%, whichever is
greater (no deductible)
Level 1 (Generics): $6 copayment (no deductible)
HOME DELIVERY
Level 2 (Preferred brand name): $36 copayment (no deductible)
MEDICARE PART B PRIMARY
Level 3 (Non-preferred brand name): $45 copayment or 30%, whichever is
90-day supply
greater (no deductible)
SPECIALTY MEDICATIONS Formulary: 7% up to a maximum of $150 (no deductible)
30-day supply Non-Formulary: 10% up to a maximum of $300 (no deductible)
compassrosebenefits.com | 9MEDICARE
DUA L CO V ERAG E, D O U B L E P R OT E C T I O N
MEDICARE BASICS
Medicare is a health insurance program for people 65 years of age or
older. Medicare has four parts: Part A (Hospital Insurance), Part B (Medical
Insurance), Part C (Medicare Advantage) and Part D (Medicare Prescription
HEL PF UL TI P
Drug Coverage).
Did you know
PARTNERING TOGETHER that there are
limited times
to enroll in a
Being enrolled in Medicare and the Compass Rose Health Plan can help
Medicare Plan?
significantly decrease your out-of-pocket health care costs. Even though
enrolling in Medicare is not required, there are some definite advantages to
having BOTH Medicare and the Compass Rose Health Plan.
Below is a list of covered benefits available when you enroll in both
Medicare Part A and Part B and the Compass Rose Health Plan.
Inpatient Hospital Care Expenses Compass Rose waives hospital copayments and coinsurance.
Outpatient Provider Expenses Compass Rose waives most calendar year deductibles, copayments
and coinsurance for medical services and supplies.
Pharmacy Compass Rose offers prescription drug copayments at a reduced
rate for 90-day Home Delivery or 30-day Retail Pharmacy in Express
Scripts Rx Network (for Medicare Part B participants).
Network of Physicians and Hospitals Once you are enrolled in Part B, you have the freedom to be
seen by ANY participating Medicare provider WITHOUT penalty
(whether PPO or non-PPO).
You can verify that your provider participates in Medicare by
visiting compassrosebenefits.com/Medicare.
Other Covered Services Hearing Aids
Diabetes testing supplies
Respiratory supplies
Immunosuppressive medications
Oral anti-cancer medications
compassrosebenefits.com | 10ADDITIONAL RESOURCES
G E T THE MOST O U T O F YO U R CO V E R AGE +
LIV E A HEA LT HI ER L I F E
MEMBER PORTAL DENTAL & VISION DISCOUNT PROGRAM
The Member Portal provides secure online We partner with Careington International
access to claims, Explanation of Benefits (EOBs), Corporation to bring a national Dental and Vision
ID cards and more. Discount Program to all Compass Rose Health
Plan members. Members and their qualifying
The Member Portal allows you to: dependent(s) are automatically enrolled at no
- Print and request Health Plan Member ID card(s) additional cost.
- View Explanation of Benefits (EOBs)
- Review claims status
- Locate in-network providers
- Estimate the cost for health services
- Access health and wellness resources
- Manage prescriptions PRENATAL CARE PROGRAM
A healthy pregnancy is key to having a healthy
baby. Whether you are currently expecting, or are
planning on becoming pregnant, the Compass
FITNESS & WELLNESS Rose Health Plan is committed to helping provide
the support you need for a healthy and happy
Staying active is important. We provide a full range
pregnancy. Our FREE prenatal care resources on our
of options to get fit, feel more energized and live a
website provide helpful tips and guidance to help
healthier lifestyle. We partner with GlobalFit which
you through each trimester.
offers discounts on gym memberships, personal
trainers, diet programs and more!
WELLNESS SUPPORT
DOCTOR ON DEMAND If you need help navigating the health care system,
we have several FREE resources. For instance,
Skip the waiting room with Doctor On Demand if you have certain medical conditions such as
— a service that lets you see a board-certified high blood pressure, diabetes or congestive heart
physician face-to-face over live video from your failure, we provide a Care Management Program
smartphone, tablet or computer. They can diagnose, that can help you manage your condition.
treat and even prescribe medication if necessary.
They are available 7 days a week—even when other
health care options are closed. If you would like more information on any of
the resources listed above, please visit
compassrosebenefits.com.
compassrosebenefits.com | 11PLAN RATES 2 0 1 8 MEMBER P R EM I U M S TYPE OF ENROLLMENT BIWEEKLY RATE MONTHLY RATE Self Only (421) $92.11 $199.57 Self Plus One (423) $216.00 $468.00 Self & Family (422) $249.69 $541.00 ENROLLMENT CONVENIENT + EASY ENROLLMENT CODES Self Only use code 421 Self Plus One use code 423 Self and Family use code 422 ACTIVE EMPLOYEES Contact your Health Benefits Officer or Human Resources Representative within your organization/agency. You will need to complete a 2809 Enrollment Form. To see if you are eligible, visit compassrosebenefits.com/Eligibility. RETIREES Contact OPM directly: - During Open Season: (800) 332-9798 - Outside of Open Season: (888) 767-6738 Visit opm.gov for additional enrollment options. QUESTIONS Call a Compass Rose Member Advocate at (866) 368-7227 (option 3) Monday - Friday 9:00am - 5:00pm (EST). compassrosebenefits.com | 12
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