COMPASS ROSE HEALTH PLAN PROTECTING OUR MEMBERS SINCE 1948

Transcription

1 PLAN YEAR 2018 COMPASS ROSE HEALTH PLAN PROTECTING OUR MEMBERS SINCE 1948 POWERED BY compassrosebenefits.com 1

2 WELCOME WE ARE HERE TO HELP YOU SOLVE THE COMPLEXITIES OF INSURANCE PLAN HIGHLIGHTS COMPASS ROSE HEALTH PLAN CUSTOMER SERVICE NETWORK + COVERAGE HEALTH BENEFITS PRESCRIPTIONS MEDICARE ADDITIONAL RESOURCES RATES + ENROLLMENT compassrosebenefits.com 2

3 COMPASS ROSE HEALTH PLAN Using the UnitedHealthcare Choice Plus Network: $15 $15 $25 $5 PRIMARY CARE DOCTOR TELEHEALTH VISITS SPECIALIST VISITS GENERIC PRESCRIPTIONS Lab Work 100% *LabCorp Preventive Care 100% Maternity 100% WORLDWIDE COVERAGE NO REFERRALS NEEDED Intelligence Community EXCLUSIVE MEMBERSHIP Department of Defense Department of State compassrosebenefits.com 3

4 YOUR HEALTH, OUR PLAN WE ARE COMMITTED TO SERVING OUR MEMBERS 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

5 WE ARE HERE FOR YOU OUR MEMBER ADVOCATES HELP SIMPLIFY THE COMPLEXITIES OF INSURANCE 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 13 th - December 11 th don t miss your chance to enroll. CALL: (888) from 8:00am - 8:00pm (EST) askcrbg@compassrosebenefits.com ONLINE: compassrosebenefits.com/openseason compassrosebenefits.com 5

6 HOW OUR PLAN WORKS YOU CHOOSE YOUR OWN HEALTH CARE PROVIDERS OUR NETWORK The Compass Rose Health Plan is a nationwide Preferred Provider Organization (PPO). When you visit a network provider, you receive covered services at a reduced cost. The Plan is powered by the UnitedHealthcare (UHC) Choice Plus network in all states. The UHC network consists of over 840,000 doctors and more than 5,700 hospitals. Our health plan gives you the freedom to choose ANY doctor or hospital, in- or out-of-network, and we never require a referral. FIND THE RIGHT DOCTOR HELPFUL TIP Providers may not recognize our Plan name, be sure to ask if your provider participates in the UnitedHealthcare Choice Plus network. 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: Self - $350 Self Plus One - $700 Self and Family - $700 Out-of-Network Annual Deductible: Self - $400 Self Plus One - $800 Self and Family - $800 CATASTROPHIC PROTECTION Catastrophic Medical PPO & Pharmacy Network Coverage: $4,000 Catastrophic Medical Non-PPO Coverage: $7,000 compassrosebenefits.com 6

7 BENEFITS GET THE MOST FROM YOUR PLAN TO HELP YOU SAVE MONEY Your cost when you use in-network providers for covered services: BENEFIT ROUTINE PREVENTIVE CARE (ADULT AND CHILDREN) DOCTOR OFFICE VISITS - PRIMARY PHYSICIAN DOCTOR OFFICE VISITS - SPECIALIST TELEHEALTH: DOCTOR ON DEMAND STATESIDE AND OVERSEAS $0 $15 copayment (No Deductible*) $25 copayment (No Deductible) $15 copayment (No Deductible) LABWORK PROGRAM THROUGH LABCORP $0 X-RAY & OTHER DIAGNOSTIC SERVICES URGENT CARE FACILITY EMERGENCY ROOM INPATIENT HOSPITAL CARE 1 SURGICAL SERVICES 1 10% of the Plan Allowance $50 copayment, waived if admitted (No Deductible) $100 copayment, waived if admitted (No Deductible) $200 copayment per hospital stay (No Deductible) 10% of the Plan Allowance (No Deductible) ROUTINE MATERNITY CARE $0 BASIC CHIROPRACTIC CARE ACUPUNCTURE CARE OUTPATIENT THERAPY 1,2 ALLERGY CARE ANNUAL DEDUCTIBLE OUT-OF-POCKET MAXIMUM $20 copayment (No Deductible, 20 visits max) 10% of the Plan Allowance (24 visits max) 10% of the Plan Allowance (90 visits max) $15 co-pay in Primary Physician s office (No Deductible) $25 co-pay for Specialists (No Deductible) $350 Self Only $700 Self Plus One or Self and Family $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 7

8 PRESCRIPTION DRUG PROGRAM CONVENIENT OPTIONS TO FILL PRESCRIPTIONS 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) To access our list of preferred medications and exclusions, visit compassrosebenefits.com/formulary. RETAIL PHARMACY IN-NETWORK You may fill your prescription at a network pharmacy. To locate a pharmacy in your area, please call (877) or visit express-scripts.com/pharmacy. HOME DELIVERY PROGRAM HELPFUL TIP With the Home Delivery Program, members receive a 3-month supply of their prescription for the cost of 2 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) compassrosebenefits.com 8

9 PRESCRIPTION DRUG CO-PAYS CONVENIENT OPTIONS TO FILL PRESCRIPTIONS BENEFIT IN-NETWORK RETAIL 30-day supply YOUR COST Level 1 (Generics): $5 copayment (no deductible) Level 2 (Preferred brand name): $35 copayment (no deductible) Level 3 (Non-preferred brand name): $50 copayment or 30%, whichever is greater (no deductible) IN-NETWORK RETAIL MEDICARE PART B PRIMARY 30-day supply Level 1 (Generics): $3 copayment (no deductible) Level 2 (Preferred brand name): $18 copayment (no deductible) Level 3 (Non-preferred brand name): $35 copayment or 30%, whichever is greater (no deductible) HOME DELIVERY 90-day supply Level 1 (Generics): $10 copayment (no deductible) Level 2 (Preferred brand name): $70 copayment (no deductible) Level 3 (Non-preferred brand name): $100 copayment or 30%, whichever is greater (no deductible) HOME DELIVERY MEDICARE PART B PRIMARY 90-day supply Level 1 (Generics): $6 copayment (no deductible) Level 2 (Preferred brand name): $36 copayment (no deductible) Level 3 (Non-preferred brand name): $45 copayment or 30%, whichever is greater (no deductible) SPECIALTY MEDICATIONS 30-day supply Formulary: 7% up to a maximum of $150 (no deductible) Non-Formulary: 10% up to a maximum of $300 (no deductible) compassrosebenefits.com 9

10 MEDICARE DUAL COVERAGE, DOUBLE PROTECTION 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 Drug Coverage). PARTNERING TOGETHER Being enrolled in Medicare and the Compass Rose Health Plan can help 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. HELPFUL TIP Did you know that there are limited times to enroll in a Medicare 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 Outpatient Provider Expenses Pharmacy Network of Physicians and Hospitals Compass Rose waives hospital copayments and coinsurance. Compass Rose waives most calendar year deductibles, copayments and coinsurance for medical services and supplies. 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). 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 10

11 ADDITIONAL RESOURCES GET THE MOST OUT OF YOUR COVERAGE + LIVE A HEALTHIER LIFE MEMBER PORTAL The Member Portal provides secure online access to claims, Explanation of Benefits (EOBs), ID cards and more. The Member Portal allows you to: - Print and request Health Plan Member ID card(s) - 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 FITNESS & WELLNESS Staying active is important. We provide a full range of options to get fit, feel more energized and live a healthier lifestyle. We partner with GlobalFit which offers discounts on gym memberships, personal trainers, diet programs and more! DENTAL & VISION DISCOUNT PROGRAM We partner with Careington International Corporation to bring a national Dental and Vision Discount Program to all Compass Rose Health Plan members. Members and their qualifying dependent(s) are automatically enrolled at no additional cost. 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 Rose Health Plan is committed to helping provide the support you need for a healthy and happy pregnancy. Our FREE prenatal care resources on our website provide helpful tips and guidance to help you through each trimester. WELLNESS SUPPORT DOCTOR ON DEMAND Skip the waiting room with Doctor On Demand a service that lets you see a board-certified physician face-to-face over live video from your smartphone, tablet or computer. They can diagnose, treat and even prescribe medication if necessary. They are available 7 days a week even when other health care options are closed. If you need help navigating the health care system, we have several FREE resources. For instance, if you have certain medical conditions such as high blood pressure, diabetes or congestive heart failure, we provide a Care Management Program that can help you manage your condition. If you would like more information on any of the resources listed above, please visit compassrosebenefits.com. compassrosebenefits.com 11

12 PLAN RATES 2018 MEMBER PREMIUMS TYPE OF ENROLLMENT BIWEEKLY RATE MONTHLY RATE Self Only (421) $92.11 $ Self Plus One (423) $ $ Self & Family (422) $ $ 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) Outside of Open Season: (888) Visit opm.gov for additional enrollment options. QUESTIONS Call a Compass Rose Member Advocate at (866) (option 3) Monday - Friday 9:00am - 5:00pm (EST). compassrosebenefits.com 12