COMPASS ROSE HEALTH PLAN PROTECTING OUR MEMBERS SINCE 1948

Transcription

1 PLAN YEAR 2019 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 NETWORK + COVERAGE HEALTH BENEFITS COORDINATION WITH MEDICARE PRESCRIPTIONS WELLNESS REWARDS PROGRAM HEALTH TOOLS & WELLNESS PROGRAMS RATES + ENROLLMENT compassrosebenefits.com 2

3 COMPASS ROSE HEALTH PLAN Using the UnitedHealthcare Choice Plus Network: $15 $0 $25 $5 PRIMARY CARE DOCTOR TELEHEALTH VISITS SPECIALIST VISITS GENERIC PRESCRIPTIONS Lab Work 100% *LabCorp Preventive Care 100% Maternity 100% WORLDWIDE COVERAGE NO REFERRALS 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 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 350,000 primary care providers, 800,000 specialists and more than 6,750 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: Self - $4,000 Self Plus One and Self and Family - $5,000 Catastrophic Medical Non-PPO Coverage: Self - $7,000 Self Plus One and Self and Family - $9,000 compassrosebenefits.com 5

6 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 STATESIDE AND OVERSEAS $0 $15 copayment (No Deductible*) $25 copayment (No Deductible) TELEHEALTH: DOCTOR ON DEMAND $0 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 OFFICE VISIT 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, $5,000 Self Plus One and 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 FEHB Plan Brochure. Please refer to the 2019 FEHB Plan Brochure for complete benefit information at compassrosebenefits.com/brochure. compassrosebenefits.com 6

7 HOW WE WORK WITH 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. 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. HELPFUL TIP Did you know that there are limited times to enroll in a Medicare Plan? Look out for a notification from the Social Security Administration. 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 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 (Formulary/preferred brand name): $35 copayment (no deductible) Level 3 (Non-formulary/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 (Formulary/preferred brand name): $18 copayment (no deductible) Level 3 (Non-formulary/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 (Formulary/preferred brand name): $70 copayment (no deductible) Level 3 (Non-formulary/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 (Formulary/preferred brand name): $36 copayment (no deductible) Level 3 (Non-formulary/non-preferred brand name): $45 copayment or 30%, whichever is greater (no deductible) SPECIALTY MEDICATIONS 30-day supply Generic: 20% up to a maximum of $150 (no deductible) Formulary brand name: 20% up to a maximum of $200 (no deductible) Non-formulary brand name: 25% up to a maximum of $300 (no deductible) compassrosebenefits.com 9

10 LIVE HEALTHY, GET REWARDED EARN REWARDS FOR TAKING AN ACTIVE ROLE IN YOUR HEALTH WELLNESS REWARDS PROGRAM Having a partner to help you reach your health goals can make a difference. That is why we offer tools and programs to support members on their journey to better health. Adult members and their covered spouse can each earn up to $250 per calendar year by completing qualifying activities and screenings through our Wellness Rewards Program. WAYS TO EARN Complete an online clinical health risk assessment (CHRA) 50 reward points Receive your yearly biometric screening 50 reward points Get your annual routine preventive care check-up 50 reward points Receive certain preventive care screenings: 100 reward points - cervical cancer screening 100 reward points - mammogram 50 reward points - colorectal cancer screening Use the UMR Health Cost Estimator tool 50 reward points Complete health coaching like Care Management, Tobacco Cessation and Maternity Management 100 reward points HOW REWARD POINTS WORK One reward point equals one dollar. The money you earn will be applied to your deductible the following calendar year. Members who have Medicare B as their primary insurance will receive their reward in a health reimbursement account that can be used for qualified medical expenses such as medical and prescription drug copayments and Medicare premiums. Learn more at compassrosebenefits.com/rewards. compassrosebenefits.com 10

11 HEALTH TOOLS & WELLNESS PROGRAMS GET THE MOST OUT OF YOUR COVERAGE + LIVE A HEALTHIER LIFE COMPASS ROSE 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 WEIGHT LOSS PROGRAM Need help losing weight? We offer a FREE online weight loss program through Real Appeal to motivate eligible members to make long-term healthy lifestyle changes. This program provides: A Transformation Coach to motivate you to reach your goals Online tools and trackers available 24/7 A Success Kit with scales, recipes, workout DVDs and more DENTAL & VISION DISCOUNT PROGRAM We partner with Careington International Corporation to provide members with a national Dental and Vision Discount Program at no additional cost. (This plan is not insurance and is not intended to replace health insurance.) 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. MATERNITY MANAGEMENT PROGRAM A healthy pregnancy is key to having a healthy baby. Our FREE Maternity Management program provides access to a nurse coach who will help you learn about healthy lifestyle choices and good medical care during pregnancy. Participants also receive educational materials and their choice of one out of six pregnancy books. WELLNESS SUPPORT 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 2019 MEMBER PREMIUMS ENROLLMENT TYPE & CODE BIWEEKLY RATE MONTHLY RATE Self Only (421) $91.18 $ Self Plus One (423) $ $ Self & Family (422) $ $ ENROLLMENT CONVENIENT + EASY Open Season is November 12 - December 10 don t miss your chance to enroll. To see if you are eligible, visit compassrosebenefits.com/eligibility. ACTIVE EMPLOYEES Contact your Health Benefits Officer or Human Resources Representative within your organization/agency. You will need to complete a Health Benefits Election Form (SF 2809). RETIREES Contact OPM directly: - During Open Season: (800) Outside of Open Season: (888) Visit opm.gov for additional enrollment options. QUESTIONS? WE ARE HERE FOR YOU CALL: (888) from 8:00am - 8:00pm (EST) askcrbg@compassrosebenefits.com ONLINE: compassrosebenefits.com/openseason compassrosebenefits.com 12