Association Benefit Plan (ABP)
Frequently Asked Questions (FAQ)
Q. What is a PPO?
A. A PPO is a group of health care providers (physicians, hospitals and other providers) that have agreed to care for PPO members in exchange for negotiated, contracted rates. You may receive care from any provider you choose, but if you choose a PPO provider, you will realize lower out-of-pocket costs.
Q. Do I Always Have to See the Same Doctor?
A. In a PPO, all network providers are considered “preferred,” and you can visit any of them, even specialists, without first seeing a primary care physician. Certain services may require Plan pre-certification, an evaluation of the medical necessity of inpatient admissions and the number of days required to treat your condition.
Q. How Do I Obtain Pre-certification?
A. You are responsible for ensuring that your admission stay is pre-certified by calling Coventry Health Care at the number on the back of your insurance card. If this requirement is not met, reduced benefits may apply.
Q. How Do I Know Which Providers Are Preferred?
A. There are three ways to find a preferred provider (also called participating or in-network).
- Call Customer Service on the number on your ID card with the name of a provider in which you are interested. A representative can verify for you whether or not he/she is participating.
- Consult the on-line First Health Provider Directory, www.firsthealth.com. The online login is: abp
- Verify with the Doctor to find out if they participate in the First Health network.
Q. What is a PPO Service Area?
A. A service area is a list of zip codes, counties, or states where a plan has participating providers. To find out if you live in a service area, consult your Plan brochure. You are eligible for PPO benefits if you live in a listed service area. If you live outside a service area, non-PPO benefits apply to all services you receive.
Q. How Will Preferred Providers Know I'm a PPO Member?
A. You will need to show your ID card prior to receiving services. Your ID card contains a recognizable logo to the provider that tells him/her that you are a PPO member
Q. Am I notified when my child turns 22 years of age and is no longer on my health plan?
A. No, you will not be notified. Please contact Federal Insurance Programs on 703-613-7008 for information regarding Temporary Continuation of Coverage (TCC).
Q. Can I get my doctor added to the Preferred Provider Organization (PPO)?
A. If your doctor is located in the PPO Network Area and is interested in joining the PPO, call the number on the back of your health card with the doctor’s name, address, phone number. The decision to add a particular doctor is made exclusively by the PPO, not ABP.
Q. How can I obtain a listing for a PPO physician or facility?
A. To obtain a physician or facility in the Plan's Preferred Provider Organization (PPO), you can access the directory on the Internet at www.compassrosebenefits.com under health, or www.firsthealth.com, or call the number on the back of your health card. When accessing the First Health Web site, the login is: abp. The electronic directory is the most convenient way to search for a provider. Please be sure to enter a 25 mile from your home, searching with an expanded radius gives you a better chance of pulling up the information you are seeking. First Health updates the directory daily.
Q. How do I submit a prescription through the Association Benefit Plan (ABP) mail order program?
A. Click here for instructions.
Q. When I retire and am eligible for Medicare, should I keep ABP? Will the ABP premiums change?
A. When you are enrolled in Medicare, it is very important to have supplemental insurance. If your doctor accepts Medicare, his/her office will submit your medical claims to Medicare first and Medicare will then coordinate with ABP, who will pay the difference for most covered charges. The government will pay its share of your ABP premiums and your monthly premiums will be deducted from your annuity. If you have any questions, please call Compass Rose at 703-613-7215.
Q. Who is eligible to enroll in ABP?
A. For all of the Association Benefit Plan's (ABP) history, the ABP was a closed plan, limited to Agency staff employees and retirees. In the fall of 2005, the ABP was opened to the Intelligence Community. It is still considered a 'closed' plan since it is now limited to only employees of the Intelligence Community members.
As a Federal employee, you may enroll in any federal plan; however, it is important to understand that the ABP provides extensive in-house customer service support. Compass Rose Benefits Group customer service representatives work directly with Coventry Health Care employees to clarify and resolve any health insurance issues you may have.
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