Welcome

Getting Started

Since 1948, the Compass Rose Health Plan has helped its members navigate the complexities of insurance. We want to help you get the most out of your health care coverage.


Member Portal

Our Member Portal is a tremendous resource for accessing your coverage information—available to all Compass Rose members! It gives you access to tools and information designed to help you stay organized and save money.


Features of the Member Portal include:

  • PLAN BENEFITS: Discover plan benefits and personalized services
  • ACCOUNT UPDATES: Update your address and view ID cards, claims & EOBs
  • EXCLUSIVE TOOLS: Take advantage of resources such as Express Scripts' Portal, UMR's Health Cost Estimator, UMR's Health Education Library and more

Get started and personalize your health care experience. Health Plan members will need their member ID number.





Using our Network

The Compass Rose Health Plan is a Preferred Provider Organization (PPO) that utilizes UnitedHealthcare's Choice Plus Network.


How to Find In-network Providers

To find doctors, hospitals or medical facilities in the UnitedHealthcare Choice Plus Network:

  • Search our Provider Directory using your zip code. TIP: use a wide mile range to ensure a broad selection of providers.
  • Call your provider's office directly and ask if they participate in the UnitedHealthcare Choice Plus Network.
  • Call our claims payer, UMR, at (888) 438-9135 and ask for help in locating a participating provider in your area.

 


 




 


2018 Plan Highlights

Stateside and Overseas Your Cost
Doctor Office Visits:
Primary Care Physician 
$15 Copayment
Doctor Office Visits: Specialist $25 Copayment
Prescription Drugs (Generic) $5 Copayment 
$3 Copayment (medicare B)
Lab Program through LabCorp 100% Coverage
Routine Preventive Care (Adult and Children)  100% Coverage
Basic Chiropractic Care $20 Copayment (maximum 20 visits)
In-Network Coverage Covered at 90%
Out-of-Network Coverage Covered at 70%
Annual Deductible In-Network:
Self = $350
Self Plus One = $700
Self and Family = $700

Out-of-network:
Self = $400
Self Plus One = $800
Self and Family = $800
Catastrophic Coverage $4,000 out-of-pocket (max in-network)
$7,000 out-of-pocket (max out-of-network)
Urgent Care $50 Copayment
Emergency Care $100 Copayment
Inpatient Hospital Benefit In-Network / Overseas:
$200 Copayment (per hospital stay)
No Deductible

Out-of-network:
See page 61 of FEHB Plan Brochure

 

For payment purposes, the Compass Rose Health Plan considers primary care physicians (PCP) to be family practitioners, general practitioners, doctors of internal medicine, pediatricians, obstetrician-gynecologists (OB-GYN), nurse practitioners, physician assistants, and mental health/substance abuse providers. Any other type of health care provider type — like dermatologist, surgeons, etc. — are considered to be specialists. No referral is needed to visit a specialist.

We want to make sure you receive care within a reasonable time frame. Here are the access care standards for health care services received within our network at a primary care provider's office:

 

Type of Service (Appointment Type) Standard
Preventive Care Within four weeks
Regular/Routine Care Within 14 days
Urgent Care Same day
Emergency Care Immediate
After-Hours Care 24 hours/seven days a week for after-hours messaging and emergency contact information

 


 

How to Read Your ID Card & EOB

Non-Medicare Members
Medicare Members


Filing Medical Claims

Claims are processed by our Claims Administrator, UMR (NOT UnitedHealthcare). Your provider is responsible for submitting claims on your behalf; however, there may be instances where you will need to submit medical claims directly to UMR, such as for out-of-network doctors or overseas claims. 

For covered services received overseas, you must submit a completed claim form, itemized bills and proof of payment to UMR. It is important to send all the documents for your claim as soon as possible.

If another health plan is your primary payer and does not automatically submit claims to your secondary payer, you must submit a copy of the Explanation of Benefits (EOB) you received from your primary payer along with a claim form to UMR. NOTE: If you have Medicare primary coverage, Medicare generally sends the processed claim to UMR for secondary coverage consideration.

All claims MUST be mailed to:

UMR
P.O. Box 8095
Wausau, WI 54402

Access Claim Forms:
Stateside Claim Form
Overseas Claim Form


If you have questions about filing a claim, please contact UMR at (888) 438-9135.

 


Compass Rose Health Plan and Medicare

Click here to learn how the Compass Rose Health Plan and Medicare work together.


Prescription (Rx) Drug Plan

Our Prescription Drug Plan is through Express Scripts. The Compass Rose Member Portal gives you access to Express Scripts to help you manage your prescriptions, find local pharmacies, receive refill alerts and learn about drug interactions. Be sure to check the current formulary, a list of commonly preferred drugs used by the plan, to view preferred medications and exclusions. Not all drugs listed are covered by our plan; call Express Scripts at (877) 438-4449 to ask about a specific drug.


NOTE: Express Scripts launched a new electronic claims submission process. This option is available on the Express Scripts member portal. Members that have paid out of pocket for prescriptions will now be able to use this enhanced process for claim submissions. For more information click here


Prescription (Rx) Co-Pays

Speciality Pharmacy Benefit

Medications used to treat severe and/or chronic medical conditions, usually administered by injections or infusions, may be subject to the Specialty Pharmacy Benefit. A representative from Accredo will contact members who use Specialty medications; however, members may also call Accredo at (877) 988-0057.


How to Fill your Prescriptions

You can fill prescriptions through a local retail pharmacy, or through Express Scripts Home Delivery in the case of maintenance drugs (drugs prescribed for at least 90 days, up to one year).


With the Home Delivery Program, members receive a three-month supply of their prescription for the cost of two months. To obtain a prescription through the Express Scripts Home Delivery Program, ask your provider to write a new prescription for a 90-day supply with authorized refills for up to one-year. Your order can be submitted several ways:


Online:

The easiest way to enjoy the convenience of Home Delivery is to ask your provider to send your prescription(s) electronically to the Express Scripts Pharmacy℠.


Mail:

Mail in a prescription your provider has written with these steps:

  1. Complete the Home Delivery Form in your prescription drug welcome packet, which is sent to you from Express Scripts. If you have NOT received your packet, please call Express Scripts at (877) 438-4449.
  2. Attach your prescription(s) to the Home Delivery Form.
  3. Submit the Home Delivery Form and your prescription(s) to: Express Scripts, P.O. Box 66577 St Louis, MO 63166-6577.

Fax:

Your provider can call (888) 327-9791 for specific faxing instructions. They will need your member ID number.

Please note: Express Scripts can only accept a faxed prescription from your provider's office. Faxes sent from other locations, such as your home or workplace, will not be accepted. Express Scripts cannot accept controlled substance prescriptions by fax — prescriptions for these medications MUST be mailed.


Prior Authorization


Certain drugs require prior authorization or may be subject to quantity limits. If your prescription is for a drug requiring prior authorization, additional information from your physician will be needed before the medication is dispensed.

This extra screening protects you or your family members by making sure the medication is safe for you and prescribed at the right dosage. Prior authorization helps you avoid taking a medication that could have adverse effects on your health. It also reduces costs associated with inappropriate medication use.


Examples of when prior authorization may be required:

  • Medications with age or gender limitations
  • Medications prescribed for a quantity exceeding normal limits
  • A more effective alternative may exist

If your prescription needs prior authorization, your pharmacist will make a request to your provider. Only your provider can submit this information.


For drugs requiring prior authorization or with quantity limits, call the Express Scripts prior authorization number 
(800) 753-2851.

Wellness Support

Managing Chronic Conditions

When you are diagnosed with a chronic disease, it can be overwhelming and frightening. Through UMR's Care Management Program, members receive professional support through nurse coaches. To participate, you or a family member must have been diagnosed with one of the following conditions: diabetes, heart failure, asthma, coronary artery disease or chronic obstructive pulmonary disease.


Members who qualify can call UMR at (866) 575-2540, or join online following the instructions below:

  • Login to your Compass Rose Member Portal.
  • Click on CLAIMS & EOBs in the menu bar. Then, following the instructions on the page, click on your most recent plan*. This will redirect you to your UMR member profile.
  • In UMR's portal, click HEALTH CENTER from the 'myMenu'.
  • Choose GET A HEALTH COACH from the 'I need to...' menu.

*Applies only for members with multiple policies listed; if only one plan is listed, click it.


Qualified adult members (age 18 or older) who complete an assessment with their nurse coach will receive a FREE blood pressure cuff to help them successfully manage their condition.


Case Management Program

For members facing a catastrophic or complex medical problem, or a severe accident, support from specially trained Case Managers can be a great resource. Compass Rose Health Plan members have access to services through UMR’s Case Management Program. A Case Management Nurse can help coordinate necessary care, communicate with medical professionals and answer any questions and concerns. If you are in need of additional help, please call (888) 438-9135 to review your situation and determine next steps.


Maternity Management Program

If you are thinking about having a baby or are already expecting, we invite you to sign up for our Maternity Management program. Enrolling in this program can help you learn how healthy lifestyle choices and good medical care before and during your pregnancy — like seeing your obstetrician within the first trimester — can increase your chances of having a healthy, full-term baby.


Through this program, you will receive educational materials and your choice of one out of six pregnancy books at no cost to you.


We want to help support you during your special time. Learn more and sign-up.


Well Child Visits

It is important for your child to get a healthy start in life and we want to help. Regular well-child visits, screenings and immunizations in the first 15 months are vital to your child’s lifelong health and well-being. For your convenience, Compass Rose designed a well-child visits tracking form to help you schedule and record your baby’s healthcare visits. Remember to use an in-network provider to get the best coverage.


Preventive Care

One of the best ways to stay healthy is by taking advantage of your Preventive Care benefits. The Compass Rose Health Plan provides 100% coverage for a variety of screenings when using an in-network provider. Please note: To receive 100% coverage, your physician's bill must clearly state "Routine Physical Exam". Services include screenings for conditions such as breast cancer, cervical cancer, colon cancer, lung cancer and high cholesterol. We also cover immunizations including flu shots and well-child visits. For detailed information, please refer to the preventive care section (page 34) in our 2018 FEHB Plan Brochure.


Telehealth: Doctor on Demand

Next time you’re sick, 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 medications if necessary. They are available 7 days a week—even when other health care options are closed. Download the app and pre-register today!



Lab Work Program

To receive 100% coverage for covered outpatient laboratory testing, you will need to show your health member ID card at your doctor’s office and tell them that your testing MUST be processed by LabCorp. If you choose NOT to use the LabCorp benefit, you still have coverage; however, you will be responsible for the deductible, coinsurance or co-pay portion of your lab work.


Visit LabCorp to find a facility near you or call (888) 438-9135 for assistance. This program is not applicable to members with Medicare B as their primary insurance.


Dental and Vision Discount Plan

Dental & Vision Discount Program

As a Compass Rose Health Plan member, you and your qualifying dependent(s) are automatically included in our Dental & Vision Discount Program through Careington at no additional cost. For details on this discount program, you can visit Careington online or call them directly at (800) 441-0380.


Access your discount membership card. You will be prompted for a PIN number. Enter 0512 and simply print your membership card. Providers MUST be in the Careington Network to receive the discounts. There is no out-of-network discount.




Weight Loss Program: Real Appeal

Achieve your personal weight loss goals with Real Appeal®, a free online weight loss program available to eligible Compass Rose Health Plan members at no additional cost. Real Appeal’s approach is focused on combining simple steps with personalized tools and support. Start your own success story today — enroll for free!

Tobacco Cessation Program

The Compass Rose Health Plan offers a FREE Tobacco Cessation Program, provided through UMR, to support its members wishing to quit smoking. Quitting smoking is one of the BEST things you can do to improve your health and the health of those around you. With determination, a positive attitude and a little help, you can do it! UMR's Tobacco Cessation Program is effective in helping participants break the habit and remain tobacco-free.

Take the first step toward your smoke-free life. For more information on UMR's Tobacco Cessation Program or to enroll,
call (800) 207-7680.


Fitness and Wellness Program

Our Fitness and Wellness Program through GlobalFit provides Compass Rose Health Plan members with discounts at over 8,000 fitness centers, clubs and studios nationwide. Members also have access to:

  1. Elite nutrition, fitness and health products
  2. Educational tools and resources
  3. A monthly digital magazine
  4. Interactive health and nutrition coaching
  5. Wellness programs
  6. Discounts on in-home exercise programs

For more information, or to activate your account, visit GlobalFit online or call (800) 294-1500.


Mission Financial Solutions

Mission Financial Solutions is customized and tailored exclusively for Compass Rose Benefits Group members. The free website provides educational articles and interactive tools on financial topics centered around the needs of our members. Mission Financial Solutions seeks to help members better prepare for their financial future. 


You Talk. We Listen.

Thank you for choosing the Compass Rose Health Plan for your health care needs. Our members’ feedback means a lot to us, which is why we would like to learn why you decided to enroll in our plan. Please take a moment to complete our online survey. Thank you for your time—we look forward to reviewing your comments.


If you have questions about any of the benefits explained above, do not hesitate to contact us.