Getting Started with the
Compass Rose Health Plan

Understand your coverage

Welcome

 

Enrolling in health insurance is the easy part. When it comes to understanding and actually using your benefits it can get confusing. Our goal is to help you understand your coverage and feel confident in making the most of it — when you first enroll and every year after that.

Your Member ID Cards

 

Look for your health plan member ID card in the mail. Keep you card with you to use at doctor visits and when filling prescriptions. If you misplace or lose your ID card, you can view and print a temporary card as well as order a new one through your Member Portal Account (see manage your account online below). You may also call UMR directly at (888) 438-9135 to request a replacement.

You can learn about the information that included on your ID card, with one of our online guides.

FIND A PROVIDER

 

The Compass Rose Health Plan uses the UnitedHealthcare Choice Plus network of doctors and hospitals to provide in-network care. Your out-of-pocket costs will be lower if you use an in-network provider.

  • Go to our Provider Directory and
    select search for a medical provider.
  • Enter your zip code. TIP: use
    a wide mile range.
  • Search by specialty or category.
    You may also enter a provider’s
    name if you know it.

 

NOTE: If you are looking for a behavioral health provider be sure to select the behavioral health directory link.

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

MANAGE YOUR ACCOUNT ONLINE

 

The Compass Rose Member Portal gives you access to tools and information designed to help you stay organized and save money. With a Compass Rose Member Portal account you can:

  • View plan details and coverage information
  • Access your ID card, claims and explanation of benefits (EOBs)
  • Estimate costs for covered services
  • Access Express Scripts to manage your prescriptions
  • Enroll in one of our health and wellness programs
  • Take your Clinical Health Risk Assessment (CHRA) and earn rewards

NOTE: You will need your member ID number to enroll.

TAKE ADVANTAGE OF OUR HEALTH AND WELLNESS PROGRAMS

 

We offer many benefits, discounts, tools and wellness programs to help our members meet their health goals and get the most out of their coverage. Our members can earn up to $250 per calendar year, connect with a doctor from their phone 24/7, get help losing weight, pay $0 for covered lab work and more — all at no cost to you!

TAKE CHARGE OF YOUR HEALTH

 

Staying healthy is important for you and your family. We are here to help.

Preventive Care

Routine preventive care — like an annual physical exam, screenings and vaccinations — at every stage of life can help you stay healthy, avoid or delay the onset of disease and keep medical conditions you may already have from becoming worse or debilitating.

Our members can access a wide range of preventive care services at no cost when seeing a network provider. 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 in our 2019 FEHB Plan Brochure.

Speak to your primary care doctor about which preventive care services are recommended for you.

Please note: To receive 100% coverage, your physician's bill must clearly state "Routine Physical Exam."

Managing Chronic Conditions

Being diagnosed with a chronic disease can be overwhelming and frightening. We offer our members personalized support with access to a nurse coach who can help you manage your condition through UMR's Care Management Program. Members 18 or older and diagnosed with asthma, chronic obstructive pulmonary disease (COPD), coronary artery disease, congestive heart failure, hypertension and/or diabetes are eligible to participate.

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. Enroll now.

Case Management

Members facing a catastrophic or complex medical problem, or a severe accident, can receive support from specially trained Case Managers 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 UMR at (888) 438-9135 to review your situation and determine next steps.

GET TO KNOW YOUR PLAN

 

The key to understanding your health care coverage is learning about what services are covered, getting familiar with your costs and knowing the difference between in-network and out-of-network.

    • With the Compass Rose Health Plan you enjoy low copays and the freedom to choose your providers without needing a referral. Learn about common covered services and find out how much you can expect to pay in-network.

      Learn More

    • Your prescription drug coverage is through Express Scripts, which gives you options for getting your prescriptions filled. Find out how you can obtain the prescriptions you need.

      Learn More

    • 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 outside the United States and Puerto Rico, you must submit a completed overseas claim form, itemized bills and proof of payment to UMR, our claims payer. If you are filing an overseas claim for prescription drugs, please use the overseas claim form and submit to UMR. Do not use the Express Scripts claim form or submit your claim to Express Scripts.

      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.

      It is important to send all documents for your claim as soon as possible. You must submit the claim by December 31 of the year after you received the service. If you were unable to file on time because of Government administrative operations or legal incapacity, you must submit your claim as soon as reasonably possible.

      To file a claim with UMR, you can either send a fax to (855) 405-2189 or mail to: 
      UMR 
      P.O. Box 8095 
      Wausau, WI 54402

      Stateside Claim Form
      Overseas Claim Form

    • There are some advantages to having BOTH Medicare and the Compass Rose Health Plan, like decreased out-of-pocket costs.

      Learn More


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 know why you chose our plan. Please take a moment to complete our online survey.