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COMPASS ROSE HEALTH PLAN

PROTECTING OUR MEMBERS SINCE 1948POWERED BY

PLAN YEAR 2018

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PLAN HIGHLIGHTS

COMPASS ROSE HEALTH PLAN

CUSTOMER SERVICE

NETWORK + COVERAGE

HEALTH BENEFITS

PRESCRIPTIONS

MEDICARE

ADDITIONAL RESOURCES

RATES + ENROLLMENT

WELCOMEWE ARE HERE TO HELP YOU SOLVE THE COMPLEXIT IES OF INSURANCE

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Preventive Care 100%

COMPASS ROSE HEALTH PLAN

$15 PRIMARY CARE

DOCTOR

$15 TELEHEALTH

VISITS

$25 SPECIALIST

VISITS

$5 GENERIC

PRESCRIPTIONS

WORLDWIDE COVERAGE — NO REFERRALS NEEDED

EXCLUSIVE MEMBERSHIPIntelligence Community

Department of Defense

Department of State

Using the UnitedHealthcare Choice Plus Network:

Lab Work 100% *LabCorp

Maternity 100%

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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.

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, visitcompassrosebenefits.com/Eligibility

YOUR HEALTH, OUR PLANWE ARE COMMIT TED TO SER VING OUR MEMBERS

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YOUR HEALTH, OUR PLAN WE ARE HERE FOR YOUOUR MEMBER ADVOCATES HELP S IMPLIFY THE COMPLEXIT IES 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.

CALL:(888) 438-9135 from 8:00am - 8:00pm (EST)

E-MAIL: askCRBG@compassrosebenefits.com

ONLINE: compassrosebenefits.com/OpenSeason

OPEN SEASON

Don’t let your questions go unanswered. If you need assistance during Open Season, please contact our customer service information centerMonday - Friday.

Open Season is November 13th - December 11th — don’t miss your chance to enroll.

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OUR NETWORK

The Compass Rose Health Plan is a nationwide Preferred ProviderOrganization (PPO). When you visit a network provider, you receivecovered services at a reduced cost.

The Plan is powered by the UnitedHealthcare (UHC) Choice Plusnetwork 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

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 - $350Self Plus One - $700Self and Family - $700

CATASTROPHIC PROTECTION

Catastrophic Medical PPO & Pharmacy Network Coverage: $4,000Catastrophic Medical Non-PPO Coverage: $7,000

HOW OUR PLAN WORKSYOU CHOOSE YOUR OWN HEALTH CARE PROVIDERS

HELPFUL TIP

Providers may not recognize our Plan name, be sure to ask if your provider participates in the UnitedHealthcare Choice Plus network.

Out-of-Network Annual Deductible: Self - $400Self Plus One - $800Self and Family - $800

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BENEFIT STATESIDE AND OVERSEASROUTINE PREVENTIVE CARE (ADULT AND CHILDREN) $0

DOCTOR OFFICE VISITS - PRIMARY PHYSICIAN $15 copayment (No Deductible*)

DOCTOR OFFICE VISITS - SPECIALIST $25 copayment (No Deductible)

TELEHEALTH: DOCTOR ON DEMAND $15 copayment (No Deductible)

LABWORK PROGRAM THROUGH LABCORP $0

X-RAY & OTHER DIAGNOSTIC SERVICES 10% of the Plan Allowance

URGENT CARE FACILITY $50 copayment, waived if admitted (No Deductible)

EMERGENCY ROOM $100 copayment, waived if admitted (No Deductible)

INPATIENT HOSPITAL CARE1 $200 copayment per hospital stay (No Deductible)

SURGICAL SERVICES1 10% of the Plan Allowance (No Deductible)

ROUTINE MATERNITY CARE $0

BASIC CHIROPRACTIC CARE $20 copayment (No Deductible, 20 visits max)

ACUPUNCTURE CARE 10% of the Plan Allowance (24 visits max)

OUTPATIENT THERAPY1,2 10% of the Plan Allowance (90 visits max)

ALLERGY CARE $15 co-pay in Primary Physician’s office (No Deductible)$25 co-pay for Specialists (No Deductible)

ANNUAL DEDUCTIBLE $350 Self Only$700 Self Plus One or Self and Family

OUT-OF-POCKET MAXIMUM $4,000 Self Only, Self Plus One or Self and Family

BENEFITSGE T THE MOST FROM YOUR PLAN TO HELP YOU SAVE MONEY

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 atcompassrosebenefits.com/Brochure.

Your cost when you use in-network providers for covered services:

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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) 438-4449.

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) 438-4449 or visit express-scripts.com/Pharmacy.

PRESCRIPTION DRUG PROGRAMCONVENIENT OPTIONS TO F ILL PRESCRIPT IONS

HOME DELIVERY PROGRAM

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) 803-2523.

HELPFUL TIP

With the Home Delivery Program, members receive a 3-month supply of their prescription for the cost of 2 months.

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BENEFIT YOUR COST

IN-NETWORK RETAIL30-day supply

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 RETAILMEDICARE PART B PRIMARY30-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 DELIVERY90-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 DELIVERYMEDICARE PART B PRIMARY90-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 MEDICATIONS30-day supply

Formulary: 7% up to a maximum of $150 (no deductible)Non-Formulary: 10% up to a maximum of $300 (no deductible)

PRESCRIPTION DRUG CO-PAYSCONVENIENT OPTIONS TO F ILL PRESCRIPT IONS

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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.

MEDICAREDUAL COVERAGE, DOUBLE PROTEC TION

Inpatient Hospital Care Expenses

Outpatient Provider Expenses

Pharmacy

Network of Physicians and Hospitals

Other Covered Services

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.

Hearing AidsDiabetes testing suppliesRespiratory supplies Immunosuppressive medicationsOral anti-cancer medications

HELPFUL TIP

Did you know that there are limited times to enroll in a Medicare Plan?

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ADDITIONAL RESOURCESGE T THE MOST OUT OF YOUR COVERAGE + L IVE A HEALTHIER L IFE

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

MEMBER PORTAL

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.

WELLNESS SUPPORT

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.

DENTAL & VISION DISCOUNT PROGRAM

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!

If you would like more information on any of the resources listed above, please visit compassrosebenefits.com.

FITNESS & WELLNESS

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.

DOCTOR ON DEMAND

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.

PRENATAL CARE PROGRAM

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ENROLLMENT CODESSelf Only use code 421Self Plus One use code 423Self and Family use code 422

ACTIVE EMPLOYEESContact 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.

RETIREESContact OPM directly:- During Open Season: (800) 332-9798- Outside of Open Season: (888) 767-6738Visit opm.gov for additional enrollment options.

QUESTIONSCall a Compass Rose Member Advocate at (866) 368-7227 (option 3)Monday - Friday 9:00am - 5:00pm (EST).

PLAN RATES2018 MEMBER PREMIUMS

TYPE OF ENROLLMENT BIWEEKLY RATE MONTHLY RATE

Self Only (421) $92.11 $199.57

Self Plus One (423) $216.00 $468.00

Self & Family (422) $249.69 $541.00

ENROLLMENTCONVENIENT + EASY