The Compass Product Highlights
- You must select a primary care provider (PCP) from the NY Compass network. Your PCP will be your first point of contact to help you get care when you need it. You will be asked to select your PCP when you pay your first bill.
- Your PCP can refer you to any doctor or hospital in the NY Compass network. You save money when you use doctors (including specialists), hospitals and labs in the Compass network because health care providers in the network have agreed to charge lower prices.
Note: You won't have coverage if you go out of the network. This means you will have to pay the full cost of services.
- You must get a referral from your PCP before you can see another doctor or specialist. Electronic referrals from your PCP are required before you see another doctor or specialist. If you don’t get a referral, you won’t have coverage. You will have to pay the full cost of services.
- Your preventive care is covered 100% in the network. You don't have to pay any out-of-pocket costs for preventive care as long as you use your PCP.
How The Compass Product works
Note: the following does not apply for preventive care that is received in the network.
- You will pay a co-payment each time you see your PCP.
If your PCP feels you need special care, they will provide a referral for you to see a network specialist. You will need to pay a co-payment each time you see a specialist.
- You will have a deductible.
- If you paid the deductible, your plan will likely have co-insurance.
- You are protected with an out-of-pocket limit. This is the most you will pay during a plan year for covered services. If you reach the limit, the plan will pay 100% of covered services for the rest of the plan year.
For certain services, you may be required to have approval before those services can be covered by your plan.
Summary of Benefits and Coverage (SBC) and Insurance Policy Documents
Insurance Policy Document Example
This is an example of an insurance policy. Please use this information only as a general reference for plan coverage. Once you're a member, you'll receive your insurance policy in your welcome packet. In the state of New York exchange health plans are covered by UnitedHealthcare of New York, Inc.
Insurance Policy Document Example
Summary of Benefits and Coverage Documents (SBCs)
The Summary of Benefits and Coverage (SBC) is designed to help you understand and compare different medical plan options. SBCs for each of our plans are listed below.
Which SBC should I review?
The Standard Plans listed below show what is available for most consumers. Some products are designed for specific groups, such as American Indians and Alaska Native Americans. Other products may only be available for individuals or families based on income levels. The Marketplace (or state exchange) will show only the plans available to you based on your income and how you answer a few other questions. This website shows the total list of plans and SBCs.
Health plans offered through the Marketplaces “exchanges” are grouped into “metal” levels such as Bronze, Silver and Gold.
Plan levels differ by how much you pay each month for the premium and for out-of-pocket costs for medical care. Some plans may cost less each month but require you to pay more out-of-pocket when you receive care. Other plans may cost more each month but require you to pay less out-of-pocket when you receive care.
CSR: Cost Share Reduction Plans