Open Season 2025
APWU Health Plan offers a fee-for-service High Option and a Consumer Driven Option paired with a Personal Care Account. Explore coverage details and health benefits for employees and retirees covered under the Federal Employees Health Benefits (FEHB) Program.
| FEHB enrollment code | Biweekly | Monthly / Retiree |
|---|---|---|
| Self - 471 | $140.16 | $303.68 |
| Self + One - 473 | $265.11 | $574.40 |
| Self & Family - 472 | $337.72 | $731.73 |
| FEHB enrollment code | Biweekly | Monthly / Retiree |
|---|---|---|
| Self - 474 | $100.62 | $218.00 |
| Self + One - 476 | $218.68 | $473.81 |
| Self & Family - 475 | $238.56 | $516.89 |
In-network
In-network (after deductible is met)
| BENEFITS |
HIGH OPTION In-network |
CONSUMER DRIVEN OPTION
In-network (after deductible is met) |
|---|---|---|
| Medical visits | ||
| Office and specialists visits | $25 copay (no deductible applied) | 15% of Plan allowance (Plan allowance: The maximum amount a plan will pay for a covered healthcare service) |
| Virtual visits |
$0 copay for first 2 visits $10 copay (no deductible applied) |
|
| Preventive care | ||
| Well-child | $0 | $0 — No PCA used. Receive a $25 wellness incentive for each family member who completes an annual physical exam, mammogram, or cervical cancer screening |
| Childhood immunizations | ||
| Annual adult routine exams | ||
| Adult immunizations | ||
| Preventive screenings | ||
| Dental care | ||
| Routine dental | 30% of Plan allowance (no deductible applied) | See Careington Dental Discount Network for savings information |
| Diabetes care | ||
| Generic oral medication, formulary blood glucose test strips and lancets (used to reduce blood sugar) | $0 through mail-order | See prescription coverage details |
| Maternity | ||
| Complete maternity care, including prenatal, delivery, postnatal and initial exam of newborn covered under family enrollment | $0 | $0 — No PCA used |
| Hospital/facility care | ||
| Diagnostic tests or imaging | 15% ($0 for covered blood work performed at LabCorp and Quest Diagnostics) | 15% of Plan allowance |
| Outpatient surgery | 15% | 15% of Plan allowance |
| Inpatient surgery | 15% | 15% of Plan allowance |
| Cancer Center of Excellence | 5% | 10% of Plan allowance |
| Infertility treatment | ||
| Diagnostic and treatment services | 15% | 15% of Plan allowance |
| Emergency care | ||
| Accidental injury (within 72 hours) | $0 | 15% of Plan allowance |
| Urgent care | $30 copay (no deductible applied) | |
| Emergency room | 15% | |
| Ambulance | 15% (no deductible applied) | |
| Hearing services | ||
| Diagnostic hearing tests | 15% every 2 years | 15% every 2 years |
| Hearing aids | All charges in excess of $1,500 (every 3 years, no deductible applied) | All charges in excess of $1,500 (every 3 years) |
| Mental health/substance use | ||
| Office visits | $25 copay (no deductible applied) | 15% of Plan allowance |
| Outpatient treatment | 15% | |
| Diagnostics, inpatient and outpatient service | 15% | |
| Alternative care | ||
| Chiropractic care | $25 copay (24 visits per year, no deductible applied) | 15% of Plan allowance (24 visits per year, no deductible applied) |
| Acupuncture | $25 copay (26 visits per year, no deductible applied) | 15% of Plan allowance |
| Physical, occupational and speech therapy | 15% (60 visits per year, no deductible applied) | 15% of Plan allowance (up to 60 visits per year) |
| Prescription drugs | ||
| Retail prescription (30-day supply) | Per Rx: $10 for Tier 1 drugs, 25% for Tier 2 drugs – max $200, 45% for Tier 3 drugs – max $300 | Per Rx: 25% with a min of $15 and a max of $200 for Tier 1 or Tier 2 drugs, 40% with a min $15 and a max of $300 for Tier 3 drugs |
| Mail-order prescription (90-day supply) | Per Rx: 20% for Tier 1 drugs, 25% for Tier 2 drugs – max $300, 40% for Tier 3 drugs – max $500 | Per Rx: 25% with a min $10 and a max of $200 for Tier 1 or Tier 2 drugs, 40% with a min $10 and a max of $300 for Tier 3 drugs |