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.
| BENEFITS |
HIGH OPTION In-network |
CONSUMER DRIVEN OPTION
In-network |
|---|---|---|
| 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) |
| 24/7 Virtual Visits with Teladoc® | $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 |
| Medical food formulas are covered to treat phenylketonuria (PKU) and other inborn errors of metabolism | 15% | 15% of Plan allowance |
| 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 |
| Gender affirming care | ||
| Gender dysphoria therapy and gender affirming surgery | 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, no deductible applied) |
| Mental health/substance use | ||
| Office visits | $25 copay (no deductible applied) | 15% of Plan allowance |
| Outpatient treatment | 15% | |
| Diagnostics, inpatient and outpatient service | 15% | |
| Alternate care | ||
| Chiropractic care | $25 copay (no deductible applied) | 15% of Plan allowance (24 visits per year) |
| Acupuncture | $25 copay (no deductible applied) | 15% of Plan allowance |
| Physical, occupational and speech therapy | 15% | 15% of Plan allowance (up to 60 visits per year) |
| Prescription drugs | ||
| Retail prescription (30-day supply) | $10 for Tier 1 drugs, 25% for Tier 2 drugs, max $200 per Rx, 45% for Tier 3 drugs, max $300 per Rx | 25% for Tier 1 or Tier 2 drugs, $200 maximum per Rx for 30-day supply, 40% for Tier 3 drugs,$300 maximum per Rx for 30-day supply |
| Mail-order prescription (90-day supply) | 20% for Tier 1, 25% for Tier 2 drugs, max $300 per Rx, 40% for Tier 3 drugs, max $500 per Rx | 25% for Tier 1 or Tier 2 drugs, $400 maximum per Rx for 60-day supply, $600 maximum for 90-day supply, 40% for Tier 3 drugs, $600 maximum per Rx for 30-day supply, $900 maximum per Rx for 30-day supply |
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