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 Postal Service Health Benefits (PSHB) 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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In order to provide Postal Service employees and Postal Service annuitants with additional time to review and/ or change their health insurance enrollment during this inaugural Postal Service Health Benefits Program (PSHBP) year, OPM is extending Open Season through Friday, December 13, 2024, for the PSHBP.
This extension does not include the Federal Employees Health Benefits Program, Federal Employees Dental and Vision Insurance Program.