We have Preferred Provider Organizations (PPOs):

Our fee-for-service plans offer services through PPO networks. This means that certain hospitals and other health care providers are “preferred providers”. When you use our network providers, you will receive covered services at reduced cost. APWU Health Plan is solely responsible for the selection of PPO providers in your area. The PPO networks for the High Option and the Consumer Driven Option are different.

The non-PPO benefits are the standard benefits of this Plan. PPO benefits apply only when you use a PPO provider. Provider networks may be more extensive in some areas than others. We cannot guarantee the availability of every specialty in all areas. If no PPO provider is available, or you do not use a PPO provider, the standard non-PPO benefits apply. However, if surgical services are rendered at a PPO hospital or a PPO freestanding ambulatory facility by a PPO primary surgeon, we will pay the services of anesthesiologists who are not preferred providers at the PPO rate, based on Plan allowance.

High Option PPO Network: Contact APWU Health Plan at 800/222-APWU to request a High Option PPO directory. You can also go to our Web page, which you can reach through the FEHB website, www.opm.gov/insure. If you need assistance in identifying a participating provider or to verify their continued participation, call the Plan's PPO administrator for your state: CIGNA 800/582-1314 for providers in Arkansas, Arizona, California, Colorado, Connecticut, District of Columbia, Delaware, Florida, Georgia, Hawaii, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia, Wisconsin and Wyoming; Coventry Health Care (formerly First Health) 800/447-1704 for providers in Alaska, Idaho, North Dakota and Oregon; Private Healthcare Systems (PHCS) 800/661-7563 for providers in Alabama, Illinois, Indiana, Michigan, Montana, Nevada and Washington; PreferredOne 800/451-9597 for providers in Minnesota; or V.I. Equicare 340/774-5779 for providers in the U.S. Virgin Islands. For mental conditions/substance abuse providers (all states), call ValueOptions toll-free 888/700-7965.

When you leave your state of residence, CIGNA is your travel network, available in all 50 states and the District of Columbia. When out of your state of residence, if you do not use a CIGNA PPO provider or a CIGNA PPO provider is not available, standard non-PPO benefits apply. For assistance in identifying a provider in the travel network, call CIGNA 800/582-1314.

General features of our Consumer Driven Health Plan (CDHP)

Preventive benefits: This component provides first dollar coverage for specified preventive care for adults and children if you use a network provider.

Personal Care Account (PCA) benefits: This component is used first to provide first dollar coverage for covered medical, dental and vision care services until the account balance is exhausted.

Traditional benefits: After you have used up your Personal Care Account and satisfied a Member Responsibility, the Plan starts paying benefits under the Traditional Health Coverage as described in Section 5.

Consumer Driven Option PPO Network: If you need assistance identifying a participating provider or to verify their continued participation, call the Plan's Consumer Driven Option administrator, Definity Health of St. Louis Park, MN, at 866/833-3463 or you can go to their Web page, www.definityhealth.com, User ID: APWUHP Password: HPINFO for a full nationwide online provider directory. Printed provider directories are not available.

How we pay providers

PPO Providers: Allowable benefits are based upon charges and discounts which we or our PPO administrators have negotiated with participating providers. PPO provider charges are always within our plan allowance.

Non-PPO providers: We determine our allowance for covered charges by using health care charge data prepared by the Health Insurance Association of America (HIAA) or other credible sources, including our own data, when necessary. We apply this charge data under the High Option at the 70th percentile and under the Consumer Driven Option at the 80th percentile.

Your Rights

OPM requires that all FEHB Plans provide certain information to their FEHB members. You may get information about us, our networks, and our providers. OPM's FEHB Web site ( www.opm.gov/insure) lists the specific types of information that we must make available to you. Some of the required information is listed below.

• PHCS, which provides preferred provider networks in specified states, is accredited by URAC for Health Network with Credentialing and certified by the National Committee for Quality Assurance (NCQA) for Credentialing and Recredentialing.

• CareAllies inpatient pre-certification and case management services are provided for the High Option in those states using the CIGNA preferred provider network. Intracorp, the company through which CareAllies program is administered, is fully accredited by URAC for Health Utilization Management and Case Management.

• CIGNA performs Disease Management for the High Option. They are accredited by The American Accreditation Health Care Commission/URAC and The National Committee for Quality Assurance (NCQA) for Disease Management.

• IntelliCare provides a 24/7 Nurse Advice Line service for the High Option. They are accredited by The American Accreditation HealthCare Commission/URAC as a Health Call Center.

• ValueOptions performs hospital precertification, continued stay review and outpatient prior authorization for mental health/substance abuse services. They are accredited by The American Accreditation Health Care Commission/URAC for Health Utilization Management and by the National Committee for Quality Assurance (NCQA) for Managed Behavioral HealthCare Organizations.

• The American Postal Workers Union Health Plan is a not-for-profit Voluntary Employee's Beneficiary Association (VEBA) formed in 1972.

• We meet applicable State and Federal licensing and accreditation requirements for fiscal solvency, confidentiality and transfer of medical records.

If you want more information about us, call 800/222-APWU, or write to APWU Health Plan, P.O. Box 1358, Glen Burnie, MD 21060-1358. You may also contact us by fax at 410/424-1588 or visit our Web site at www.apwuhp.com.

Your medical and claims records are confidential

We will keep your medical and claims records confidential. Please note that we may disclose your medical and claims information (including your prescription drug utilization) to any of your treating physicians or dispensing pharmacies.

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