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Consumer Driven Option — Low
Cost, Great Benefits in 2008.
| APWU Health Plan's
Consumer Driven Option for 2008 provides:
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- Some of the lowest costs available
- Personal Care Account (PCA) covers 100% of medical expenses, including dental and vision services up to certain limits
-first $1,200 for an individual
-first $2,400 for a family
- Roll over PCA benefits not used in a year
- 100% preventive coverage for in-network physicians and hospitals
- Huge network, choose any provider in or out-of-network
- "Peace of mind" of traditional health coverage
The Consumer Driven Option is administered for APWU Health Plan by Definity Health and its affiliates.
We’ve provided a link to Definity’s website, where you can take a tour and see the
benefits of the Consumer Driven Option. You can:
- Find what Consumer Driven healthcare is, and how it works
- Calculate estimates of your personal potential out-of-pocket expenses
- See if your doctor is part of the Consumer Driven Option networks, or find doctors and hospitals in your area
- Get pricing estimates for medical visits and procedures specific to your area of the country
- Find out what current members and the media have to say about their
experiences with Consumer Driven Option
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Click here to explore the Consumer Driven Option website
How the Consumer Driven Option Works
- Personal Care Account (PCA): The Foundation
- You receive a fully funded account with benefit dollars available to you in the PCA (Health Reimbursement Arrangement)
- You have flexibility about how to use
- Used FIRST for your healthcare needs; pays 100% of eligible expenses
- Total amount is available to use on the first day of the year
- For the majority of members, it’s all you’ll need all year
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Self Only |
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Self and Family |
| Annual PCA Benefit |
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$1,200 |
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$2,400 |
- Rollover
Any unused PCA balance rolls over at benefit year-end for you to use in the future.
- In-Network Preventive Care-100% Coverage
Preventive care is covered 100% in-network and does not reduce your PCA
balance.
- Member Responsibility: Bridging Your PCA and Health Coverage
- If you use all of your PCA, you are responsible for paying for additional healthcare expenses up to the amount of your Member Responsibility. Your Member Responsibility will be less if you roll over PCA benefit dollars from the previous benefit year.
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Self Only |
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Self and Family |
| Member Responsibility |
$600 |
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$1,200 |
- Traditional Health Coverage: The Extra Security
- If you exceed
your PCA and meet your Member Responsibility, Traditional Health Coverage pays
for additional healthcare expenses according to the schedule below. Many other services apply, in addition to these.
| Service |
You Pay
In-Network |
|
You Pay
Out-of-Network |
| Office visit |
15% |
|
40% |
| Chiropractic |
15% |
|
40% |
| Prescription drugs |
25% |
|
not covered |
Infertility diagnosis
and treatment |
15% |
|
40% |
| Maternity |
15% |
|
40% |
| Emergency Room Care |
15% |
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15% |
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