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Consumer Driven Health Plan
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Click here to explore the Consumer Driven Option website
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Consumer Driven Option New Benefits and Low Costs for 2009.
| Take a look at APWU Health Plan's Consumer Driven Option for 2009:
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- NEW hearing benefit
- NEW prescription drug maximums
- Premium costs rank among the lowest available
- 100 percent preventive coverage with in-network doctors. You do not need to use your PCA dollars!
- An APWU Health Plan-funded Personal Care Account (PCA) provides 100 percent coverage of medical and pharmacy expenses while PCA dollars are available
- Ability to use PCA dollars for most vision and dental services
- Rollover unused PCA benefit dollars for the following year
- No upfront deductible of copays
- Enjoy the freedom to choose a doctor from a network of 560,000 outpatient providers, or select a doctor outside of the network
New Hearing Benefit
- Diagnostic hearing tests for hearing aids every two years
PPO: You pay 15% of the Plan allowance
Non-PPO: You pay 40% of the Plan allowance
- Hearing aids are covered every three years up to $1,500
New Maximum for Prescription Drugs
- There's a maximum of $200 per prescription when you use a Network Retail Pharmacy
- When you use the Network Mail Order Pharmacy, the maximum is $600 per prescription
The Consumer Driven Option is administered for APWU Health Plan by United Healthcare. We've provided a link to United Healthcare's website, where you can take a tour and see the benefits of the Consumer Driven Option.
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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.
- Deductible: 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 Deductible. Your Deductible 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 |
| Deductible |
$600 |
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$1,200 |
- Traditional Health Coverage: The Extra Security
- If you exceed
your PCA and meet your Deductible, 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 |
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You Pay Out-of-Network |
| Office visit |
15% |
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40% |
| Chiropractic |
15% |
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40% |
| Prescription drugs |
25% |
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not covered |
Infertility diagnosis and treatment |
15% |
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40% |
| Maternity |
15% |
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40% |
| Emergency Room Care |
15% |
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15% |
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