A deductible is the dollar amount you pay for covered healthcare services and supplies before APWU Health Plan starts to pay.
Copayments and coinsurance amounts do not count toward any deductible. When a covered service or supply is subject to a deductible, only the Plan allowance for the service or supply counts toward the deductible.
High Option
Under a Self enrollment, the calendar-year deductible is $450 if you use in-network providers. The deductible is satisfied and benefits are payable to you when your covered expenses applied to the calendar-year deductible reach this amount.
Under a Self Plus One enrollment, the deductible is satisfied and benefits are payable to you and one other eligible family member when the combined covered expenses applied to the calendar-year deductible reach $800.
Under a Self & Family enrollment, the deductible is satisfied and benefits are payable to all family members when the combined covered expenses applied to the calendar-year deductible for family members reach $800.
If you use out-of-network providers, your calendar-year deductible increases to a maximum of $1,000 per person (or $2,000 for Self Plus One and Self & Family enrollment).
Consumer Driven Option
Your deductible is the amount of eligible expenses you’re required to meet before traditional health coverage begins. It is reduced by applying the funds in your Personal Care Account (PCA), which APWU Health Plan funds in January.
Your net deductible is the remaining deductible amount you have to pay once the funds in your PCA have been exhausted.
By using the funds in your PCA to pay for eligible medical expenses, you decrease your total deductible and out-of-pocket expenses.
Your net deductible for in-network providers is $1,000 for a Self enrollment or $2,000 for a Self Plus One or Self & Family enrollment.
For Self Plus One or Self & Family coverage, once one individual meets the Self net deductible of $1,000, traditional health coverage begins for that individual.
Once the other covered members meet the additional $1,000 net deductible, traditional health coverage begins for them.
If you use out-of-network providers, your calendar-year net deductible increases to $1,500 Self and $3,000 for Self Plus One and Self & Family.
As long as you remain in this plan, you may reduce your deductible in subsequent years by rolling over any unused portion of your PCA remaining at the end of the calendar year. The maximum amount allowed in your PCA balance in any given year is $5,000 for Self and $10,000 for Self Plus One and Self & Family.
Learn more about how health plans work by reading Deductibles, copays, and coinsurance: Understanding the out-of-pocket costs of health insurance.