Federal health plan benefits at a glance
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 Federal Employees Health Benefits (FEHB) Program.
Compare 2026 health plan premium rates
HIGH OPTION
Premiums
| FEHB enrollment code | Biweekly | Monthly / Retiree |
|---|---|---|
| Self - 471 | $140.16 | $303.68 |
| Self + One - 473 | $265.11 | $574.40 |
| Self & Family - 472 | $337.72 | $731.73 |
CONSUMER DRIVEN OPTION
Premiums
| FEHB enrollment code | Biweekly | Monthly / Retiree |
|---|---|---|
| Self - 474 | $100.62 | $218.00 |
| Self + One - 476 | $218.68 | $473.81 |
| Self & Family - 475 | $238.56 | $516.89 |
Benefits at a glance
BENEFITS
HIGH OPTION
CONSUMER DRIVEN OPTION
| BENEFITS |
HIGH OPTION In-network |
CONSUMER DRIVEN OPTION
In-network (after deductible is met) |
|---|---|---|
| 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) |
| Virtual visits | $0 copay for the first 2 visits $10 copay (no deductible applied) | |
| Personal Care Account (PCA) | ||
| PCA funds | The High Option does not have a PCA | In January each year, the Health Plan deposits funds into your Personal Care Account (PCA) for covered medical care. You’re covered at 100% until those funds are spent. The Plan provides $1,200 for Self and $2,400 for Self + One and Self & Family, with no deductibles, copays, or coinsurance until the PCA is used. |
| 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) | Save 20% – 50% on most procedures at dentists in the Careington Dental Discount Network |
| 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 |
| Insulin |
$25 for certain insulin See prescription coverage details |
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 |
| 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% of Plan allowance | 15% of Plan allowance |
| Inpatient surgery | 15% of Plan allowance | 15% of Plan allowance |
| Cancer Center of Excellence | 5% of Plan allowance | 10% of Plan allowance |
| Infertility treatment | ||
| Diagnostic and treatment services | 15% of Plan allowance | 15% of Plan allowance |
| Emergency care | ||
| Accidental injury (within 72 hours) | $0 outpatient | 15% of Plan allowance |
| Urgent care | $30 copay (no deductible applied) | |
| Emergency room | 15% of Plan allowance | |
| 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 |
| Mental health/substance use | ||
| Office visits | $25 copay (no deductible applied) | 15% of Plan allowance |
| Outpatient treatment | 15% of Plan allowance | |
| Diagnostics, inpatient, and outpatient services | 15% of Plan allowance | |
| Alternative care | ||
| Chiropractic care | $25 copay for up to 24 visits per year (no deductible applied) | 15% of Plan allowance for up to 24 visits per year |
| Acupuncture | $25 copay for up to 26 visits per year (no deductible applied) | 15% of Plan allowance |
| Physical, occupational and speech therapy | 15% of Plan allowance for up to 60 visits per year | 15% of Plan allowance for up to 60 visits per year |
| Prescription drugs | ||
| Retail prescription (30-day supply) | Per Rx: $10 for Tier 1 drugs, 25% Tier 2 drugs – max $200 coinsurance, 45% Tier 3 drugs – max $300 coinsurance (no deductible applies) | Per Rx: 25% with a min of $15 and a max of $200 for Tier 1 or Tier 2 drugs, 40% with a min of $15 and a max of $300 for Tier 3 drugs |
| Mail-order prescription | Per Rx: $20 for Tier 1, 25% Tier 2 drugs – max $300 coinsurance, 45% Tier 3 drugs – max $500 coinsurance for a 90-day supply (no deductible applies) | Per Rx: Tier 1 or Tier 2 drugs 25% with a min of $10 and a max of $200 for a 30-day supply, $400 for a 60-day supply, and $600 for a 90-day supply, Tier 3 drugs 40% with a min of $10 and a max of $300 for a 30-day supply, $600 for a 60-day supply, and $900 for a 90-day supply |
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