Benefits and coverage for your Consumer Driven Option federal plan
The Consumer Driven Option is a proactive alternative to conventional healthcare, paired with a Health Plan-funded Personal Care Account (PCA) that helps pay for medical expenses.
Use your PCA to pay for
- Medical care
- Prescription drugs and supplies
- Dental and vision, including eyeglasses and contact lenses (up to $400 for Self coverage, and $800 for Self Plus One or Self & Family coverage)
- Surgery and hospital services
- Mental health and substance use treatment
- Emergency care
- Medicare Part B premium
100% coverage for in-network services
- Preventive care and screenings
- Maternity care and support
- Breast cancer screenings
- Quit for Life® tobacco cessation program
- One Pass Select fitness and gym discounts
- Maven maternity program
- Receive $25 wellness incentives for completing an annual physical exam, mammogram, and cervical cancer screening
Your PCA covers 100% of all covered healthcare expenses
In January each year, APWU Health Plan funds a PCA you can use for covered medical services. You’re covered 100% until your PCA is exhausted.
Get to know how your PCA works and how it can decrease your plan deductible and out-of-pocket expenses.
Self
$1,200 — APWU Health Plan contribution
Self Plus One / Self & Family
$2,400 — APWU Health Plan contribution
2025 Consumer Driven Option coverage
2025 BENEFITS
In-network you pay
| Preventive care | |
|---|---|
| Well-child care, immunizations, adult routine exams, preventive screenings | $0 — No PCA used |
| Receive a $25 wellness incentive for each family member who completes an annual physical exam, mammogram, or cervical cancer screening | |
| Medical visits | |
| Office, specialist, & Virtual Visits | 15% of Plan allowance (Plan allowance: The maximum amount a plan will pay for a covered healthcare service |
| Dental care | |
| Save 20% – 50% on most procedures at dentists in the Careington Dental Discount Network | |
| Maternity | |
| Complete maternity care, including prenatal, delivery, postnatal and initial exam of newborn covered under family enrollment | $0 — No PCA used |
| Medical food formulas are covered to treat phenylketonuria (PKU) and other inborn errors of metabolism | 15% of Plan allowance |
| Hospital/facility care | |
| Diagnostic tests or imaging | 15% of Plan allowance |
| Outpatient surgery | 15% of Plan allowance |
| Inpatient surgery | 15% of Plan allowance |
| Cancer Center of Excellence | 10% of Plan allowance |
| Infertility treatment | |
| Diagnostic and treatment services | 15% of Plan allowance |
| Gender affirming care | |
| Gender dysphoria therapy and gender affirming surgery | 15% of Plan allowance |
| Emergency care | |
| Accidental injury (within 72 hours) | 15% of Plan allowance |
| Urgent care | 15% of Plan allowance |
| Emergency room | 15% of Plan allowance |
| Ambulance | 15% of Plan allowance |
| Air Ambulance | 15% of Plan allowance |
| Hearing services | |
| Diagnostic hearing tests | 15% every 2 years |
| Hearing aids | All charges in excess of $1,500 (every 3 years, no deductible applied) |
| Mental health/substance use | |
| Office visits | 15% of Plan allowance |
| Outpatient treatment | 15% of Plan allowance |
| Diagnostics, inpatient and outpatient service | 15% of Plan allowance |
| Virtual Behavioral Health Care | 15% of Plan allowance |
| Alternate care | |
| Chiropractic care | 15% of Plan allowance (24 visits per year) |
| Acupuncture | 15% of Plan allowance |
| Physical, occupational and speech therapy | 15% of Plan allowance (up to 60 visits per year) |
| Prescription coverage | |
|
Network retail Tier 1/Tier 2 Lower cost/Mid-range cost |
25%, min. $15 and max. per Rx of $200 for a 30-day supply, $400 for a 60-day supply, $600 for a 90-day supply |
|
Tier 3 Highest cost |
40%, min. $15 and max. per Rx of $300 for a 30-day supply, $600 for a 60-day supply, $900 for a 90-day supply |
|
Network home delivery Tier 1/Tier 2 Lower cost/Mid-range cost |
25%, min. $10 and max. per Rx of $200 for a 30-day supply, $400 for a 60-day supply, $600 for a 90-day supply |
|
Tier 3 Highest cost |
40%, min. $10 and max. per Rx of $300 for a 30-day supply, $600 for a 60-day supply, $900 for a 90-day supply |
Take advantage of added benefits for Consumer Driven Option members
Download and access Health Plan resources
2025 Federal Brochure
2025 FEHB Consumer Driven Option Summary of Benefits and Coverage (SBC)
Consumer Driven Option Preferred Formulary
See a list of generic and brand-name prescription drugs covered by your health plan.
