PSHB health plans FAQ: Explore coverage and benefits for postal workers
APWU Health Plan is here to help you understand your coverage options and make the most of your benefits under the PSHB Program.
If you can’t find an answer to your question, contact us to speak with a customer service representative:
1-800-222-2798 | 1-800-622-2511 (TTY)
Monday – Friday, 8:30 am – 6:30 pm ET
Sections
PSHB Program health plans
What is the Postal Service Health Benefits (PSHB) Program?
The Postal Service Health Benefits (PSHB) Program is a new, separate health insurance program within the Federal Employees Health Benefits (FEHB) Program that provides coverage to eligible United States Postal Service employees, retired USPS employees, annuitants, and family members.
Who needs to enroll in the PSHB Program?
U.S. Postal Service employees and annuitants are no longer eligible for FEHB coverage as of January 1, 2025, and need to enroll in a PSHB plan. In addition, certain Postal Service annuitants and their Medicare-eligible family members are required to be enrolled in Medicare Part B after January 1, 2025, in order to maintain PSHB coverage.
Will all Postal Service employees and retirees be required to enroll in the PSHB program?
Yes, all active and retired Postal Service employees who elect federal health insurance coverage must now get it through the new PSHB Program. Postal Service employees and annuitants are no longer eligible for FEHB coverage as of January 1, 2025, and need to enroll in a PSHB plan.
However, if a Postal Service employee or annuitant is covered under a family member’s FEHB plan, they may remain in their family member’s FEHB plan.
If Postal Service employees and annuitants are not currently covered under a family member’s FEHB plan but wish to be, they may be enrolled in their family member’s FEHB plan during Open Season.
Who should I contact if I have questions about the PSHB Program?
Feel free to contact PSHB Program customer support by phone or email:
PSHB Helpline
7 am – 8:45 pm ET, Monday – Friday
Active postal employees
Contact USPS by email:
All others
Contact the PSHB Helpline by email: PSHBHelpline@opm.gov
PSHB Program information and resources are also available online:
Enroll in your PSHB health plan during Open Season: PSHB Open Season enrollment system
Access key information about the PSHB Program: Postal Service Health Benefits (PSHB) Program
PSHB health plans & Medicare
I’m an active Postal Service employee. What do I need to know about my PSHB plan selection and coordination with Medicare coverage?
As an active employee, you are not required to enroll in Medicare while employed. However, you can select a new health insurance plan under the PSHB program to continue coverage.
As a retired Postal Service employee, am I required to enroll in Medicare Part B?
Depending on your age and whether you are an annuitant on or before January 1, 2025, you may be required to also enroll in Medicare Part B to continue PSHB coverage in retirement.
If I retire from USPS before January 1, 2025, and do not have Medicare Part B on that date, will I be required to enroll in Medicare Part B to continue my health benefits in PSHB?
No. If you are an annuitant on or before January 1, 2025, and are not enrolled in Medicare Part B on that date, you are not required to enroll in Medicare Part B to retain your PSHB health insurance coverage, regardless of your age.
I’m an active Postal Service employee and am 64 or older on or before January 1, 2025. Will I be required to enroll in Medicare Part B to maintain my PSHB health insurance?
No. If you are an active Postal Service employee age 64 or older on or before January 1, 2025, you are not required to enroll in Medicare Part B to continue your PSHB health insurance coverage in retirement. This is because you are eligible for an exception to the Medicare Part B enrollment requirement. This exception will also apply to your covered family members.
While you are not required to enroll in Medicare Part B, you may choose to enroll in Medicare Part B. If you qualify for an exception as an active employee aged 64 or older on or before January 1, 2025, if you enroll in Medicare Part B, you are not required to maintain Part B enrollment to continue your PSHB insurance coverage.
Are there any other exceptions to the Medicare Part B enrollment requirement for Postal Service retirees and their covered family members?
Yes, you may qualify for an exception if you:
- Demonstrate that you reside outside the United States and its territories
- Are enrolled in health care benefits provided by the Department of Veterans Affairs
- Are eligible for health services from the Indian Health Service
Covered family members may have their own exception, even if you do not, if they can demonstrate meeting any of these exceptions. Individuals will be responsible for providing proof of eligibility for the applicant exception(s) to the designated agency.
I retired from USPS on or before January 1, 2025, and have Medicare Part B coverage. Do I need to keep my coverage? What about my spouse?
Maybe. If you are an annuitant on or before January 1, 2025, and you are enrolled in Medicare Part B on January 1, 2025, you are required to remain enrolled in Medicare Part B to continue coverage under PSHB, unless you are eligible for an exception.
Also, if you are the spouse of an annuitant who is already enrolled in Medicare Part B, you are required to enroll in Medicare Part B when you become entitled to Medicare Part A, unless you are eligible for an exception.
I’m an active Postal Service employee and am under the age of 64 as of January 1, 2025. Am I required to enroll in Medicare Part B when I retire?
Maybe. If you are an active employee under the age of 64 as of January 1, 2025, you are required to enroll in Medicare Part B after you retire and become entitled to Medicare Part A, typically at age 65, unless you qualify for an exception.
Are there any exceptions to the requirement to enroll in Medicare Part B when I enroll in PSHB?
Yes, there are a few exceptions to the requirements to enroll in Medicare Part B. As a Postal Service annuitant, these exceptions will also apply to your covered family members.
Family members may also be eligible for their own exception, even if the annuitant is required to enroll in Medicare Part B. Postal Service annuitants and family members may be responsible for providing proof of eligibility for the applicable exceptions. These exceptions are:
- Residing outside of the United States and its territories. (You are required to follow the policy and procedures set forth by USPS to be eligible for this exception.)
- Enrolled in health care benefits provided by the Department of Veterans Affairs.
- Eligible for health services provided by the Indian Health Service.
What is Medicare coordination?
Medicare coordination requires certain Medicare-eligible Postal Service annuitants to enroll in Medicare Part B in order to maintain their PSHB coverage in retirement. Enrollment in Medicare Part B does not cancel your PSHB coverage or reduce the benefits that are available to you under your federal health insurance plan. The idea is to coordinate your PSHB and Medicare coverage when you become eligible for Medicare.
I’m a Medicare-eligible retiree. Will Medicare become my primary payer?
Yes. For Medicare-eligible annuitants and your Medicare-eligible family members, Medicare would become the primary payer for your medical claims, with your PSHB plan becoming your secondary payer.
Would I be able to save money by coordinating my PSHB coverage with Medicare? How does PSHB and Medicare coordination add value to my healthcare coverage?
As an annuitant, enrolling in PSHB and Medicare may reduce your out-of-pocket costs for healthcare. Though there is a premium cost for Medicare Part B, it is important to consider your long-term health care needs. As you get older you may realize a greater benefit from having PSHB and Medicare coverage.
While annuitants will have an additional cost associated with Medicare Part B coverage, many PSHB plans may eliminate cost-sharing and reimburse part of the Part B premium for Medicare enrollees. Also, annuitants may be able to select a lower cost PSHB plan when enrolling in Medicare. These savings may offset the costs of Medicare Part B coverage.
What does Medicare coordination to my PHSB plan mean for my spouse and family?
Postal Service employees and annuitants’ eligibility determines spousal and family PSHB coverage. If the enrollee is not required to enroll in Medicare Part B, neither will dependent family members.
APWU Health Plan for postal workers & retirees
Does APWU Health Plan offer PSHB health plans?
Yes. As a national preferred provider organization (PPO), APWU Health Plan offers both a fee-for-service High Option plan and a Consumer Driven Option plan. Both options are open to all employees and retirees covered under the Postal Service Health Benefits (PSHB) Program.
Who is eligible to join APWU Health Plan?
APWU Health Plan is open to all eligible postal employees and retirees, eligible federal employees and retirees, and their family members.
If an employee, retiree, surviving spouse, or child is eligible to enroll in the PSHB Program or FEHB Program, that person is eligible to join APWU Health Plan.
- Most USPS employees who are eligible to enroll in the PSHB Program may become members of an APWU Health Plan.
- Non-career postal support employees (PSEs) have access to the PSHB Program and can enroll in the Consumer Driven Option plan.
- All active Postal Service employees who are in the APWU bargaining unit must become dues-paying members of the APWU, except where exempt by law. You will be billed directly by the union after you enroll in your health plan.
- Postal Service employees in non-APWU bargaining units (including letter carriers, mail handlers, and rural carriers) may enroll in an APWU Health Plan by becoming an associate member of the union for only $35.
How can I contact APWU Health Plan for enrollment support?
High Option
For questions about the High Option, contact APWU Health Plan to speak with a customer service representative:
1-800-PIC-APWU (Open Season)
1-800-222-APWU (2798)
1-800-622-2511 (TTY)
8:30 am – 6:30 pm ET, Monday – Friday
If the Health Plan is experiencing a high call volume, you can schedule a call back, 9 am – 6:30 pm ET, Monday – Friday.
Consumer Driven Option
For questions about the Consumer Driven Option, contact UnitedHealthcare:
Medicare Advantage
To find out if you’re eligible to enroll in the Medicare Advantage plan, call:
711 (TTY)
8 a.m. – 8 p.m. CT, Monday – Friday
Medicare
For questions about Medicare, contact the OPM Postal Enrollment Retirement Call Center:
How do I find out if my doctor is in the APWU Health Plan network?
As a member, APWU Health Plan provides you with access to a comprehensive network of doctors, hospitals, and healthcare providers.
You can choose between two smart medical plans—the High Option and Consumer Driven Option—that feature a nationwide UnitedHealthcare network of 1.7+ million providers and 7,000 hospitals and care facilities—with no need for referrals.
You also have access to:
- 13,500 urgent/convenience care clinics
- 5,800 freestanding ambulatory surgery centers
- 305K+ behavioral health providers
- 100% digitally focused virtual primary care
What are the PSHB enrollment codes for APWU Health Plan?
Use these PSHB codes when you enroll in APWU Health Plan:
High Option
- Self — PSHB enrollment code 23A
- Self Plus One — PSHB enrollment code 23C
- Self & Family — PSHB enrollment code 23B
Consumer Driven Option
- Self — PSHB enrollment code 23D
- Self Plus One — PSHB enrollment code 23F
- Self & Family — PSHB enrollment code 23E
APWU Health Plan benefits & coverage
How do I log in to the member portal?
The APWU Health Plan member portal gives you the tools you need to manage your health plan benefits, access your claims and health records, and get on the path to healthier living.
High Option member portal
Your myapwuhp member portal features resources to keep you healthy and tools to help you get the most from your plan. Log in to your portal to:
- Access deductibles, copays, and maximums
- Check the provider network to find a doctor
- Print or request an ID card
- View or print claims and authorizations
- See benefit and eligibility information
Consumer Driven Option member portal
Access your Health Plan 24/7. After you’re signed in, you’ll have easy access to tools and resources that can help you understand your benefits and make informed decisions about your care:
- Find care and compare costs with the provider search and cost estimate tool
- Get estimates for treatments and procedures
- Price medications, explore lower cost options, and order refills
- View claims and Personal Care Account (PCA) balances
- Access Virtual Visits
How do I download the mobile app?
The APWU Health Plan member app give you the tools you need to manage your health plan benefits, access your claims and health records, and get on the path to healthier living.
High Option mobile app
The myapwuhp member app helps you manage your health plan. See your claims, year-to-date information, prescriptions, and more.
Download on the App Store®
Get it on Google Play™
Consumer Driven Option mobile app
The UnitedHealthcare app® helps you find care, price medications, review and manage claims, view and share your digital Health Plan ID card and more—all from your mobile device.
Download on the App Store®
Get it on Google Play™
The UnitedHealthcare® app is available for download for iPhone® or Android®. iPhone is a registered trademark of Apple, Inc. Android is a registered trademark of Google LLC.
Does APWU Health Plan cover preventive care and routine screenings?
Yes, as a member of the High Option or Consumer Driven Option, you’ll enjoy 100% coverage for in-network preventive care:
Wellness checkups
- Annual adult routine exams and immunizations
- Well-child exams and immunizations
Recommended screenings
- High blood pressure screenings
- Diabetes screenings
- Cervical cancer screenings
- Colorectal cancer screenings
- Breast cancer screenings
Care and support
- Maternity care
- Contraception
See the postal brochure for complete details.
Does APWU Health Plan offer mental health and substance use benefits?
To help you feel better and more in control of your emotional well-being, APWU Health Plan offers mental health and substance use services through Behavioral Health Solutions. If you or a loved one are facing emotional struggles or substance use issues, you’re not alone. Behavioral Health Solutions offers confidential assistance to help you find the support you need to do all of this and more:
- Manage stress and anxiety
- Cope with depression
- Address the challenges of adoption
- Access caregiver support
- Treat substance use disorders
With Virtual Behavioral Health Care, you can talk to a behavioral health professional without leaving home. Help is completely confidential.
See the postal brochure or federal brochure for complete details.
Does APWU Health Plan cover hearing tests and hearing aids?
APWU Health Plan covers diagnostic hearing tests every two years and hearing aids every three years. For hearing tests, members pay 15% of the Plan allowance, while hearing aids are covered up to $1,500.
High Option and Consumer Driven Option members can access more than 2,000 name-brand models and styles of hearing aids at significant savings through UnitedHealthcare Hearing. Choose virtual care with hearing aid home delivery or in-person care at more than 7,000 hearing providers nationwide. Plus, get in-person or virtual support for every stage or your hearing health journey.
See the postal brochure or federal brochure for complete details.
What health management programs are available to APWU Health Plan members?
As an APWU Health Plan High Option or Consumer Driven Option member, you have access to a number of programs that can help you protect your health and well-being:
Rally® is a digital health experience that offers personalized recommendations to help you move more, eat better, and feel great. It even rewards your progress with Rally Coins, which you can use to contribute to a charity.
Call 1-866-569-2064 — or visit Rally
One Pass Select is a fitness and well-being subscription-based network that provides access to over 16,000 gyms and studios. Members can use multiple locations during the same month and change locations at any time. Choose from five membership tiers, with the option to change tiers monthly.
Visit One Pass Select — or visit Rally
Maven provides free, 24/7 virtual support for pregnancy, postpartum, and returning to work after parental leave.
Call 1-866-569-2064
Quit For Life® helps you move beyond tobacco and take control of your health. The program includes counseling by phone, group therapy sessions, or educational sessions with a doctor. FDA-approved prescription drugs and over-the-counter drugs to treat tobacco dependence are also available for those age 18 or older.
Call 1-866-569-2064 — or visit Quitnow
See the postal brochure or federal brochure for complete details.
Does APWU Health Plan cover treatment for infertility?
Infertility is a struggle. When you want to start or expand your family but have been unable to conceive within a reasonable period of time, it can affect your emotional health.
For members who are ready to seek medical help on the journey to becoming a parent, the APWU Health Plan High Option and Consumer Driven Option cover a range of services to diagnosis and treat infertility.
See the postal brochure or federal brochure for complete details.
Does APWU Health Plan provide gender-affirming care?
APWU Health Plan recognizes that transgender, non-binary, and other gender-diverse members require healthcare delivered by providers experienced in gender-affirming health.
Gender-affirming services include therapy to address feelings of gender dysphoria and medical treatments that help you achieve physical characteristics that better align with your gender identity.
Gender affirming surgery requires prior approval. Under the High Option and Consumer Driven Option, members need to call UnitedHealthcare before receiving gender-affirming surgery. Failure to do so will result in a minimum $500 penalty for an inpatient hospital stay.
See the postal or federal brochure for complete details.
How do I locate a Cancer Center of Excellence?
When you enroll in the APWU Health Plan, you will have access to designated Cancer Centers of Excellence around the country.
High Option: With pre-approval, you pay only 5% of the treatment costs at these in-network designated centers.
Consumer Driven Option: If you decide to use a designated Cancer Center of Excellence, you may receive prior approval for travel and lodging costs. With pre-approval and in the network, you pay 10% of the Plan allowance.
Do I need a referral to see a specialist?
You do not need a referral to see a specialist when you are a member of APWU Health Plan. You are free to choose your covered providers without seeking our permission.
Do I need prior approval or precertification for certain services?
Precertification—sometimes called prior authorization—is a process that requires physicians and healthcare providers to obtain advanced approval from the Health Plan before delivering a specific service to the patient to qualify for payment coverage.
High Option members need prior approval for certain services
Before having certain types of medical care or services, you will need to get precertification. It’s important that you understand when precertification is needed to keep your benefits from being reduced.
Examples of services that require precertification include:
- Inpatient hospital admission
- Organ transplantation
- Surgery that can be considered cosmetic
- Durable medical equipment
- Genetic testing
- Inpatient residential treatment center admission
- Skilled nursing facility admission
- Outpatient radiology services, including CT/CAT, MRI, MRA, and PET scans
- Mental health and substance use disorder inpatient treatment
- Other services as outlined in the Plan brochure (see Section 3: How you get care)
How to request precertification or prior approval
At least two business days before admission or services requiring prior authorization are rendered, you, your representative, your physician, or your hospital must call UnitedHealthcare. This number is available 24 hours a day:
UnitedHealthcare: 1-866-569-2064
Consumer Driven Option members need prior approval for certain services
Before having certain types of medical care or services, you will need to get either prior approval or precertification. It’s important that you understand when prior approval or precertification are needed to keep your benefits from being reduced.
Examples of services that require precertification include:
- Inpatient hospital admission
- Organ transplantation
- Surgery that can be considered cosmetic
- Durable medical equipment
- Genetic testing
- Other services as outlined in the Plan brochure (see Section 3: How you get care)
How to request precertification or prior approval
You, your representative, your physician, or your hospital must call UnitedHealthcare at least 2 business days before admission or services requiring prior authorization are rendered:
UnitedHealthcare: 1-855-808-3003
For mental health and substance use disorder inpatient treatment, your doctor or your hospital must call UnitedHealthcare Behavioral Health Solutions at least 2 business days before admission or services requiring prior authorization. This number is available 24 hours a day:
UHC Behavioral Health Solutions: 1-855-808-3003
For the High Option, what is catastrophic protection out-of-pocket coverage? What is considered a catastrophic condition?
The catastrophic out-of-pocket maximum or limitation does not indicate any single illness or condition. The catastrophic limitation is the maximum amount of coinsurance that a member has to pay out of their own pocket before the Health Plan pays covered charges at 100% for the balance of the calendar year.
Most conditions that the Health Plan pays on your behalf for the High Option, at a percentage amount, will have your portion of the fee (the coinsurance) apply toward a maximum out-of-pocket amount. Once a member meets the maximum amount (the catastrophic limit), the Plan pays covered charges for the remainder of the calendar year at 100% of the Plan allowance, or the PPO negotiated rate if you us a preferred provider.
See the postal brochure or federal brochure for complete details.
Do charges that are applied to my deductible or charges over the Plan allowance apply to the catastrophic amount?
Yes. The amounts that are accrued toward the catastrophic limitation are coinsurance or copayments for medical, prescription, and deductible covered services.
See the postal brochure or federal brochure for complete details.
Does the High Option cover me when I am away from my home? Am I covered when I’m outside of the United States?
When you select the High Option as your health plan, you are always covered no matter where you are. Your coverage always goes with you, whether you are in another state or another country. When you have services outside the U.S., you will probably have to pay the bill at the time of service, and then submit a bill directly for reimbursement.
See the postal brochure or federal brochure for complete details.
What are the legal and privacy policies of APWU Health Plan?
APWU Health Plan is committed to safeguarding your privacy online. In general, you can visit our website without revealing any personal information about yourself. At times, we may ask you for personal information if it is necessary to help you in selecting appropriate services offered by APWU Health Plan. All information is provided voluntarily and explicitly by visitors to the site.
The Health Plan’s online access to membership details and claims history for High Option members—myapwuhp—is secure and protected and meets all federal requirements for privacy and security. Access is available only when you register and enter your user ID and password.
The email facilities at our site do not provide a means for completely secure and private communication between us. Your email, like most non-encrypted internet email communications, may be accessed and viewed without your knowledge or permission while in transit to us. If you consider the information you are communicating to be confidential and you wish to keep it private, please do not use email. Instead, call us at 1-800-222-APWU (2798) or, if you are a current member, at the number listed on the back of your identification card.
Please note that email sent to us will be shared with our customer service representatives or the staff members who are best able to address your questions. Once we have responded to your communication, it may be discarded or archived, depending on the nature of the inquiry.
The APWU Health Plan website gathers routine usage information, such as how many people visit the site, the pages visited, and the length of time a visitor spends on the site. This information is collected on an anonymous basis, which means no personal identifiable information is associated with the data. This data helps us to improve the site content and overall usefulness for visitors.
The site contains hypertext links to other websites. APWU Health Plan has no control over the content or the availability of these sites and assumes no responsibility for the privacy practices of such websites. These links are provided for convenience and reference purposes only. Therefore, we are not liable for any information or materials contained in them.
High Option pharmacy program
Who is Express Scripts?
The High Option prescription drug plan includes access to nearly 64,000 pharmacies that belong to the Express Scripts network, along with home delivery options in all 50 states. The pharmacies discount their charges and bill the Health Plan automatically for members.
The convenient mail order program is ideal for members with long-term prescriptions. Both programs offer no deductible and low copayments.
Can I access my pharmacy benefits online or with a mobile app?
Yes, create an account on express-scripts.com or download the Express Scripts mobile app for free from your mobile device’s app store. Registering is safe and simple, and your information is secure and confidential. Please have your member ID number or SSN available.
Once you create an account, you can:
- Check your order status
- Refill and renew prescriptions
- Find your nearest preferred pharmacy
- View and print member ID cards
- Enroll eligible prescriptions in automatic refill
- Set reminders to take your medication
- Enroll in home delivery
The Express Scripts mobile app is available for iPhone®, iPad®, and Android™ mobile devices.
Does Express Scripts offer home delivery?
Whether you use your express-scripts.com account or the Express Scripts mobile app, it’s simple and convenient to enroll in home delivery to get your 90-day prescriptions shipped right to your door.
Fill a new prescription
Contact your doctor to request a 90-day prescription that can be e-prescribed directly to Express Scripts home delivery.
Or, print a form by selecting Forms from the menu under Benefits. Print the home delivery form and follow the mailing instructions.
Or, call Express Scripts at 1-800-841-2734 or 1-800-759-1089 (TTY), and we’ll contact your doctor for you.
Please allow 10 to 14 days for your first prescription order to be shipped.
Transfer a retail prescription to home delivery
Select Add to Cart for eligible prescriptions and check out. We’ll contact your provider on your behalf and take care of the rest. Check Order Status to track your order.
Refill and renew prescriptions
Select Add to Cart for eligible prescriptions and check out. We’ll contact your provider on your behalf, if renewals are included, and take care of the rest.
Does Express Scripts cover insulin?
Express Scripts Patient Assurance® Program Participating Drugs on the National Preferred Formulary
PLEASE NOTE: This list is subject to change. Not all of the drugs listed are covered by all prescription plans; check your benefit materials for the specific drugs covered for your prescription plan. This list is effective beginning January 1, 2024.
Prior to filling any prescription and for additional information about your prescription coverage, register or log in to express-scripts.com.
- FARXIGA®
- GLYXAMBI®
- HUMALOG®
- HUMALOG® KWIKPEN
- HUMALOG® MIX
- HUMULIN®
- HUMULIN® KWIKPEN
- HUMULIN® N
- HUMULIN® N KWIKPEN
- HUMULIN® R
- HUMULIN® R KWIKPEN
- JARDIANCE®
- LYUMJEV™
- LYUMJEV™ KWIKPEN
- SEMGLEE®
- SYNJARDY®
- SYNJARDY® XR
- TRIJARDY® XR
- TRULICITY®
- XIGDUO XR
All trademarks are the property of their respective owners.
Does the High Option cover contraceptives and birth control?
Your prescription plan covers contraceptives at no cost to you.
Under the Affordable Care Act, your plan covers contraceptive medications and medical devices approved by the U.S. Food and Drug Administration. There are many contraceptive options available to you that can help prevent pregnancy, including:1
- Medication taken by mouth (“the pill”)
- Diaphragm
- Emergency contraceptives
- Shot/injection
- Over-the-counter methods
- Skin patch
- Implantable rod
- Vaginal ring
- Intrauterine systems (“IUD”)
- Cervical cap
Consult with your health care provider to ensure you are using the contraception method most appropriate for you, your body and your future.
For more information about contraception benefits, visit the website of the Office of Personnel Management (OPM):
1 The success rate of contraceptive methods varies, depending on the specific medication or device used.
Does the High Option cover medications to help me quit using tobacco?
Talk with your doctor about getting the help you need to quit tobacco.
Under the Affordable Care Act, your prescription plan covers several types of treatments that are approved by the U.S. Food and Drug Administration (FDA).
Nicotine-replacement therapies (NRT)—such as the patch, gum, spray or inhaler—are proven effective at helping people quit tobacco use. The success rate is significantly better when two types of NRTs are used.
Medications recommended and covered with $0 copay include:
- Nicotine patch*
- Nicotine gum, lozenges*
- Nicotine nasal spray
- Nicotine inhaler
- Bupropion SR 150mg tablets
- Varenicline tablets
* Over-the-counter medication. Coverage limitations may apply; refer to your plan specifications for details.
Which vaccines does the High Option cover?
To help you stay healthy, you can receive vaccinations covered by your prescription plan at a participating retail pharmacy. Certain age restrictions may apply; please refer to your plan details.
Call your local pharmacy to:
- Ask your pharmacist which vaccines are right for you
- Find out if your pharmacist can administer the recommended vaccinations
- Learn which vaccinations are covered by your plan
Don’t forget to present your member ID card to the pharmacist.
The following vaccines are available from pharmacists at participating retail pharmacies:
- COVID-19
- Hepatitis
- Pneumonia
- Flu (seasonal influenza)
- Respiratory syncytial virus (RSV)
- Human papillomavirus (HPV)
- Shingles/zoster
- Tetanus, diphtheria, pertussis
- Meningitis
- Childhood vaccines (MMR, etc.)
Please refer to your plan specifications for additional details on the coverage of vaccines at $0 copay.
What is the specialty pharmacy for the High Option?
At Accredo, your High Option specialty pharmacy, taking care of you is our focus. You might be newly diagnosed and beginning with a specialty medication, or you might just be new to Accredo. Either way, our specialty-trained pharmacists, nurses, pharmacy techs, and patient care advocates understand chronic and complex conditions. We’re here to help you navigate this journey.
To manage your medications how you want, when you want, visit Accredo or download the Accredo mobile app from your mobile device’s app store. You can order available refills, check order status, view medication history, and much more.
Your Accredo team works with your doctor to manage your overall medication therapy and make your path as smooth as possible throughout treatment.
Consumer Driven Option pharmacy program
Who is OptumRx®?
The Consumer Driven Option pharmacy benefit is provided by OptumRx, a UnitedHealth Group company offering high quality pharmacy benefit services. The OptumRx network includes more than 64,000 retail pharmacies, including all large national chains, many local community pharmacies, and OptumRx Home Delivery.
You can be confident that your prescription claims will be processed quickly and accurately. You will also enjoy additional advantages, such as an easy online experience, option to set up mobile text refill reminders, and superior customer service.
How can I find pharmacies covered by my plan?
The OptumRx network includes more than 64,000 retail pharmacies, including all large national chains, many local, community pharmacies, and the OptumRx Home Delivery.
To search for a network pharmacy near you, log in to your myuhc.com member portal and visit the pharmacy section. Or call 1-855-808-3003.
Can I find my prescription information online?
Yes, you can access your prescription and mail service information online. Just log in to your myuhc.com member portal and visit the pharmacy section. You can quickly view your medications, check status, and refill mail service prescriptions.
How can I view my dependent’s or spouse’s pharmacy benefit online?
Log in to your myuhc.com member portal to view and manage information for dependents under the age of 13.
In order to protect the privacy and personal health information of our members, OptumRx has adopted a process for you to request permission to access your dependent(s) or spouse’s prescription information. For more information, call 1-855-808-3003.
If I place an order through OptumRx Home Delivery, how quickly will I get my medication?
New and transferred prescription orders are delivered by standard U.S. mail and will arrive around 10 business days from the date OptumRx receives the order. Refills are sent the same way and normally arrive within 7 business days of OptumRx receiving your order.
If you have an email address on file, you can expect to receive an email when your prescription ships. If you don’t have an email address on file, you’ll receive a phone call.
What are the advantages of using OptumRx Home Delivery?
Many members use mail service for the convenience, safety, and savings. Medications are delivered directly to your home, which means fewer trips to the pharmacy, and you will receive a 3-month supply, which may save you money.
Registered pharmacists are available to answer questions 24 hours a day, 7 days a week. And you can feel confident in OptumRx’s 99.99% mail service accuracy rate. All prescriptions go through multiple checks by licensed pharmacists and technicians, and are screened for potential harmful interactions with other medications on file.
To learn more about mail service, log in to your myuhc.com member portal and visit the pharmacy section.
This is a summary of benefits and features offered by the APWU Health Plan. All benefits are subject to the definitions, limitations, and exclusions set forth in the Plan’s postal brochure (RI 71-019).
The information provided is for general informational purposes only and is not intended to be medical advice or a substitute for professional health care. You should consult an appropriate health care professional for your specific needs and to determine whether making a lifestyle change or decision based on this information is appropriate for you. Some treatments mentioned may not be covered by your health plan. Please refer to your benefit plan documents for information about coverage.
Health plan coverage provided by or through UnitedHealthcare Insurance Company, UHC of California and UnitedHealthcare Benefits Plan of California. Administrative services provided by United Healthcare Services, Inc., Optum Rx or OptumHealth Care Solutions, Inc. Behavioral health products are provided by U.S. Behavioral Health Plan, California (USBHPC).
Administrative services provided by United HealthCare Services, Inc. or their affiliates.