- Am I Eligible?
SHOPPING FOR A PLAN?
APWU Health Plan is a National Preferred Provider Organization (PPO) offering both a fee-for-service High Option Health Plan and a Consumer Driven Option Health Plan. We have been proudly serving America's workforce since 1960.Compare Plan Options See Premiums See Provider Networks See 2017 Federal Brochure
- HIGH OPTION
- CONSUMER DRIVEN OPTION
- CONVERSION OPTION
New members can enroll during Open Season in the fall, or within 60 days of new employment, or for a qualifying life event.How to Enroll
- ENROLLMENT FACTS
- HOW TO ENROLL
- Healthy Living
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A: The American Postal Workers Union Health Plan is open to all eligible postal and federal employees and retirees. Additionally, it is open to employees of the District of Columbia who were employed by the District prior to October 1, 1987. As a rule of thumb, if an employee, retiree, surviving spouse or child is eligible to enroll in the Federal Employees Health Benefits Program, that person is eligible to join the APWU Health Plan.
A: You may make an address change online here. Other enrollment changes, such as to add or drop a family member, to add or change Medicare or other insurance coverage, send a letter explaining the situation to:
APWU Health Plan 799 Cromwell Park Drive Suites K-Z Glen Burnie, MD 21061 Attention: Enrollment Department
For your protection and ours, we do not accept enrollment change requests online.
A. Yes. Our online eHealthRecord is available to High Option members with internet access and an e-mail address.
A. Members can view:
- Your claims
- Explanation of Benefits (EOB)
- A new Health Statement with year-to-date information about claims, including:
- In- and out-of-network deductible balances for medical and mental health and substance abuse benefits
- Catastrophic limits
- Claims detail
- Details of prescription drug transactions
When you log in for the first time, your member identification number (located on your member ID card) and your email address re required. You will then receive a user ID and create a password.
Other eHealthRecord capabilities include:
- Family members can be added and deleted
- Member contact can be modified (HIPAA Representatives)
- PPO network is displayed under Member Detail
- You can view your member ID and order a duplicate card
- You can choose to stop printing Explanation of Benefits (EOB) documents
- You can see when a check has cleared for claims payment and when a claim will be paid if it is in process
A. There are several ways:
- Log in to eHealthRecord, our online tool for membership details and claims history.
- Send an email request.
- Call our automated phone system 24/7 at 1-800-222-APWU (2798) for an answer to your claim status question.
If you need to talk to a Customer Service Representative, call 1-800-222-APWU (2798) between 8:30 am and 6 pm EST, Monday - Friday.
A. The Health Plan's contract requires precertification for inpatient hospital stays, home nursing care, the services of a physical, speech or occupational therapist, and durable medical equipment. See the Plan's Federal Brochure below to determine if a service you are about to receive needs precertification or preauthorization.
- Unless a hospital stay takes place outside of the United States or Puerto Rico, or unless you have other insurance, including Medicare Part A as your primary health insurer, all inpatient hospital stays must be precertified.
- If a hospital stay is not precertified, a $500 penalty will be assessed when the claim is paid.
- Planned admission into the hospital must be precertified as least two business days prior to the admission to avoid the precertification penalty.
- If you have an emergency admission or an unscheduled maternity admission, you must certify the stay within two business days of the admission, even if you have already been discharged.
- For a maternity admission, the newborn's stay does not have to be precertified unless the child stays in the hospital after the mother has been discharged. At the time of the mother's discharge, the newborn's stay becomes a separate admission.
For High Option Plan precertification for hospital stays, call Cigna at 1-800-582-1314.
If home nursing, physical, speech or occupational therapy services re not preauthorized, the Health Plan may deny services, even if they are considered medically necessary and appropriate. These benefits are covered when prescribed by a doctor, and the doctor submits a treatment plan for these services. For High Option Plan precertification for these services, all Cigna at 1-800-582-1314.
Prior approval of these procedures is required. Failure to obtain required precertification can result in a $100 penalty and/or denial of the claim pending review. Have your provider call prior to these procedures. For High Option Plan precertification for these services, all Cigna at 1-800-582-1314.
A. 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 that maximum amount (the catastrophic limit) has been met by a member, 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.
For more details on catastrophic protection for High Option members, see the APWU Federal Brochure.
A. Yes. The amounts that are accrued toward the catastrophic limitation are coinsurance or copayments for medical, prescription, and deductible covered services.
For more details on catastrophic protection for High Option members, see the Federal Brochure.
A. There are several ways to determine if your provider – doctor, hospital or other – participates with the APWU Health Plan. For the High Option, if you have a Preferred Provider Organization (PPO) directory, consult the directory. If you do not have a directory, either ask the provider's office if they participate with one of the Plan's PPOs, or call the Health Plan at 1-800-222-2798 between 8:30 am and 7 pm EST, Monday through Friday, and request a PPO directory. Or, check the online High Option Preferred Provider Directory.
Another way to find out if your provider belongs or to find a provider who does belong is to call the PPO itself during normal business hours:
Preferred Provider Network: 1-340-774-5779
A. You do not need a referral to see a specialist when you are a member of the APWU Health Plan. You are free to choose your covered providers without seeking our permission.
A. The Health Plan offers two comprehensive prescription drug programs to its members. There is no deductible to satisfy for either program. With the Plan's Mail Order drug benefit, for generic prescriptions, members pay a $20 copayment and a coinsurance of 25% for preferred brand name drugs, 40% for non-preferred brand name drugs.
The Plan also has a contract with 69,300 pharmacies nationwide to allow our members to purchase prescriptions at a discount. Our members may purchase covered prescriptions at any network pharmacy and receive the network discount.
A. When you select the APWU High Option health plan as your insurer 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, then submit a bill directly for reimbursement.
A. The 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 the 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 – eHealthRecord – is secure and protected and meets all Federal requirements for privacy and security. Access is available only when you enter your Member Identification Number from your ID card and your email address and receive a 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. The 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.