When used properly, this different model of health care can save money. With UnitedHealthcare’s expansive national network, this option provides low premiums and a proactive alternative to traditional health plans.
What’s NEW for 2021
- Automatically receive a $25 wellness incentive—added to your PCA—when you or a covered family member completes an annual physical exam.
COVERED 100%
When you choose a network doctor.
- In January, the Health Plan funds a Personal Care Account (PCA) members can use for covered medical services. Members are covered at 100% until the PCA is exhausted. The Plan funds the PCA at $1,200 for Self Only and $2,400 for Self Plus One and Self and Family.
- Preventive care and screenings
- Maternity care
- Healthy Pregnancy Program
- Tobacco Cessation Program
Personal Care Account (PCA) |
Personal Care Account provides 100% coverage for the first $1,200 of your annual medical expenses for Self-Only or $2,400 for Self Plus One and Self and Family. |
PCA rollover |
As long as you remain in this plan, any unused remaining balance in your PCA at the end of the calendar year may be rolled over to subsequent years. The maximum amount allowed in your PCA in any given year is $5,000 per Self-Only enrollment and $10,000 per Self Plus One and Self and Family. |
Self Only $1,200 |
Self Plus One $2,400 |
Self and Family $2,400 |
When the PCA is exhausted, member must meet a deductible. |
Net deductible (In-network) |
Self Only $1,000 |
Self Plus One $2,000 |
Self and Family $2,000 |
Net deductible (Out-of-network) |
Self Only $1,500 |
Self Plus One $3,000 |
Self and Family $3,000 |
Out-of-pocket maximum (both medical and prescription drugs) |
Because the unexpected happens, this plan has a built-in out-of-pocket maximum which, when reached, allows the rest of your annual health care costs to be paid at 100% (both medical and prescription drugs and PCA). |
In-network you pay |
Out-of-network you pay |
|
Self Only $6,500 |
Self Only $12,000 |
|
Self Plus One $13,000 |
Self Plus One $24,000 |
|
Self and Family $13,000 |
Self and Family $24,000 |
Coinsurance |
Once the deductible is met, member pays coinsurance for in- or out-of-network medical services and prescription drugs. |
In-network you pay |
Out-of-network you pay |
Medical services |
15% |
50% |
Prescription drugs (retail or mail order) |
25% for Tier 1 and Tier 2; 40% for Tier 3 |
N/A |
Preventive care (adults and children) |
In-network preventive care and screenings, such as mammograms, yearly check-ups, and child and adult immunizations are covered at 100%. No PCA dollars are used. |
In-network you pay |
Out-of-network you pay
|
$0 (No PCA used) |
May use PCA while funds are available. |
15% of the Plan allowance |
50% of the Plan allowance* |
$0 (No PCA used) |
50% of the Plan allowance* |
15% |
50% of the Plan allowance* |
All charges in excess of $1,500 |
All charges in excess of $1,500 |
15% |
50% of the Plan allowance* |
15% |
50% of the Plan allowance* |
15% |
50% of the Plan allowance* |
10% |
N/A |
15% |
15%* |
25% for Tier 1 drugs, $200 maximum per Rx 25% for Tier 2 drugs, $200 maximum per Rx 40% for Tier 3 drugs, $300 maximum per Rx |
All charges |
25% for Tier 1 or Tier 2 drugs 40% for Tier 3 drugs $600 maximum for 60-day supply $900 maximum for 90-day supply |
N/A |
15% |
50% of the Plan allowance* |
15% |
50% of the Plan allowance* |
15% |
50% of the Plan allowance* |
* If there is a difference between allowance and billed amount, member is responsible for that difference.
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 for the in the Plan’s Brochure (RI 71-004).
THIS PLAN INCLUDES: