What Are the Plan Choices?

What are the plan choices?

APWU Health Plan gives you two smart plans to consider. Compare them side by side.

High Option
Consumer Driven Option

High Option

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With low copays, low deductibles, and a vast network of providers, this is a premier plan in the Federal Employees Health Benefits Program.

What’s NEW for 2021

Medicare Advantage enhanced benefits for High Option members with Parts A and B, which features no deductible, coinsurance or copays and a $50 Medicare Part B monthly reimbursement
Diabetes medications available through mail-order: $0 copay for generic oral medication, formulary blood glucose test strips and lancets (used to reduce blood sugar)
$25 copay for most insulin
Mammograms enhanced to include 100% coverage for in-network annual mammograms for women age 65+
Cigna Behavioral Health replaces Beacon Health Options to offer expanded coverage that features a larger, broader network of providers and enhanced services

COVERED 100%

When you choose a network doctor.

Preventive care and screenings
Maternity care
Accidental injury outpatient services within 72 hours
Lab tests ($0 for covered blood work performed at LabCorp and Quest Diagnostics)
Visits to registered dietician/nutritionist
Lifestyle management programs: tobacco cessation and weight management

	In-network you pay	Out-of-network you pay
Calendar year deductible: Self Only	$450	$1,000
Self Plus One	$800	$2,000
Self and Family	$800	$2,000
Annual out-of-pocket maximum (both medical and prescription drugs)	$6,500 Self Only $13,000 Self Plus One and Self and Family	$12,000 Self Only $24,000 Self Plus One and Self and Family
Medical office and specialist visits	$25 copay**	40% of the Plan allowance*
Virtual visits through Amwell	$15 copay**	N/A
Maternity care
Complete maternity (obstetrical) care, such as prenatal care delivery, postnatal care, and initial examination of a newborn child covered under family enrollment	$0	40% of the Plan allowance*
Preventive care
Well child care (through age 12)	$0	Difference between the Plan allowance billed amount
Childhood immunizations (through age 18)	$0	Difference between the Plan allowance and billed amount
Annual adult routine exams	$0	40% of the Plan allowance*
Adult immunizations (shingles vaccine covered at 100% in network at age 50)	$0	40% of the Plan allowance*
Preventive screenings	$0	40% of the Plan allowance*
Routine dental	N/A	40% of the Plan allowance*
Hospital/facility care
Diagnostics tests or imaging	15% ($0 for blood work performed at LabCorp or Quest Diagnostics)	40% of the Plan allowance*
Outpatient surgery, facility fee, lab visits, and surgeon fee	15%	40% of the Plan allowance*
Inpatient facility fee	15%	40% of the Plan allowance* ($300 per admission)
Cancer Centers of Excellence	5%	N/A
Surgical and facility fee	15%	40% of the Plan allowance*
Hearing services
Diagnostic hearing tests (every 2 years)	15%	40% of the Plan allowance*
Hearing aid (every 3 years)	All charges in excess of $1,500**	All charges in excess of $1,500
Emergency care
Accidental injury (care within 72 hours of injury)	$0	Difference between the Plan allowance and billed amount
Urgent care	$30 copay**	40% of the Plan allowance*
Emergency room	15%	15% of the Plan allowance*
Ambulance	15%**	40% of the Plan allowance*
Alternative care
Chiropractic care (24 visits annually)	$25 copay**	40% of the Plan allowance*
Acupuncture (26 visits annually)	$25 copay**	40% of the Plan allowance*
Prescription drugs
Retail prescription drugs - non-specialty (30-day supply)	$10 for Tier 1 drugs 25% for Tier 2 drugs, $200 maximum per Rx 45% for Tier 3 drugs, maximum $300 per Rx No deductible	50% ($10 minimum coinsurance), (no deductible)
Mail-order prescription drugs - non-specialty (90-day supply)	$20 for Tier 1 drugs 25% for Tier 2 drugs, maximum $300 per Rx 45% for Tier 3 drugs, maximum $500 per Rx No deductible	N/A
Retail prescription drugs - specialty	25% for Tier 1 drugs, maximum $300 per Rx 25% for Tier 2 drugs, maximum $600 per Rx 45% for Tier 3 drugs, maximum $1,000 per Rx No deductible	50% ($10 minimum coinsurance), (no deductible)
Mail-order prescription drugs - specialty	25% for Tier 1 drugs, maximum $150 per Rx 25% for Tier 2 drugs, maximum $300 per Rx 45% for Tier 3 drugs, maximum $500 per Rx No deductible	N/A
Mental health/substance misuse disorder
Office visit	$25 copay**	40% of the Plan allowance*
Outpatient treatment	15%	40% of the Plan allowance*
Diagnostics, inpatient, and outpatient services	15%	40% of the Plan allowance*

* If there is a difference between the allowance and billed amount, the member is responsible for that difference.
** No deductible applied

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 ALSO INCLUDES:

Consumer Driven Option

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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

Overall plan features
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).
Out-of-pocket maximum (both medical and prescription drugs)	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.
Coinsurance	In-network you pay	Out-of-network you pay
Medical services	15%	50%
Prescription drugs (retail or mail order)	25% for Tier 1 25% for 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
Preventive care
Well-child care, immunizations, well-woman care, adult routine exams, preventive screenings	$0 (No PCA used)	May use PCA while funds are available.
Medical benefits
Office visits, virtual visits and specialist visits	15% of the Plan allowance	50% of the Plan allowance*
Maternity care
Complete maternity (obstetrical) care, such as prenatal care, delivery, postnatal care, initial examination of a newborn child covered under family enrollment	$0 (No PCA used)	50% of the Plan allowance*
Hearing services
Diagnostic hearing test (every 2 years)	15%	50% of the Plan allowance*
Hearing aids (every 3 years)	All charges in excess of $1,500	All charges in excess of $1,500
Hospital/facility care
Diagnostic tests or imaging	15%	50% of the Plan allowance*
Outpatient surgery, facility fee, lab visits, and surgeon fee	15%	50% of the Plan allowance*
Inpatient	15%	50% of the Plan allowance*
Cancer Centers of Excellence	10%	N/A
Emergency care
Accidental injury (within 72 hours), urgent care, emergency room, ambulance	15%	15%*
Prescription drugs
Retail prescription (30-day supply)	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
Mail-order prescription (90-day supply)	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
Mental health/substance misuse disorder
Office visit	15%	50% of the Plan allowance*
Outpatient treatment	15%	50% of the Plan allowance*
Diagnostics, inpatient, and outpatient services	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:

FOR ALL
FEDERAL WORKERS
AND RETIREES

SHOPPING FOR A PLAN?
START HERE.

KEY ENROLLMENT
DATES

TIPS AND TOOLS FOR
A HEALTHIER YOU

APWU HEALTH
PLAN IS PROUD
TO SERVE YOU.

YOU CAN CONTACT US AT

FOR ALL
FEDERAL WORKERS
AND RETIREES

SHOPPING FOR A PLAN?
START HERE.

KEY ENROLLMENT
DATES

TIPS AND TOOLS FOR
A HEALTHIER YOU

APWU HEALTH
PLAN IS PROUD
TO SERVE YOU.

YOU CAN CONTACT US AT

What are the plan choices?

About Us

Providers

Benefit Officers

FOR ALLFEDERAL WORKERSAND RETIREES

SHOPPING FOR A PLAN?START HERE.

KEY ENROLLMENTDATES

TIPS AND TOOLS FORA HEALTHIER YOU

APWU HEALTHPLAN IS PROUDTO SERVE YOU.

YOU CAN CONTACT US AT

What are the plan choices?

FOR ALL
FEDERAL WORKERS
AND RETIREES

SHOPPING FOR A PLAN?
START HERE.

KEY ENROLLMENT
DATES

TIPS AND TOOLS FOR
A HEALTHIER YOU

APWU HEALTH
PLAN IS PROUD
TO SERVE YOU.