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ARE YOU AN APWU BARGAINING UNIT EMPLOYEE?
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What are the plan choices?

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

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: