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Answers to frequently asked questions about the APWU High Option health plan

Enrollment
Q: Who is eligible to join the APWU Health Plan?

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.

Q: I have an enrollment issue with the Health Plan. How do I handle it? Can I take care of it online?

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.

Benefits and claims
Q. Does APWU Health Plan offer online access to my claims and other health records?

A. Yes. Our online eHealthRecord is available to High Option members with internet access and an e-mail address.

Q. What information can I view with eHealthRecord?

A. Members can view:

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:

Q. I have read about "precertification of services. What services must I have precertified?

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.

Hospital stays
Home nursing, physical, speech or occupational therapy

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.

CAT/CT/MRI/PET scans

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.

Q. What is catastrophic protection out-of-pocket coverage? What is considered a "catastrophic" condition?

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.

Q. Do charges that are applied to my deductible or charges over the Plan allowance apply to the catastrophic amount?

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.

Q. How do I find out if my provider participates with one of the High Option's Preferred Provider Organizations? How do I find a provider who does participate?

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:

All states except the Virgin Islands - CIGNA

1-800-582-1314

U.S. Virgin Islands - V.I. Equicare

Preferred Provider Network: 1-340-774-5779

All states Mental Health and Substance Abuse - Beacon Health Options

1-800-700-7965

Q. How do I get a referral to see a specialist - either a PPO specialist or non-PPO specialist?

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.

Q. What is the Health Plan's High Option prescription drug coverage?

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.

Q. Am I covered when I am away from my home? Am I covered when I'm outside of the United States?

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.

Online security
Q. What are APWU Health Plan's legal and privacy policies?

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.