Policies and forms for your health plan
Access the forms, medical policies, and privacy policies you need to make the most of your APWU Health Plan benefits.
Member policies and forms
Member forms
Contact Us
Get answers to questions about your health plan.
Order Health Plan Brochures by Mail
Request copies of Plan brochures and flyers.
Request a Copy of Your 1095-B
The tax form includes important information about your health coverage.
Add a Dependent to Your Plan
Learn how to add an adult child to your High Option plan.
Post-enrollment Questionnaire
Please complete our form after you enroll in APWU Health Plan.
Coverage Inquiry for Members
Request information about your coverage with APWU Health Plan.
Change Your Address
Update your mailing address for your High Option or Consumer Driven Option plan.
Member claim forms
Send a Claim Status Inquiry
Ask a question about your APWU Health Plan insurance claim.
Prescription Drug Claim Form
Request payment for covered medications under your High Option plan.
Dental Claim Form
Request payment for covered dental services under your High Option plan.
Health Insurance Claim Form
Request payment for covered medical services under your High Option plan.
Order Claim Forms
Request to receive Health Plan claim forms by postal mail.
Deemed Exhaustion Appeal
Ask us to reconsider our claim decision or appeal to OPM.
Medical policies
Bariatric Surgery Medical Policy
Review coverage details for a surgical procedure used to manage obesity.
Infertility Medical Policy
Review coverage details for services to diagnosis and treat infertility.
Gender Dysphoria Treatment Medical Policy
Services address a mismatch between a person’s biological sex and gender identity.
Health Plan policies
Privacy Policy
Review how we collect and handle your personal information.
Notice of Privacy Practices
Review how we may use and disclose your personal health information.
Member Rights and Responsibilities Statement
Review your rights and responsibilities as a member of APWU Health Plan.
HIPAA privacy forms
Request for Restriction
Limit the information we disclose about you for medical treatment.
Confidential Communications
Choose how you receive messages about your protected health information.
Accounting of Disclosures of Protected Health Information
Understand when and where APWU Health Plan has shared your PHI.
Request to Access PHI
Obtain copies of your protected health information from APWU Health Plan.
Designation of Personal Representative
Authorize a person to act on your behalf in making healthcare decisions.
Authorization for Release of Protected Health Information
Allow a designated individual to have access to your PHI.
Enrollment forms
PS Form 8202: Pre-tax Election/Waiver
Begin or waive pre-tax treatment of your contributions toward your premiums.
PS Form 8141: Sufficient Earnings Requirement
Verify that your earnings will cover the withholding of your health plan premiums.
PostalEASE Worksheet
Enroll in your health benefits, change your enrollment, or cancel your enrollment.
Health Benefits Election Form (OPM2809)
Complete this form if you are an annuitant or former spouse of an annuitant.
Health Benefits Election Form (SF2809)
Complete this form if you are an employee eligible to enroll in health benefits.
Employee Cost Acknowledgement Form
Review OPM enrollment guidelines for non-career postal employees.