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APWU Health Plan FAQ

APWU Health Plan has been offering affordable, comprehensive coverage to postal workers, federal employees, and retirees since 1960. We’re here to help you choose a plan that’s right for you and make the most of your benefits.

If you can’t find an answer to your question, contact us to speak with a customer service representative:

1-800-222-2798 | 1-800-622-2511 (TTY)

Monday – Friday, 8:30 am – 6:30 pm ET

Displaying FAQs for Consumer Driven Option

Are Virtual Visits available for routine checkups and primary care?

Yes, you can connect with a virtual primary care provider and a team of healthcare professionals¹ without leaving home or work.² Services include:

Annual checkups, prescriptions, and non-urgent care³
Check-ups for ongoing conditions like asthma, diabetes, and more
Follow-up visits

The care team will guide you, when needed, to in-person care, such as labs, imaging, specialists, and more.

High Option members: Your first two Teladoc Virtual Visits are free. After that, you have a copay of just $10 per visit.

Consumer Driven Option members: You’ll pay 15% of the Plan allowance for a Virtual Visit through Amwell, Teladoc, and Doctor on Demand, less than the cost of an in-person office visit. To get started, log in to your myuhc.com member portal.

Call 911 immediately or go to the nearest emergency room if you believe you are experiencing a medical emergency.

¹ Data rates may apply.

² Virtual primary care is applied to primary care benefits—it is not applied to the 24/7 Virtual Visits benefit.

³ Certain prescriptions may not be available, and other restrictions may apply.

Virtual primary care are services available with a provider via video, chat, email, or audio-only where permitted under state law. Virtual primary care services are only available if the provider is licensed in the state that the member is located at the time of the appointment. Virtual primary care is not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members. Certain prescriptions may not be available, and other restrictions may apply.

Does APWU Health Plan offer Virtual Visits?

Yes, Virtual Visits let you connect with a doctor by phone or video.¹ Doctors can treat a wide range of health conditions—including many of the same conditions as an emergency room (ER) or urgent care—and may even prescribe medications.²

Virtual Visits are good for a wide range of issues, including:

Allergies
Bronchitis
Colds
Flu
Migraines
Pink eye
Rashes
Sinus infections
Urinary tract infections

High Option members: Your first two Teladoc Virtual Visits are free. After that, you have a copay of just $10 per visit.

Call 911 immediately or go to the nearest emergency room if you believe you are experiencing a medical emergency.

¹ Data rates may apply.

² Virtual primary care is applied to primary care benefits—it is not applied to the 24/7 Virtual Visits benefit.

³ Certain prescriptions may not be available, and other restrictions may apply.

24/7 Virtual Visits is a service available with a provider via video, or audio-only where permitted under state law. It is not an insurance product or a health plan. Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. 24/7 Virtual Visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members. Check your benefit plan to determine if these services are available.

Can I get an estimate for how much a procedure will cost before I receive treatment?

Estimate costs—including your deductible, coinsurance, and out-of-pocket maximum—before you see a doctor or healthcare provider.

Search for providers and facilities in the UnitedHealthcare network, and narrow your search results by specialty, procedure, or doctor.

High Option members: To get started, log in to the Viveka Health Price Transparency Tool with your member ID and date of birth. You can find your member ID on your Health Plan ID card or by logging in to your member portal.

Consumer Driven Option members: Log in to your myuhc.com member portal.

Does the Consumer Driven Option provide Part D pharmacy benefits if I’m enrolled in Medicare?

As a Consumer Driven Option member, you can receive Medicare Part D coverage at no extra cost through the UnitedHealthcare MedicareRX Part D plan.

If you are enrolled in Medicare and are not enrolled in a Medicare Advantage plan (Part C), you will be automatically enrolled in the Medicare PDP for APWU Health Plan.

The plan is a prescription drug benefit for Medicare-eligible annuitants and family members covered under the Postal Service Health Benefits (PSHB) Program.

With this Medicare Part D coverage, you have access to:

• Low copays/coinsurance

• $2,000 out-of-pocket maximum

• Home delivery service

The Medicare PDP is not available to Consumer Driven Option members covered under the Federal Employees Health Benefits (FEHB) Program.

To learn more about the Medicare Part D prescription drug plan, contact UnitedHealthcare MedicareRx Part D at 1-888-201-4265, 8 am – 8 pm local time, Monday – Friday.

How does APWU Health Plan work with Medicare?

If you or your spouse are employed and have APWU Health Plan, the Health Plan is your primary coverage and Medicare is secondary. If both you and your spouse are retired, Medicare is your primary coverage and APWU Health Plan is secondary.

Part A (hospital insurance)

In general, if you have Part A as your primary insurance, you do not need to get precertification for a hospital stay. However, a stay must be precertified prior to the 90th day of confinement in a benefit period.

Part B (medical coverage)

With Part B, Medicare pays first, and APWU Health Plan pays second. When Medicare is primary and you have the High Option, most of your medical expenses are covered 100% because your deductible and coinsurance are waived for covered services. With the Consumer Driven Option, deductibles and coinsurance are not waived, but you can use your PCA to be reimbursed for your Part B premiums.

Medicare participating doctors and suppliers

Medicare usually pays 80% for covered services after you satisfy the Part B annual deductible. As long as services represent a covered benefit, the High Option pays the Part B deductible and the 20% coinsurance, which means you’re covered 100%. With the Consumer Driven Option, if you have benefit dollars in your Personal Care Account, the Medicare deductible and coinsurance will be paid.

Part D

Prescription drug program (PDP)

As a retiree covered under the Postal Service Health Benefits (PSHB) Program or Federal Employees Health Benefits (FEHB) Program, you will be automatically enrolled in our Part D prescription drug program (PDP).

The Medicare PDP is not available to retirees covered under the FEHB Program who enroll in the Consumer Driven Option.

What are the FEHB enrollment codes for APWU Health Plan?

Use these FEHB codes when you enroll in APWU Health Plan:

High Option

Self — FEHB enrollment code 471
Self Plus One — FEHB enrollment code 473
Self & Family — FEHB enrollment code 472

Consumer Driven Option

Self — FEHB enrollment code 474
Self Plus One — FEHB enrollment code 476
Self & Family — FEHB enrollment code 475

Does APWU Health Plan offer FEHB health plans?

Yes. As a national preferred provider organization (PPO), APWU Health Plan offers both a fee-for-service High Option plan and a Consumer Driven Option plan. Both options are open to all employees and retirees covered under the Federal Employees Health Benefits (FEHB) Program.

How can I compare FEHB health plans?

Use the FEHB plan comparison tool to view your options for health insurance coverage.

APWU Health Plan offers both a fee-for-service High Option and a Consumer Driven Option.

What are the advantages of using OptumRx Home Delivery?

Many members use mail service for the convenience, safety, and savings. Medications are delivered directly to your home, which means fewer trips to the pharmacy, and you will receive a 3-month supply, which may save you money.

Registered pharmacists are available to answer questions 24 hours a day, 7 days a week. And you can feel confident in OptumRx’s 99.99% mail service accuracy rate. All prescriptions go through multiple checks by licensed pharmacists and technicians, and are screened for potential harmful interactions with other medications on file.

To learn more about mail service, log in to your myuhc.com member portal and visit the pharmacy section.

APWU Health Plan FAQ

¹ Data rates may apply.

² Virtual primary care is applied to primary care benefits—it is not applied to the 24/7 Virtual Visits benefit.

³ Certain prescriptions may not be available, and other restrictions may apply.

¹ Data rates may apply.

² Virtual primary care is applied to primary care benefits—it is not applied to the 24/7 Virtual Visits benefit.

³ Certain prescriptions may not be available, and other restrictions may apply.

Part A (hospital insurance)

Part B (medical coverage)

Medicare participating doctors and suppliers

Part D

Prescription drug program (PDP)

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Together. Better health.

APWU Health Plan FAQ

1 Data rates may apply.

2 Virtual primary care is applied to primary care benefits—it is not applied to the 24/7 Virtual Visits benefit.

3 Certain prescriptions may not be available, and other restrictions may apply.

1 Data rates may apply.

2 Virtual primary care is applied to primary care benefits—it is not applied to the 24/7 Virtual Visits benefit.

3 Certain prescriptions may not be available, and other restrictions may apply.

Part A (hospital insurance)

Part B (medical coverage)

Medicare participating doctors and suppliers

Part D

Prescription drug program (PDP)

¹ Data rates may apply.

² Virtual primary care is applied to primary care benefits—it is not applied to the 24/7 Virtual Visits benefit.

³ Certain prescriptions may not be available, and other restrictions may apply.

¹ Data rates may apply.

² Virtual primary care is applied to primary care benefits—it is not applied to the 24/7 Virtual Visits benefit.

³ Certain prescriptions may not be available, and other restrictions may apply.