In January each year, APWU Health Plan funds a PCA you can use for covered medical services. You’re covered 100% until your PCA is exhausted.
Get to know how your PCA works and how it can decrease your plan deductible and out-of-pocket expenses.
$1,200 — APWU Health Plan contribution
$2,400 — APWU Health Plan contribution
| Preventive care | |
| Well-child care, immunizations, adult routine exams, preventive screenings | $0 — No PCA used |
| Receive a $25 wellness incentive for each family member who completes an annual physical exam, mammogram, or cervical cancer screening | |
| Medical visits | |
| Office, specialist, & Virtual Visits | 15% of Plan allowance (Plan allowance: The maximum amount a plan will pay for a covered healthcare service |
| Dental care | |
| Save 20% – 50% on most procedures at dentists in the Careington Dental Discount Network | |
| Maternity | |
| Complete maternity care, including prenatal, delivery, postnatal and initial exam of newborn covered under family enrollment | $0 — No PCA used |
| Medical food formulas are covered to treat phenylketonuria (PKU) and other inborn errors of metabolism | 15% of Plan allowance |
| Hospital/facility care | |
| Diagnostic tests or imaging | 15% of Plan allowance |
| Outpatient surgery | 15% of Plan allowance |
| Inpatient surgery | 15% of Plan allowance |
| Cancer Center of Excellence | 10% of Plan allowance |
| Infertility treatment | |
| Diagnostic and treatment services | 15% of Plan allowance |
| Gender affirming care | |
| Gender dysphoria therapy and gender affirming surgery | 15% of Plan allowance |
| Emergency care | |
| Accidental injury (within 72 hours) | 15% of Plan allowance |
| Urgent care | 15% of Plan allowance |
| Emergency room | 15% of Plan allowance |
| Ambulance | 15% of Plan allowance |
| Air Ambulance | 15% of Plan allowance |
| Hearing services | |
| Diagnostic hearing tests | 15% every 2 years |
| Hearing aids | All charges in excess of $1,500 (every 3 years, no deductible applied) |
| Mental health/substance use | |
| Office visits | 15% of Plan allowance |
| Outpatient treatment | 15% of Plan allowance |
| Diagnostics, inpatient and outpatient service | 15% of Plan allowance |
| Virtual Behavioral Health Care | 15% of Plan allowance |
| Alternate care | |
| Chiropractic care | 15% of Plan allowance (24 visits per year) |
| Acupuncture | 15% of Plan allowance |
| Physical, occupational and speech therapy | 15% of Plan allowance (up to 60 visits per year) |
| Prescription coverage | |
|
Network retail Tier 1/Tier 2 Lower cost/Mid-range cost |
25%, min. $15 and max. per Rx of $200 for a 30-day supply, $400 for a 60-day supply, $600 for a 90-day supply |
|
Tier 3 Highest cost |
40%, min. $15 and max. per Rx of $300 for a 30-day supply, $600 for a 60-day supply, $900 for a 90-day supply |
|
Network home delivery Tier 1/Tier 2 Lower cost/Mid-range cost |
25%, min. $10 and max. per Rx of $200 for a 30-day supply, $400 for a 60-day supply, $600 for a 90-day supply |
|
Tier 3 Highest cost |
40%, min. $10 and max. per Rx of $300 for a 30-day supply, $600 for a 60-day supply, $900 for a 90-day supply |
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APWU Health Plan Holiday Office Hours
The Health Plan will be closed on Wednesday, January 1. We will reopen at 8:30 a.m. ET on Thursday, January 2.
Manage your High Option or Consumer Driven Option health plan 24/7 with your postal member portal or federal member portal.
