| High Option 2025 | ||
|---|---|---|
|
Calendar year deductible Self Self Plus One / Self & Family |
In-network $450 $800 |
Out-of-network
$1,000 $2,000 |
|
Annual out-of-pocket maximum Combined medical and prescription drugs |
In-network $6,500 Self $13,000 Self Plus One / Self & Family |
Out-of-network
$12,000 Self $24,000 Self Plus One / Self & Family |
| Medical visits | ||
| Office and specialist visits | $25 copay (no deductible applied) | $0 |
| Virtual Visits with Teladoc |
$0 copay for first 2 visits $10 copay (no deductible applied) |
$0 |
| Preventive care | ||
| Well-child care | $0 | n/a |
| Childhood immunizations | $0 | n/a |
| Annual adult routine exams | $0 | $0 |
| Adult immunizations | $0 | $0 |
| Preventive screenings | $0 | $0 |
| Dental care | ||
|
Routine office visits (2 per year)Fluoride treatments (2 per year) Cleanings (2 per year) X-rays of all types (2 per year) Fillings (not including crowns or in-lay/on-lay restoration) Simple extractions |
30% of Plan allowance (no deductible applied) |
$0 for preventive care $50 yearly deductible $1,000 max for non-routine per year |
| Diabetes care | ||
| Generic oral medication, formulary blood glucose test strips, and lancets (used to reduce blood sugar) | $0 through mail-order | $0 |
| Maternity | ||
| Complete maternity care, including prenatal, delivery, postnatal, and initial exam of newborn covered under family enrollment | $0 | n/a |
| Medical food formulas are covered to treat phenylketonuria (PKU) and other inborn errors of metabolism | 15% of the Plan allowance | n/a |
| Hospital/facility care | ||
| Diagnostic tests or imaging | 15% ($0 for covered blood work performed at LabCorp and Quest Diagnostics) | $0 |
| Outpatient surgery | 15% of the Plan allowance | $0 |
| Inpatient | 15% of the Plan allowance | $0 |
| Surgical | 15% of the Plan allowance | $0 |
| Cancer Centers of Excellence | 5% of the Plan allowance | $0 |
| Infertility treatment | ||
| Diagnostic and treatment services | 15% of the Plan allowance | n/a |
| Gender affirming care | ||
| Gender dysphoria therapy and gender affirming surgery | 15% of the Plan allowance | $0 |
| Emergency care | ||
| Accidental injury (within 72 hours) | $0 | $0 |
| Urgent care | $30 copay (no deductible applied) | $0 |
| Emergency room | 15% of the Plan allowance | $0 |
| Ambulance | 15% (no deductible applied) | $0 |
| Hearing services | ||
| Diagnostic hearing tests | 15% of the Plan allowance (every 2 years) | $0 |
| Hearing aids | All charges in excess of $1,500 (every 3 years, no deductible applied) | $1,500 allowance (must use UnitedHealthcare network) |
| Alternative care | ||
| Physical therapy | 15% of the Plan allowance (60 visits per year, no deductible applied) | $0 |
| Chiropractic care | $25 copay (24 visits per year, no deductible applied) | $0 |
| Acupuncture | $25 copay (26 visits per year, no deductible applied) | $0 |
| Mental health/substance use | ||
| Office visits | $25 copay (no deductible applied) | $0 |
| Outpatient treatment | 15% of the Plan allowance | $0 |
| Diagnostics, inpatient, and outpatient service | 15% of the Plan allowance | $0 |
| Prescription coverage | ||
|
Retail prescription drugs Non-specialty 30-day supply |
Benefits do not count toward your deductible $10 for Tier 1 25% for Tier 2, max $200 per Rx 45% for Tier 3, max $300 per Rx |
Learn about your Medicare Advantage plan’s Part D prescription drug coverage |
|
Mail-order prescription drugs Non-specialty 90-day supply |
$20 for Tier 1 25% for Tier 2, max $300 per Rx 45% for Tier 3, max $500 per Rx |
|
|
Retail prescription drugs Specialty 30-day supply |
25% for Tier 4, max $300 per Rx 25% for Tier 5, max $600 per Rx 45% for Tier 6, max $1,000 per Rx |
|
|
Mail-order prescription drugs Specialty 90-day supply |
25% for Tier 4, max $150 per Rx 25% for Tier 5, max $300 per Rx 45% for Tier 6, max $500 per Rx |
|
WE WANT YOUR FEEDBACK
Your feedback is valuable to us. Help us improve by sharing your thoughts.
Contact us
©2025 APWU Health Plan | All rights reserved.
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.
