ARE YOU AN APWU BARGAINING UNIT EMPLOYEE?

What are the 2024 plan choices?

APWU Health Plan gives you two smart plans to consider. Compare them side by side.

With low copays, low deductibles, and a vast network of providers, this is a premier plan in the Federal Employees Health Benefits Program.

Covered 100%

  • Preventive care and screenings
  • Maternity care and support
  • Accidental injury outpatient services within 72 hours
  • Lab tests ($0 for covered blood work performed at LabCorp and Quest Diagnostics)
  • Visits to registered dietician/nutritionist
  • Lifestyle management programs: tobacco cessation and weight management

Prescription cost calculator

Plan Choices In-network you pay Out-of-network you pay
Calendar year deductible:
Self Only		 $450 $1,000
Self Plus One $800 $2,000
Self and Family $800 $2,000
Annual out-of-pocket maximum (both medical and prescription drugs) $6,500 Self Only
$13,000 Self Plus One and Self and Family		 $12,000 Self Only
$24,000 Self Plus One and Self and Family
Medical office and specialist visits $25 copay** 40%
of the Plan allowance*
24/7 Virtual Visits with Teladoc® $10 copay** N/A
Plan ChoicesMaternity care
Complete maternity (obstetrical) care, such as prenatal care delivery, postnatal care, and initial examination of a newborn child covered under family enrollment $0 40% of the Plan allowance*
Medical foods formulas to treat phenylketonuria (PKU) and other inborn errors of metabolism 15% N/A
Plan ChoicesPreventive care
Well child care (through age 12) $0 Difference between the Plan allowance billed amount
Childhood immunizations (through age 18) $0 Difference between the Plan allowance and billed amount
Annual adult routine exams $0 40% of the Plan allowance*
Adult immunizations (shingles vaccine covered at 100% in network at age 50) $0 40% of the Plan allowance*
Preventive screenings $0 40% of the Plan allowance*
Routine dental 30% of the Plan allowance** No in-network dental providers; choose any provider
Plan ChoicesHospital/facility care
Diagnostics tests or imaging 15%
($0 for blood work performed at LabCorp or Quest Diagnostics)		 40% of the Plan allowance*
Outpatient surgery, facility fee, lab visits, and surgeon fee 15% 40% of the Plan allowance*
Inpatient facility fee 15% 40% of the Plan allowance*
($300 per admission)
Cancer Centers of Excellence 5% N/A
Surgical and facility fee 15% 40% of the Plan allowance*
Plan ChoicesHearing services
Diagnostic hearing tests (every 2 years) 15% 40% of the Plan allowance*
Hearing aid (every 3 years) All charges in excess of $1,500** All charges in excess of $1,500
Plan ChoicesEmergency care
Accidental injury (care within 72 hours of injury) $0 Difference between the Plan allowance and billed amount
Urgent care $30 copay** 40% of the Plan allowance*
Emergency room 15% 15% of the Plan allowance*
Ambulance 15%** 40% of the Plan allowance*
Plan ChoicesAlternative care
Chiropractic care (24 visits annually) $25 copay** 40% of the Plan allowance*
Acupuncture (26 visits annually) $25 copay** 40% of the Plan allowance*
Physical therapy (60 visits annually) 15% 40% of the Plan allowance*
Plan ChoicesPrescription drugs
Retail prescription drugs - non-specialty (30-day supply) $10 for Tier 1 drugs
25% for Tier 2 drugs,
$200 maximum per Rx
45% for Tier 3 drugs,
maximum $300 per Rx
No deductible		 50% ($10 minimum coinsurance),

(no deductible)
Mail-order prescription drugs - non-specialty (90-day supply) $20 for Tier 1 drugs
25% for Tier 2 drugs,
maximum $300 per Rx
45% for Tier 3 drugs,
maximum $500 per Rx
No deductible		 N/A
Retail prescription drugs - specialty (30-day supply) 25% for Tier 1 drugs,
maximum $300 per Rx
25% for Tier 2 drugs, maximum $600 per Rx
45% for Tier 3 drugs,
maximum $1,000 per Rx
No deductible 		50% ($10 minimum coinsurance),

(no deductible)
Mail-order prescription drugs - specialty (90-day supply) 25% for Tier 1 drugs,
maximum $150 per Rx
25% for Tier 2 drugs,
maximum $300 per Rx
45% for Tier 3 drugs,
maximum $500 per Rx
No deductible 		N/A
Plan ChoicesMental health/substance use disorder
Office visit $25 copay** 40% of the Plan allowance*
Outpatient treatment 15% 40% of the Plan allowance*
Diagnostics, inpatient, and outpatient services 15% 40% of the Plan allowance*

* If there is a difference between the allowance and billed amount, the member is responsible for that difference.

** No deductible applied

This is a summary of benefits and features offered by the APWU Health Plan. All benefits are subject to the definitions, limitations, and exclusions set for the in the Plan’s Brochure (RI 71-004).



THIS PLAN ALSO INCLUDES: