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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 High Option

If I enroll in Medicare Part A and B, will the High Option cover 100% of my medical bills?

Yes, when you enroll in both Medicare Part A and Part B, our High Option plan can help maximize your healthcare coverage and get your medical bills paid 100%.

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 is the specialty pharmacy for the High Option?

At Accredo, your High Option specialty pharmacy, taking care of you is our focus. You might be newly diagnosed and beginning with a specialty medication, or you might just be new to Accredo. Either way, our specialty-trained pharmacists, nurses, pharmacy techs, and patient care advocates understand chronic and complex conditions. We’re here to help you navigate this journey.

To manage your medications how you want, when you want, visit Accredo or download the Accredo mobile app from your mobile device’s app store. You can order available refills, check order status, view medication history, and much more.

Your Accredo team works with your doctor to manage your overall medication therapy and make your path as smooth as possible throughout treatment.

Which vaccines does the High Option cover?

To help you stay healthy, you can receive vaccinations covered by your prescription plan at a participating retail pharmacy. Certain age restrictions may apply; please refer to your plan details.

Call your local pharmacy to:

Ask your pharmacist which vaccines are right for you
Find out if your pharmacist can administer the recommended vaccinations
Learn which vaccinations are covered by your plan

Don’t forget to present your member ID card to the pharmacist.

The following vaccines are available from pharmacists at participating retail pharmacies:

COVID-19
Hepatitis
Pneumonia
Flu (seasonal influenza)
Respiratory syncytial virus (RSV)
Human papillomavirus (HPV)
Shingles/zoster
Tetanus, diphtheria, pertussis
Meningitis
Childhood vaccines (MMR, etc.)

Please refer to your plan specifications for additional details on the coverage of vaccines at $0 copay.

Does the High Option cover medications to help me quit using tobacco?

Talk with your doctor about getting the help you need to quit tobacco.

Under the Affordable Care Act, your prescription plan covers several types of treatments that are approved by the U.S. Food and Drug Administration (FDA).

Nicotine-replacement therapies (NRT)—such as the patch, gum, spray or inhaler—are proven effective at helping people quit tobacco use. The success rate is signiﬁcantly better when two types of NRTs are used.

Medications recommended and covered with $0 copay include:

Nicotine patch*
Nicotine gum, lozenges*
Nicotine nasal spray
Nicotine inhaler
Bupropion SR 150mg tablets
Varenicline tablets

* Over-the-counter medication. Coverage limitations may apply; refer to your plan specifications for details.

Does the High Option cover contraceptives and birth control?

Your prescription plan covers contraceptives at no cost to you.

Under the Affordable Care Act, your plan covers contraceptive medications and medical devices approved by the U.S. Food and Drug Administration. There are many contraceptive options available to you that can help prevent pregnancy, including:¹

Medication taken by mouth (“the pill”)
Diaphragm
Emergency contraceptives
Shot/injection
Over-the-counter methods
Skin patch
Implantable rod
Vaginal ring
Intrauterine systems (“IUD”)
Cervical cap

Consult with your health care provider to ensure you are using the contraception method most appropriate for you, your body and your future.

For more information about contraception benefits, visit the website of the Office of Personnel Management (OPM):

OPM Contraceptive Coverage

Contact OPM

¹ The success rate of contraceptive methods varies, depending on the speciﬁc medication or device used.

Does Express Scripts cover insulin?

Express Scripts Patient Assurance® Program Participating Drugs on the National Preferred Formulary

PLEASE NOTE: This list is subject to change. Not all of the drugs listed are covered by all prescription plans; check your benefit materials for the specific drugs covered for your prescription plan. This list is effective beginning January 1, 2024.

Prior to filling any prescription and for additional information about your prescription coverage, register or log in to express-scripts.com.

FARXIGA®
GLYXAMBI®
HUMALOG®
HUMALOG® KWIKPEN
HUMALOG® MIX
HUMULIN®
HUMULIN® KWIKPEN
HUMULIN® N
HUMULIN® N KWIKPEN
HUMULIN® R
HUMULIN® R KWIKPEN
JARDIANCE®
LYUMJEV™
LYUMJEV™ KWIKPEN
SEMGLEE®
SYNJARDY®
SYNJARDY® XR
TRIJARDY® XR
TRULICITY®
XIGDUO XR

All trademarks are the property of their respective owners.

Does Express Scripts offer home delivery?

Whether you use your express-scripts.com account or the Express Scripts mobile app, it’s simple and convenient to enroll in home delivery to get your 90-day prescriptions shipped right to your door.

Fill a new prescription

Contact your doctor to request a 90-day prescription that can be e-prescribed directly to Express Scripts home delivery.

Or, print a form by selecting Forms from the menu under Benefits. Print the home delivery form and follow the mailing instructions.

Or, call Express Scripts at 1-800-841-2734 or 1-800-759-1089 (TTY), and we’ll contact your doctor for you.

Please allow 10 to 14 days for your first prescription order to be shipped.

Transfer a retail prescription to home delivery

Select Add to Cart for eligible prescriptions and check out. We’ll contact your provider on your behalf and take care of the rest. Check Order Status to track your order.

Refill and renew prescriptions

Select Add to Cart for eligible prescriptions and check out. We’ll contact your provider on your behalf, if renewals are included, and take care of the rest.

Can I access my pharmacy benefits online or with a mobile app?

Yes, create an account on express-scripts.com or download the Express Scripts mobile app for free from your mobile device’s app store. Registering is safe and simple, and your information is secure and confidential. Please have your member ID number or SSN available.

Once you create an account, you can:

Check your order status
Refill and renew prescriptions
Find your nearest preferred pharmacy
View and print member ID cards
Enroll eligible prescriptions in automatic refill
Set reminders to take your medication
Enroll in home delivery

The Express Scripts mobile app is available for iPhone^®, iPad^®, and Android™ mobile devices.

APWU Health Plan FAQ

Part A (hospital insurance)

Part B (medical coverage)

Medicare participating doctors and suppliers

Part D

Prescription drug program (PDP)

* Over-the-counter medication. Coverage limitations may apply; refer to your plan specifications for details.

¹ The success rate of contraceptive methods varies, depending on the speciﬁc medication or device used.

Fill a new prescription

Transfer a retail prescription to home delivery

Refill and renew prescriptions

Stay informed about Health Plan news—sign up today!

Together. Better health.

APWU Health Plan FAQ

Part A (hospital insurance)

Part B (medical coverage)

Medicare participating doctors and suppliers

Part D

Prescription drug program (PDP)

* Over-the-counter medication. Coverage limitations may apply; refer to your plan specifications for details.

1 The success rate of contraceptive methods varies, depending on the speciﬁc medication or device used.

Fill a new prescription

Transfer a retail prescription to home delivery

Refill and renew prescriptions

¹ The success rate of contraceptive methods varies, depending on the speciﬁc medication or device used.