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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

Who is Express Scripts?

The High Option prescription drug plan includes access to nearly 64,000 pharmacies that belong to the Express Scripts network, along with home delivery options in all 50 states. The pharmacies discount their charges and bill the Health Plan automatically for members.

The convenient mail order program is ideal for members with long-term prescriptions. Both programs offer no deductible and low copayments.

What are the legal and privacy policies of APWU Health Plan?

APWU Health Plan is committed to safeguarding your privacy online. In general, you can visit our website without revealing any personal information about yourself. At times, we may ask you for personal information if it is necessary to help you in selecting appropriate services offered by APWU Health Plan. All information is provided voluntarily and explicitly by visitors to the site.

The Health Plan’s online access to membership details and claims history for High Option members—myapwuhp—is secure and protected and meets all federal requirements for privacy and security. Access is available only when you register and enter your user ID and password.

The email facilities at our site do not provide a means for completely secure and private communication between us. Your email, like most non-encrypted internet email communications, may be accessed and viewed without your knowledge or permission while in transit to us. If you consider the information you are communicating to be confidential and you wish to keep it private, please do not use email. Instead, call us at 1-800-222-APWU (2798) or, if you are a current member, at the number listed on the back of your identification card.

Please note that email sent to us will be shared with our customer service representatives or the staff members who are best able to address your questions. Once we have responded to your communication, it may be discarded or archived, depending on the nature of the inquiry.

The APWU Health Plan website gathers routine usage information, such as how many people visit the site, the pages visited, and the length of time a visitor spends on the site. This information is collected on an anonymous basis, which means no personal identifiable information is associated with the data. This data helps us to improve the site content and overall usefulness for visitors.

The site contains hypertext links to other websites. APWU Health Plan has no control over the content or the availability of these sites and assumes no responsibility for the privacy practices of such websites. These links are provided for convenience and reference purposes only. Therefore, we are not liable for any information or materials contained in them.

Does the High Option cover me when I am away from my home? Am I covered when I’m outside of the United States?

When you select the High Option as your health plan, you are always covered no matter where you are. Your coverage always goes with you, whether you are in another state or another country. When you have services outside the U.S., you will probably have to pay the bill at the time of service, and then submit a bill directly for reimbursement.

See the postal brochure or federal brochure for complete details.

Do charges that are applied to my deductible or charges over the Plan allowance apply to the catastrophic amount?

Yes. The amounts that are accrued toward the catastrophic limitation are coinsurance or copayments for medical, prescription, and deductible covered services.

See the postal brochure or federal brochure for complete details.

For the High Option, what is catastrophic protection out-of-pocket coverage? What is considered a catastrophic condition?

The catastrophic out-of-pocket maximum or limitation does not indicate any single illness or condition. The catastrophic limitation is the maximum amount of coinsurance that a member has to pay out of their own pocket before the Health Plan pays covered charges at 100% for the balance of the calendar year.

Most conditions that the Health Plan pays on your behalf for the High Option, at a percentage amount, will have your portion of the fee (the coinsurance) apply toward a maximum out-of-pocket amount. Once a member meets the maximum amount (the catastrophic limit), the Plan pays covered charges for the remainder of the calendar year at 100% of the Plan allowance, or the PPO negotiated rate if you us a preferred provider.

See the postal brochure or federal brochure for complete details.

Do I need prior approval or precertification for certain services?

Precertification—sometimes called prior authorization—is a process that requires physicians and healthcare providers to obtain advanced approval from the Health Plan before delivering a specific service to the patient to qualify for payment coverage.

High Option members need prior approval for certain services

Before having certain types of medical care or services, you will need to get precertification. It’s important that you understand when precertification is needed to keep your benefits from being reduced.

Examples of services that require precertification include:

Inpatient hospital admission
Organ transplantation
Surgery that can be considered cosmetic
Durable medical equipment
Genetic testing
Inpatient residential treatment center admission
Skilled nursing facility admission
Outpatient radiology services, including CT/CAT, MRI, MRA, and PET scans
Mental health and substance use disorder inpatient treatment
Other services as outlined in the Plan brochure (see Section 3: How you get care)

How to request precertification or prior approval

At least two business days before admission or services requiring prior authorization are rendered, you, your representative, your physician, or your hospital must call UnitedHealthcare. This number is available 24 hours a day:

UnitedHealthcare: 1-866-569-2064

Consumer Driven Option members need prior approval for certain services

Before having certain types of medical care or services, you will need to get either prior approval or precertification. It’s important that you understand when prior approval or precertification are needed to keep your benefits from being reduced.

Examples of services that require precertification include:

Inpatient hospital admission
Organ transplantation
Surgery that can be considered cosmetic
Durable medical equipment
Genetic testing
Other services as outlined in the Plan brochure (see Section 3: How you get care)

How to request precertification or prior approval

You, your representative, your physician, or your hospital must call UnitedHealthcare at least 2 business days before admission or services requiring prior authorization are rendered:

UnitedHealthcare: 1-855-808-3003

For mental health and substance use disorder inpatient treatment, your doctor or your hospital must call UnitedHealthcare Behavioral Health Solutions at least 2 business days before admission or services requiring prior authorization. This number is available 24 hours a day:

UHC Behavioral Health Solutions: 1-855-808-3003

Do I need a referral to see a specialist?

You do not need a referral to see a specialist when you are a member of APWU Health Plan. You are free to choose your covered providers without seeking our permission.

How do I locate a Cancer Center of Excellence?

When you enroll in the APWU Health Plan, you will have access to designated Cancer Centers of Excellence around the country.

High Option: With pre-approval, you pay only 5% of the treatment costs at these in-network designated centers.

Consumer Driven Option: If you decide to use a designated Cancer Center of Excellence, you may receive prior approval for travel and lodging costs. With pre-approval and in the network, you pay 10% of the Plan allowance.

Locate Cancer Centers of Excellence

Does APWU Health Plan provide gender-affirming care?

APWU Health Plan recognizes that transgender, non-binary, and other gender-diverse members require healthcare delivered by providers experienced in gender-affirming health.

Gender-affirming services include therapy to address feelings of gender dysphoria and medical treatments that help you achieve physical characteristics that better align with your gender identity.

Gender affirming surgery requires prior approval. Under the High Option and Consumer Driven Option, members need to call UnitedHealthcare before receiving gender-affirming surgery. Failure to do so will result in a minimum $500 penalty for an inpatient hospital stay.

See the postal or federal brochure for complete details.

Does APWU Health Plan cover treatment for infertility?

Infertility is a struggle. When you want to start or expand your family but have been unable to conceive within a reasonable period of time, it can affect your emotional health.

For members who are ready to seek medical help on the journey to becoming a parent, the APWU Health Plan High Option and Consumer Driven Option cover a range of services to diagnosis and treat infertility.

See the postal brochure or federal brochure for complete details.

What health management programs are available to APWU Health Plan members?

As an APWU Health Plan High Option or Consumer Driven Option member, you have access to a number of programs that can help you protect your health and well-being:

Rally® is a digital health experience that offers personalized recommendations to help you move more, eat better, and feel great. It even rewards your progress with Rally Coins, which you can use to contribute to a charity.

Call 1-866-569-2064 — or visit Rally

One Pass Select is a fitness and well-being subscription-based network that provides access to over 16,000 gyms and studios. Members can use multiple locations during the same month and change locations at any time. Choose from five membership tiers, with the option to change tiers monthly.

Visit One Pass Select — or visit Rally

Maven provides free, 24/7 virtual support for pregnancy, postpartum, and returning to work after parental leave.

Call 1-866-569-2064

Quit For Life® helps you move beyond tobacco and take control of your health. The program includes counseling by phone, group therapy sessions, or educational sessions with a doctor. FDA-approved prescription drugs and over-the-counter drugs to treat tobacco dependence are also available for those age 18 or older.

Call 1-866-569-2064 — or visit Quitnow

See the postal brochure or federal brochure for complete details.

Does APWU Health Plan cover hearing tests and hearing aids?

APWU Health Plan covers diagnostic hearing tests every two years and hearing aids every three years. For hearing tests, members pay 15% of the Plan allowance, while hearing aids are covered up to $1,500.

High Option and Consumer Driven Option members can access more than 2,000 name-brand models and styles of hearing aids at significant savings through UnitedHealthcare Hearing. Choose virtual care with hearing aid home delivery or in-person care at more than 7,000 hearing providers nationwide. Plus, get in-person or virtual support for every stage or your hearing health journey.

See the postal brochure or federal brochure for complete details.

APWU Health Plan FAQ

High Option members need prior approval for certain services

How to request precertification or prior approval

Consumer Driven Option members need prior approval for certain services

How to request precertification or prior approval

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Together. Better health.