Home › Prescriptions

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 Prescriptions

How do I file an online prescription drug claim?

Please submit a prescription drug claim form to request payment for covered services under your High Option plan.

Will I be penalized for not having drug coverage through APWU Health Plan previously?

If you had a Medicare Part D plan or coverage through PSHB or FEHB that included prescription drug coverage, you had what is known as “creditable coverage.” Creditable coverage means that your prescription drug coverage was at least as good as, or better than, what Medicare requires.

If you had creditable prescription drug coverage through another source, such as a spouse’s employer plan, you should have received a certificate of creditable coverage. This certificate is generally provided prior to tax season.

If you were eligible for Medicare Part D and you did not have any prescription drug coverage for more than 63 days, Medicare will determine if you need to pay a late enrollment penalty (LEP) for the length of time you were eligible but did not have Part D coverage. You may submit an appeal to have this LEP removed if you had creditable coverage. You will receive a letter from UnitedHealthcare if Medicare has reported a gap of more than 63 days with instructions on how to appeal this and provide proof of creditable coverage.

Do I need to get new OptumRx® Home Delivery mail-order prescriptions?

You may need a new prescription. Your Home Delivery pharmacy is OptumRx, a UnitedHealth Group company. The Quick Start Guide that you receive following your enrollment in the plan will include OptumRx contact information.

Medicare Advantage pharmacies and prescriptions

Does the Consumer Driven Option provide Part D pharmacy benefits if I’m enrolled in Medicare?

As a Consumer Driven Option member, you can receive Medicare Part D coverage at no extra cost through the UnitedHealthcare MedicareRX Part D plan.

If you are enrolled in Medicare and are not enrolled in a Medicare Advantage plan (Part C), you will be automatically enrolled in the Medicare PDP for APWU Health Plan.

The plan is a prescription drug benefit for Medicare-eligible annuitants and family members covered under the Postal Service Health Benefits (PSHB) Program.

With this Medicare Part D coverage, you have access to:

• Low copays/coinsurance

• $2,000 out-of-pocket maximum

• Home delivery service

The Medicare PDP is not available to Consumer Driven Option members covered under the Federal Employees Health Benefits (FEHB) Program.

To learn more about the Medicare Part D prescription drug plan, contact UnitedHealthcare MedicareRx Part D at 1-888-201-4265, 8 am – 8 pm local time, Monday – Friday.

Does the High Option provide Part D pharmacy benefits if I’m enrolled in Medicare?

As a High Option member, you can receive Medicare Part D coverage at no extra cost through the Express Scripts Medicare Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP).

If you are enrolled in Medicare and are not enrolled in a Medicare Advantage plan (Part C), you will be automatically enrolled in the Medicare PDP for APWU Health Plan.

The plan is a prescription drug benefit for Medicare-eligible annuitants and family members covered under the Postal Service Health Benefits (PSHB) Program or Federal Employees Health Benefits (FEHB) Program.

With this Medicare Part D coverage, you have access to:

Low copays/coinsurance
$2,000 out-of-pocket maximum
Home delivery service

For details about the Medicare PDP, contact Express Scripts Medicare at 1-844-818-8790, 24 hours a day, 7 days a week.

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 is Medicare Part D?

Medicare Part D helps cover the cost of prescription drugs. Sometimes called prescription drug plans, or PDPs, Part D is a separate plan that adds drug coverage to Original Medicare. While anyone who qualifies for Medicare can enroll in Part D, PDPs are optional and only available through private insurance companies approved by Medicare.

You will pay a monthly premium, and must meet a deductible. You will also need to pay either a set amount per prescription (copayment) or a percentage of the cost (coinsurance).

As an APWU Health Plan member, there is no need for you to enroll in Medicare Part D. If you are enrolled in Medicare and are not enrolled in a Medicare Advantage plan (Part C), you will be automatically enrolled in the Medicare PDP for APWU Health Plan.

What are the advantages of using OptumRx Home Delivery?

Many members use mail service for the convenience, safety, and savings. Medications are delivered directly to your home, which means fewer trips to the pharmacy, and you will receive a 3-month supply, which may save you money.

Registered pharmacists are available to answer questions 24 hours a day, 7 days a week. And you can feel confident in OptumRx’s 99.99% mail service accuracy rate. All prescriptions go through multiple checks by licensed pharmacists and technicians, and are screened for potential harmful interactions with other medications on file.

To learn more about mail service, log in to your myuhc.com member portal and visit the pharmacy section.

If I place an order through OptumRx Home Delivery, how quickly will I get my medication?

New and transferred prescription orders are delivered by standard U.S. mail and will arrive around 10 business days from the date OptumRx receives the order. Refills are sent the same way and normally arrive within 7 business days of OptumRx receiving your order.

If you have an email address on file, you can expect to receive an email when your prescription ships. If you don’t have an email address on file, you’ll receive a phone call.

How can I view my dependent’s or spouse’s pharmacy benefit online?

In order to protect the privacy and personal health information of our members, OptumRx has adopted a process for you to request permission to access your dependent(s) or spouse’s prescription information. For more information, call 1-855-808-3003.

Can I find my prescription information online?

Yes, you can access your prescription and mail service information online. Just log in to your myuhc.com member portal and visit the pharmacy section. You can quickly view your medications, check status, and refill mail service prescriptions.

How can I find pharmacies covered by my plan?

The OptumRx network includes more than 64,000 retail pharmacies, including all large national chains, many local, community pharmacies, and the OptumRx Home Delivery.

To search for a network pharmacy near you, log in to your myuhc.com member portal and visit the pharmacy section. Or call 1-855-808-3003.