This week, as I zip around the state of West Virginia for Health Fairs, I wanted to take some time to share information with the membership about some benefits that their health plans provide that are lesser known. 

Some of these plans are included at no additional cost, and some have extra fees associated with them. This is by no means an exhaustive list, and truthfully, some can be a little difficult to find information on if you aren’t logged into your account with either the High or Consumer Driven Option.

Both High Option (HO) and Consumer Driven Options (CDO) include: 

Maven – World’s largest maternity virtual clinic. Available at no additional cost to members. 

You get your own Personal Care Advocate, who is a REAL PERSON that you keep for your whole journey. They also offer on demand classes and community forums.

21-month support track for both parents with about a 1-hour response time 24/7/365, and 48 hourturnaround for in person appointments. Unlimited video appointments with 35+ types of doctors. Go to Mavenclinic.com/join/overview for more information.

One Pass Select - This is a fitness and well-being basedsubscription-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. It offers 5 different tiers and can be used nationwide. 

The first tier is digital and is $10, and they go up, with the most expensive being $159 a month. You can change tiers monthly, and each tier includes the one under it. onepassselect.com

Virtual Visits – These options allow you to connect with a doctor by phone or video. Doctors can treat a wide range of health conditions, including many of the same conditions as an Emergency Room visit or Urgent care, and may even be able to prescribe medications. Virtual visits are good for allergies, bronchitis, colds or flus, migraines, pink eye, rashes or sinus infections, behavioral health and many more. 

For High Option Members, the first two visits through Teladoc are free, and have a $10 copay after, per visit.

For Consumer Driven Option Members, you have access to Amwell, Teladoc, and Doctor on Demand at 15% of the plan allowance. In many cases Virtual visits are less expensive than an in-person office visit, and thereby can save you money in the long run. 

CDO only

Calm Health – Combines the sleep and mindfulness content of Calm with support for your mental and physical health and includes:

Mental health screenings to get personalized recommendations and track your journey,

Digital Programs to help you understand your mental health

Audio and video content and activities written by psychologists.

There is no additional cost, you can access it at any time, and anyone 16 years of age and older on the plan is eligible. To sign up, you need to log into your account with myuhc.com and click on the Coverage and Benefits link, and then go to the Mental Health Link. Around the middle of the page there is a link for Calm Health. If you try to download the app first you will run into issues. Ask me how I know. 

Carington Dental – This is a discount service, not a dental insurance. 

Find a participating dental office by calling theMember Services at

(800) 290-0523  or online at www.careington.com. Members get a fee schedule and fees stay locked for 4 – 5 years. The plan offers 20%-50% savings on most dental procedures. 

*** A word about Dental/ Vision Coverage and the APWU Health plans. The CDO does not provide any Dental or Visionbenefits, although you can submit for reimbursement for dentaland vision claims out of your Personal Care Account.  The Self plan is limited to $400 per plan year, and Self + One or Self and Family is limited to $800. The HO has benefits for Preventative dental benefits and will pay 70% of the allowed amount, and does include fillings and simple extractions. There are NO benefits for Major dental work (crowns, root canals, etc), and no vision benefits. To look at available dental and vision plans, visit benefeds.gov or visit the APWU Health Plan website for more information on their stand-alone dental plan. There is also a discount vision plan available to Union members via the Voluntary Benefits Plan.***

As a reminder, Open Season starts November 11th 2024, and goes through December 9th, 2024. While that may seem like a lot of time, it will go by quickly! You don’t want to be trying to fax in paperwork at 11pm on December 9th.  

Check back next week for some basic Medicare information!

Kayla Reynolds

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In my time as the Health Plan Coordinator, I have had a number of people tell me that insurance terms and insurance in general is very confusing. I don’t disagree with this. The last job I worked before coming to the Post Office in 2013 was Wells Fargo TPS (now HealthSmart). We provided customer service for the State of Alaska Employee insurance. We spent 6 weeks in training before they ever let us pay a claim or take a customer service phone call. Understanding insurance and how it works is VERY important. I can’t tell you the number of heartbreaking phone calls I received from recent widows and widowers who didn’t have any idea what they were doing because their partner had taken care of all of it. Below I have defined some common insurance terms that should apply to most insurances, not just the APWU Health Plan offerings, to help clear up confusion. Check back next week for some plan highlights on the High and Consumer Driven Options! 

Premium – this is the amount you pay to participate in an insurance plan. This is the amount that comes out of your check each pay period.

Deductible (DED) – this is the amount you need to spend out of your own pocket before the insurance benefits kick in. Generally speaking, the lower the deductible, the better. 

***These two definitions can be the MOST important things to look at. What the insurance plan covers may not matter if your Deductible is so high that you never reach a point where insurance will kick in.***

I also like to point out to people the big picture. Getting an idea of what you have to spend out of your own pocket before Insurance actually kicks in can be a real eye opener. I nearly switched to the High Option for the better Prescription coverage before I did the math and figured outI’d still have to spend nearly $2,000 more over the course of the year. 

This chart assumes you meet the qualifications for the CDO discount, meaning you have had a Federal Employee Health Benefit Plan (the USPS BCBS plan for PSEs is NOT a FEHB/PSHB plan) for one year, are a career employee, and are full dues paying member of the APWU. Retirees do not receive the discounted price. Non-members can still have either insurance plan, but they pay full price and must pay a yearly Associate Fee of $35, which is billed separately in April of each year. 

If you want to apply this math to another plan, take your bi-weekly premium x 25 (There are 25 pay periods in 2025) and then add your deductible to that number. 

Please keep in mind that while these numbers are important, they are NOT the only thing to look at when making a choice on what insurance to carry. Think of what your needs may be in the next year. Do you have small children, need diabetes coverage, have behavioral health concerns, or a chronic health condition? Are you generally healthy and just looking to avoid a large emergency bill? Those make a big difference in what kind of plan you want. 

***An aside. The lower your Deductible, the higher a Premium you will pay, typically. If you are paying both a high Premium AND a high Deductible, you may want to reevaluate your insurance.***

***Health Insurance plans cover a lot of “Wellness checkups” at 100%. This means your yearly checkup for both adults and children and most immunizations can be at no cost to you. This can also include preventative care and screenings, as well as maternity care and contraception. ***

In-Network – Providers and facilities that participate in the Insurance network. 

Out-of-Network  - Providers and facilities that do not participate in the Insurance network. While these claims may still be covered, they will be covered at a higher cost to the member. 

Out-of-Pocket (OOP) – this is a running total of all the money you have spent on insurance claims throughout the year.  This amount includes your deductible, and if you are on the CDO plan, includes spent monies from the Personal Care Account (PCA). Plans usually have a separate total for In-Network OOP and Out-of-Network OOP. 

Out-of-Pocket Maximum/Catastrophic Maximum – once you reach this limit, the plan will pay 100% of covered claims.  

**High Option and the Consumer Driven Option both have a Self In-Network OOP Maximum of $6,500 and Out-of-Network of $12,000. On Self + One or Self + Family, the In Network OOP Maximum is $13,000 and Out-of-Network is $24,000. That is a huge difference. United Healthcare (the carrier for both plans) is the largest in the nation, with over 1.7 Million providers nationwide participating in the network.

Plan allowance/Allowed Amount/Reasonable and Customary – these terms limit how much a provider can charge for a particular service. These amounts can vary based on where you live. 

Patient Responsibility – This is the amount you are responsible for. Please always double check your claims and make sure they are being paid properly by the insurance and that your doctor’soffice is billing you correctly. Doctors’ offices are dealing with dozens of different insurances that all do things a little differently. Do not assume that they are perfect at their jobs.

Co-insurance – a percentage that the member is responsible for after insurance pays. (e.g. your patient responsibility for most covered costs on the CDO is 15%)

Co-pay – a set amount due at the time of service. Can vary based on provider type. (e.g. an office visit has a $25 dollar co-pay for an office visit)

Personal Care Account/ Health Savings Account – In the CDO, this is money placed into the members account annually for covered health claims by the insurance plan. In other health plans, this money is typically the members money that they invest themselves. 

**Because the insurance provides this money, not you, you are still eligible for a Flex Savings Account (FSA)if you wish to have one.**

Explanation of Benefits (EOB) – This is the paper you get in the mail from Insurance that states “This is not a bill.” Typicallyit will list the charge, what was allowed or not allowed, any discount given, what the provider was paid, and what your patient responsibility MAY be. It is a breakdown of how your claim was handled by the insurance. Again, I always recommend taking time to look over these and make sure you understand what is going on. Providers mess up, and the people at insurance paying the claims mess up. We are all human. This is your money and your health. Make sure it is working for you! In the same vein, NEVER just pay the bill your provider sends you. Compare it to the EOB that your insurance sent you. Make sure they are not charging you for something your insurance paid out of your PCA/HRA (which can happen quite a bit on the CDO plan). I personally have had to call my doctor’s office and help them “find” the payment my insurance already sent. 

That covers the basics. If you have more questions, feel free to reach out to me! 

Kayla Reynolds