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

Health fair dates,

Monday, 11/4/24, 8-9:00 PM- Charleston P & D C, 1000 Centre Way, South Charleston 25309 (In the hallway close to the employee lunchroom)

Tuesday, 11/5/24, 8:9:30 AM- Charleston Post Office, 1002 Lee Street, East, 25301 (District Commons Area for ALL employees in the area- carriers, clerks, custodians, district staff, etc.)

Tuesday, 11/5/24, 10:30 AM-Noon- Charleston P & D C (In the hallway close to the employee lunchroom)

This is Kayla Reynolds, your friendly neighborhood APWU Health Plan Rep, reporting back from Baltimore and the 39thAnnual Open Season Seminar! As always, there was ton of information and I’ll attempt to sum up what I felt were the biggest points of interest below. In the coming weeks, I’ll highlight some benefits of the High and Consumer Driven options (both old and new) that I believe are underutilized by the membership. Please note that I only represent the APWU health plans. I’m happy to help anyone with questions, but I am only familiar with what our own plans offer. While I can’t speak to specific coverage under other providers, I would be more than happy to point anyone in the right direction. 

Postal Employee Health Benefits (PSHB)

All Postal Employees are being moved over to PSHB. Make sure your address is correct with the USPS, as Crosswalk letters  with OPM letterhead will be sent out starting October 28, 2024. It will show you what plan you currently have under FEHB (Federal Employee Health Benefits) and which is the most comparable under PSHB. Both the High Option and Consumer Driven Option from the APWU Health Plan will be available under PSHB. If you want to stay in the plan, you do not have to do anything and you should be automatically moved over. If you do want to switch your plan, you can do so over Open Season, which starts November 11, and goes through December 9, 2024. 

ID Cards

Another reason to be sure your address is correct is that everyone will be getting new ID cards, these cards will have a new group number and the new address of the Health Plan, which moved its location last month. 

Effective dates

Rather than starting the first full pay period of the new year, as has been the case in the past, these new plans will be effective January 1, 2025, and the premiums will be prorated. This change is occurring because of the requirements in the Postal Reform Act.

Still waiting OPM for finalized Postal Benefits

Most if not all insurance plans are still waiting on OPM to be able to release full Postal Employee benefits. More information will be coming out on November 1, 2024. While this is understandably frustrating, all the information should be available in time for Open Season. The information on the various sites I’ve linked should be updated on November 1st as well. 

Medicare/Retirement Questions

Because everyone’s situation is different, anyone with questions about  Retirement and/or changes in Medicare requirements is encouraged to visit keepingposted.org, call 833-712-7742, or email retirementbenefits@usps.gov. Keepingposted.org has recorded seminars and will still have some live seminars scheduled before the end of Open Season (December 9, 2024).

While we all hope this shift will be seamless, it would be reasonable for there to be bumps in the road. Please be vigilant and keep an eye on your deductions to be sure your information is correct. 

Dental and Vision benefits

The Dental and Vision benefits website has been movedfrom benefeds.com to benefeds.gov. You should be automatically redirected if you type in the old website, and your current login information should work. The High Option has some dental coverage (preventative and minor), while the Consumer Driven does not have specific dental coverage. You can submit to the PCA for reimbursement, and there will be a new discount dental program called Careington Dental Discount Network for CDO members in 2025. You must use a participating dentist, and can look for one nearby by using the website. The APWU does have its own dental plan through the Voluntary Benefits Plan and plan details can be found at the APWU HP website. This is not considered a federal plan. If you elect to sign up for this dental plan and don’t cancel your federal plan you will end up paying for two dental plans. 

Flex Spending Accounts

The Flex Spending Account servicer will be changed from FSAFEDS to Inspira Financial. Any money that is in your current FSA account is use or lose. Eligible expenses for your current FSA must have a claim service date no later than December 31, 2024. All claims must have been submitted by April 30, 2025. Any funds not claimed by then will be forfeit. Inspira Financial was the FSA servicer in the past, and has the benefit of also having a debit card. You can either use the debit card for eligible expenses directly, or submit to the plan for reimbursement. The FSA is separate from your health insurance. If you did not put forth the effort to sign up for an FSA on FSAFEDS.gov, then this is not something you need to worry about.

Remember! Plan details for all PSHB can/will be able to be found at OPM.gov. If you scroll to the “Enrollment and Open Season” heading you will find links for auto-enroll information, and plan premiums. Please keep in mind that the premiums displayed by OPM do not include contractually bargained discounts for the APWU CDO plan. Cost sharing for most insurance plans is 72%, whereas the Post Office covers 95% of the premium for qualifying APWU members on the CDO plan.

https://apwu.org/news/usps-policies-programs/updates-usps-eagle-clean-e4776-pilot-program-maintenance-craft

REMINDER, 

This Saturday 10/12 5-9PM is the union function at the Mardi Gras casino! Come out and have a good time with your local members!