APWU Health Plan Dental

Dear Health Plan Representatives,

The APWU Health Plan is offering a new dental insurance plan! In response to feedback from our membership, we are now offering two affordable plan options. Full details about the plan are available on our website at www.apwuhp.com. Just click the link in the blue box.

Copies of this dental brochure are on the way. Our union printer will mail them directly to your local office. Please inform your Local, State and Retiree chapter leadership that they should expect these brochures soon. This is another resource to support their union-owned Health Plan.

To ensure that our members have an opportunity to enroll in this comprehensive plan the Open Season deadline for the APWU Health Plan Dental has been extended to December 20, 2018. This deadline extension is exclusively for the APWU Health Plan Dental and does not apply to other medical or dental plans.

In friendship and solidarity,
John L. Marcotte

APWU Health Plan Incentives for APWU Local, State and Retiree Chapter Organizations

Dear Health Plan Representatives,

The delegates assembled at the 2018 National Convention took action on a resolution from Michigan, Washington, Alaska, Oregon, Idaho, and Montana Postal Worker Unions, NEB # 5. The delegates approved the NEB’s recommendation that considering concerns with the execution and accountability of NEB #5 as written recommended a substitute. In lieu of NEB #5, the delegates directed Secretary-Treasurer Liz Powell and Health Plan Director John L. Marcotte to meet and arrive at a recommendation in the spirit of this resolution within 90 days for presentation to the NEB.

Several in person and phone discussions were made by Sister Powell and myself to arrive at a recommendation that satisfies the NEB committee concerns with the resolution as written within the directed 90 days. This was reported to the HPR’s at our seminar in San Antonio.

I am pleased to inform you the National Executive Board has approved the below recommendation for cash payments and incentives to Local, State and Retiree Chapter organizations.

Please inform your Local, State and Retiree chapter leadership of this wonderful support of their Health Plan efforts by the National Executive Board.

In friendship and solidarity,

John L. Marcotte

California Wildfires: APWU Health Plan Disaster Relief Initiative

Aware of the increasing magnitude of these tragic wildfires, the APWU Health Plan is taking a proactive approach to provide support and help ease the burden of our Health Plan members.

The APWU Health Plan has altered the benefits for any Health Plan member that has been or are currently being impacted by the wildfires in the affected zip code areas of Butte, Los Angeles, and Ventura counties in California. The affected area and time frame will be extended as conditions warrant. The following accommodations will be provided to members in the High Option and Consumer Driven Option who reside in the affected zip codes no matter where services are rendered from 11/9/18 through 12/9/18:

  • All member claims will be paid as in-network regardless of the provider’s network status.
  • The Health Plan will waive precertification requirements for all in-patient admissions (medical). Beacon Health Options will use maximum flexibility in approving requests for inpatient mental health services.
  • Telephonic counseling will be available for all affected membership; members should call Beacon Health Options at 888-700-7965 to speak to a
  • Extensive provisions have been made with your pharmacy administrator so that members can obtain their prescriptions for both retail and mail order. For assistance with prescriptions, High Option members should call Express Scripts at 800-841-2734 and Consumer Driven Option members should contact Optum RX at 800-718-1299. The following exceptions will be made:
    • 30 day supply or refills can be obtained at a network retail pharmacy
    • Refills can be obtained before the refill date for members that have lost their prescription
    • Paper claims submitted by affected members will be identified and processed at the normal retail copay
  • Mail orders of narcotics and temperature-sensitive medications for impacted areas will be held; members should contact their pharmacy administrator to discuss alternative delivery options to ensure safe and accurate delivery
  • Mail orders can be shipped to a temporary alternate address by calling your pharmacy administrator
  • If a member is unable to receive their order by mail it can be transferred to a retail pharmacy for dispensing by calling your pharmacy administrator
  • Orders that have already been shipped can be reprocessed. Up to a seven-day supply obtained through a retail pharmacy at no cost to the member; members should visit a retail pharmacy to obtain the order or refill

Hurricane Michael: APWU Health Plan Disaster Relief Initiative

In response to Hurricane Michael, the APWU Health Plan is taking a compassionate proactive approach to provide support and help ease the burden of our Health Plan members.

The APWU Health Plan has altered the benefits for any Health Plan member that resides in the affected areas of Florida, Alabama, Georgia, North Carolina, South Carolina, and Virginia. The affected area and time frame will be extended as conditions warrant. The following accommodations will be provided to members in the High Option and Consumer Driven Option from October 10, 2018 through November 09, 2018:

  • All member claims will be paid as in-network regardless of the provider’s network status.
  • The Health Plan will waive precertification requirements for all in-patient admissions (medical).Beacon Health Options will use maximum flexibility in approving requests for inpatient mental health services.
  • Telephonic counseling will be available for all affected membership; members should call Beacon Health Options at 888-700-7965 to speak to a representative.
  • Extensive provisions have been made with your pharmacy administrator so that members can obtain their prescriptions for both retail and mail order. For assistance with prescriptions, High Option members should call Express Scripts at 800-841-2734 and Consumer Driven Option members should contact Optum RX at 800-718-1299. The following exceptions will be made:
  • 30 day supply or refills can be obtained at a network retail pharmacy
  • Refills can be obtained before the refill date for members that have lost their prescription
  • Paper claims submitted by affected members will be identified and processed at the normal retail copay
  • Mail orders of narcotics and temperature-sensitive medications for impacted areas will be held; members should contact their pharmacy administrator to discuss alternative delivery options to ensure safe and accurate delivery
  • Mail orders can be shipped to a temporary alternate address by calling your pharmacy administrator
  • If a member is unable to receive their order by mail it can be transferred to a retail pharmacy for dispensing by calling your pharmacy administrator
  • Orders that have already been shipped can be reprocessed. Up to a seven-day supply obtained through a retail pharmacy at no cost to the member; members should visit a retail pharmacy to obtain the order or refill

2019 APWU Health Plan Premium Change

The amount that our members will pay for health insurance went up more than was necessary had a tax break not been given to large underwritten insurance companies like Blue Cross and Blue Shield (BCBS). APWUHP is a self-insured health plan.

The Affordable Care Act (ACA) placed a tax on these underwritten carriers including BCBS that is used to pay for subsidies given to lower income Americans so they can afford health insurance. Congress waived this corporate tax for one year giving them a financial windfall that allowed them to not raise premiums that health care inflation would have otherwise required.

The amount the USPS will pay for our members health care is capped in the CBA, currently 76% of the weighted average of FEHB premiums. The weighted average is the total premiums for all FEHB plans multiplied by the number of subscribers in that plan. Any amount of premiums above this cap is paid 100% by the employee and the USPS pays nothing.

Flush with cash from congressional tax relief, underwritten carriers who insure approximately 85% of FEHB participants raised premiums less than health care cost inflation. Self-insured plans like APWUHP did not receive tax relief.

This caused the FEHB weighted average to rise at an extremely low amount not seen in 20 years. Thus pushing APWU Health Plans above the cap and forcing the portion of premiums that would have been paid by the USPS to be borne by the membership.

Download the Presidents Conference October 2018  presentation.

 

What is Medicare limiting and how does it affect my billing?

The APWU Health Plan coordinates payments to your medical provider with Medicare. This means that when the medical provider (doctor/hospital/lab) bills Medicare, the APWU obtains all the information we need to pay the bill directly from Medicare.  This streamlines the billing process for doctor’s offices. It ensures that insurance enrollees receive their maximum insurance benefits without filing additional paperwork.

Remember that for APWUHP Enrollees who are retired and have Medicare B, you pay nothing for Medicare covered procedures. 

The law requires the APWU Health plan base our payment for services at the “Medicare approved amount” regardless of whether or not our members over 65 are enrolled in Medicare.  This law is in place to keep Federal Employee Health Benefits (FEHB) costs low and plan premiums affordable for retirees. The law applies to all FEHB plans not just the APWU Health Plan.

You can read more about how our plan works with Medicare in our Blueprint to Medicare Flyer.

(FAQs): Will the APWU Health Plan cover my parents as adult dependents?

FamilyQuestions to the Director,

This is a series of common issues that have been brought to my attention by our members when they contact me for help.  

Question:

I know a coworker whose mother lives with her and her husband. Her mother receives a small disability check that it is not enough to cover basic expenses. The mother is financially dependent on this couple. She told me that her current FEHB health insurance will not cover her mother. If she were to become an APWU Health Plan member, would the APWU Health Plan cover her mother as an adult dependent?

Answer:

The question of parents living with their children is more common than many folks may think, I get asked this often. All decisions on who is eligible for health care are made by their employing agency under OPM guidelines.

OPM is very clear, in my opinion, on this issue. Here is the language I am referring to from the OPM website “Relatives Who are Not Family Members: Your parents and other relatives are not eligible family members, even if they live with and are dependent upon you.”  Please see the below link to the OPM website. As with all eligibility questions, they must be resolved with the employing agency, in the case of postal employees I refer the employee to USPS HR Shared Services for an answer.

 https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/family-members/

(FAQs): How do I use my Personal Care Account (PCA) for dental care?

Questions to the Director,

This is a series of common issues that have been brought to my attention by our members when they contact me for help.

Question:

I visited my dentist for a regular cleaning. The office staff said my dental claims was denied. I thought that APWU Health Plan Consumer Driven Option members could use my PCA dollars for dental care.

Answer:

If you wish to be reimbursed from your PCA for Extra PCA expenses, such as dental and vision services, you need to complete a 2018 09 Health Claim Transmittal form. With your submission please enclose a medical or dental claim form. These documents should be mailed to the address on the back of your card. Your doctor, dentist, or other medical provider can assist you in completing the forms.

Denials can happen for a number of reasons. You could have exhausted your PCA dollars and have no funds available. Another common reason for a claim being denied is that the claim is mailed to the wrong address. Claims and the supporting documents should be mailed to the address on the back of your card, United Health Care, P.O. Box 740810, Atlanta, GA, 30374. Please be advised that there is a company called United Health Care Dental and if claims are mailed to them and not United Health Care Medical they will be denied. These are in two separate locations and treated as separate entities by their owners. Some dental offices get this confused regularly.

If you have a dental insurance plan like Voluntary Benefits Dental Plan and you wish to use your PCA to pay for the dental plan copays and coinsurance there are three ways to request a reimbursement for co-insurance and co-pay costs:

If you need assistance registering for the United Health Care website or logging into Health4Me, please contact technical support at 1-866-633-2446.

These are the current forms used for the APWU United Health Care Reimbursement process. These forms may change. You can always check the status of a claim or request copies of the claim forms by contacting Customer Service at 1-800-718-1299.

Hurricane Florence: APWU Health Plan Disaster Relief Initiative

In response to Hurricane Florence, the APWU Health Plan is taking a compassionate proactive approach to provide support and help ease the burden of our Health Plan members.

The APWU Health Plan has altered the benefits for any Health Plan member that resides in the affected areas of Florence, currently the entire states of North and South Carolina. The affected area and time frame will be extended as conditions warrant. The following accommodations will be provided to members in the High Option and Consumer Driven Option from 9/7/18-10/7/18: 

  • Virtual Visit providers Doctor On Demand and American Well are offering free medical services to support all members affected by Hurricane Florence. Visit www.apwuhp.com on “Help members affected by disaster” for details.
  • The Health Plan will waive precertification requirements for all in-patient admissions (medical and mental health).
  • All member claims will be paid as in-network regardless of the provider’s network status.
  • Telephonic counseling will be available for all affected membership; members should call Beacon Health Options at 888-700-7965 to speak to a representative.
  • Extensive provisions have been made with your pharmacy administrator so that members can obtain their prescriptions for both retail and mail order. For assistance with prescriptions, High Option members should call Express Scripts at 800-841-2734 and Consumer Driven Option members should contact Optum RX at 800-718-1299. The following exceptions will be made:
  • 30 day supply or refills can be obtained at a network retail pharmacy
  • Refills can be obtained before the refill date for members that have lost their prescription
  • Paper claims submitted by affected members will be identified and processed at the normal retail copay
  • Mail orders of narcotics and temperature-sensitive medications for impacted areas will be held; members should contact their pharmacy administrator to discuss alternative delivery options to ensure safe and accurate delivery
  • Mail orders can be shipped to a temporary alternate address by calling your pharmacy administrator
  • If a member is unable to receive their order by mail it can be transferred to a retail pharmacy for dispensing by calling your pharmacy administrator
  • Orders that have already been shipped can be reprocessed. Up to a seven-day supply obtained through a retail pharmacy at no cost to the member; members should visit a retail pharmacy to obtain the order or refill

 

(FAQs): Inovalon

Questions to the Director,
I wanted to share with you some issues that have been brought to my attention by our members when they contact me for help.

Question:
“I have received phone calls from a company called Inovalon. How did they receive my contact information and how do I opt out?”

Answer:
The APWU Health Plan understands that our members lead busy lives and sometimes forget to schedule regular checkups and preventive screenings. The APWU Health Plan is driven to help our members achieve the best health and wellness possible.

Preventative care includes services like physicals, screenings and checkups. Preventative care detects in early stages illnesses, diseases, and other health problems so they can be treated in the least invasive manner possible. Early stage detection is when treatment is likely to work best. For APWU Health Plan members covered preventative care services are free of charge when delivered by an in network provider even if you haven’t met your deductible!

Inovalon is contracted by the APWU Health Plan to do outreach to our members in an effort to assist with scheduling visits and to remind you of preventative screenings that are due. These outreach efforts consist of mailings and telephone calls to both our members and their medical providers to ensure needed care and testing is not overlooked. These calls are to assist you in using your health benefits in the most beneficial way for you and your family.
If you do not wish to have these reminders, you may opt out by contacting us at (800) 222-APWU and we will remove you remove you from this service.