(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 740800, 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.

APWU Biennial National Convention and the APWU Health Plan

On August 20-23 The American Postal Workers Union held its 24th Biennial National Convention in Pittsburgh, Pennsylvania. The APWU Health Plan had a booth staffed for the full length of the convention offering health screenings, healthy eating tips and recipes, T-shirt and other giveaways all the while offering real time answers to the delegates’ insurance questions.

The health screening were extremely popular with conference attendees. Attendees were able to meet some of their wellness needs while at a business event by taking advantage of our hearing screenings, blood pressure screenings, blood sugar screenings, and flu shots. These services were offered free of charge.

During the convention attendees could pose their insurance questions to onsite representatives from American Specialty Hearing, Cigna, Express Scripts, United Health Care and the APWU Health Plan leadership.

To follow up on this successful national convention the APWU Health Plan will be sending representatives to Open Season Health Insurance Fairs across the country. The 2018 Open Season is November 12th through December 10th. This is an opportunity for our members and any federal employee to sign up for APWU Health Plan and enjoy comprehensive health care at an affordable price. We look forward to seeing you at an event soon! Together Better Health.

September is Flu Shot Month!

It’s Free. APWU Health Plan members can get their flu shot for free. Routine immunizations are covered at 100% when you use an in-network provider.

Shots for this flu season are available now. The CDC recommends that you take your flu shot before the end of October.  It takes your body about two weeks to develop the antibodies to provide protection against the flu virus. It’s best to get vaccinated before the flu starts spreading.

You can get the flu vaccine even if you do not have a regular doctor or nurse. Did you know flu vaccines are available at the pharmacy, urgent care clinics, health departments, in addition to the doctor’s office? Find an in network provider now by visiting our online directory or calling Customer Service.

Flu Clinic

John L. Marcotte, Health Plan Director, receiving a flu vaccine at the APWU Health Plan booth a the 24th Biennial National APWU Convention in Pittsburgh, PA.

33rd Annual Open Season Seminar 2018

Hurry to register for the 33rd Annual Open Season Seminar in beautiful San Antonio, Texas. Space is running out so register today. This training allows union officers to answer the memberships’ questions on how the FEHB program affects postal and federal employees, Medicare and APWUHP, APWU Health Plan coverage and costs, and insurance terms.

If you plan on attending you should secure your room now. Space is limited and registration is filling up fast!

Registration information is posted at https://www.apwuhp.com/events/

Photos Wanted!

Did you know that the APWU Health Plan prints photos of real postal workers on our brochures and flyers? If you, or someone from your local post office, would like to be featured please send a photo of you at work to my office by September 01, 2018. Submission of your photo will also serve as consent for photo publication. Photos that don’t reach us by the deadline will be considered for future printings.

 

 

Frequently Asked Questions (FAQs) Health Plan Seminar

Question:

I want to early register for the Health Plan Seminar in 2018 in San Antonio. What are the dates?

Answer:

The Seminar is from October 26-28 in San Antonio, Texas. You may register for the hotel now at:

Hyatt Regency, San Antonio Texas (123 Losoya Street, San Anotnio, TX, 78205.)https://aws.passkey.com/gt/213111698?gtid=d5e8938d8d196632775c96adefb83b97

The full course schedule will be finalized soon. Class Registration information and the schedule of events will be posted on our website https://www.apwuhp.com/events/ soon.

As always, with any questions and concerns you can call me at 410-424-1504.

Martin Luther King Jr. Day

On this day when we honor the life and legacy of Reverend Dr. Martin Luther King Jr., I feel honored to share one of his many quotes that provides a compass for us to navigate life by. “The time is always right, to do what’s right.”  
 
These simple words provide a foundation and focus for the APWU Health Plan. Please know that here at the Health Plan, we strive to do what’s right for our members every day, whether it’s answering a quick question or helping solve a complex health care challenge, we are here for you and dedicated to doing what is right.
 
Enjoy this special day as we reflect on the life and principles of Reverend Doctor King… Together Better Health