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Resources for Members Impacted by California Fires and Storms

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For our members and their families affected by the fires in the Los Angeles, California area, or the fires in parts of AR, OK, NY or Storm Damage in MO, AL, or MS, the Health Plan will: 

·         Relax plan requirements for care received through early April. 

·         For supplies and medications, the Health Plan will waive refill-too-soon limitations for members in the affected areas who cannot use the mail-order service for refills and lost or destroyed medications. 

·         High Option Teladoc coverage for members in CA: The Health Plan will expand Teladoc telehealth coverage for our High Option members by providing five virtual visits at zero cost, rather than the normal two through April 7, 2025. 

·         Members in CA who have our High Option or Consumer Driven Option can take advantage of an additional free Teladoc visit by calling 855-885-5032. Learn more at TeladocHealth.com/Disaster-Hotline through April 7, 2025. 

·         In-patient hospital stays will be paid at the in-network rate even if you are confined in an out-of-network facility.  

·         A toll-free emotional support helpline is available at 866-447-3573. This line will be open Monday – Friday from 6 a.m. – 6 p.m. CST for two weeks from the date of the natural disaster. The service is free of charge and open to anyone. 

·         Another resource is Optumwellbeing.com, a public website where you can access resources to help you navigate difficult situations. The Critical Support Center section of the website includes a library of content grouped by topic (trauma, natural disasters, etc.) for you to access during a critical event. 

Our thoughts go out to all those affected. We will continue to monitor this situation closely. 

Early Detection Saves Lives: Your Guide to Breast Cancer Awareness

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Did you know that 1 in 8* women will be diagnosed with breast cancer in their lifetime? The good news is, early detection is the key to successful treatment. October is Breast Cancer Awareness Month, a time dedicated to raising awareness about this disease and supporting those affected.

Know Your Risk and Get Screened

  • Consult with Your Doctor: Discuss your personal risk factors and determine when mammograms are appropriate for you.
  • Mammograms Save Lives: Regular mammograms are a crucial tool for detecting breast cancer early, when it’s most treatable.

When Should I Get a Mammogram?

As part of our preventive care benefit, the APWU Health Plan covers in-network routine mammograms at 100%.  From age 40 through 64, one preventive mammogram is recommended each calendar year. To build your personalized list of preventive services go to https://health.gov/myhealthfinder. However, it’s important to consult with your healthcare provider to determine the best schedule for you, especially if you have a family history of breast cancer or other risk factors.

Understanding Breast Cancer

  • Common Cancer: Breast cancer is the most common cancer among women in the United States, excluding skin cancer.
  • Early Detection: Mammograms can identify breast cancer before it causes noticeable symptoms.

Recognizing Symptoms

  • Be Aware: While some people may experience no symptoms, be mindful of changes in your breasts, such as lumps, pain, discharge, or changes in size or shape.
  • Consult Your Doctor: If you notice any concerning symptoms, seek medical advice promptly.

Reducing Your Risk

  • Healthy Lifestyle: Maintaining a healthy weight, being physically active, and limiting alcohol consumption can help reduce your risk.
  • Genetic Factors: If you have a family history of breast or ovarian cancer, discuss genetic testing with your doctor.

Let’s Make a Difference

This month the APWU Health Plan will once again participate in the Making Strides Against Breast Cancer Walk to fight breast cancer. By raising awareness, promoting early detection, and supporting those affected, we can make a significant impact in the fight against breast cancer.

Take Action Now

Schedule a mammogram today! Visit to find an in-network provider. Visit the national Cancer Institute website for self-exam resources: https://www.nationalbreastcancer.org/breast-self-exam/.

Sources

* American Cancer Society. (2023). Breast Cancer Statistics | How Common Is Breast Cancer? [Online]. Available at: https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html

Resources for Members Affected By Hurricane Helene

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For members affected by the storm, the APWU Health Plan alters our benefits for Health Plan members in both the High Option and Consumer Driven Option Plan in the affected areas. Altered benefits include relaxed precertification requirements for all types of care (medical and mental health) and we will make payment at the higher PPO rate to any provider of service regardless of their non-network status for a designated period of time. Below are some other accommodations:

  • APWUHP members have telehealth options available to them for medical and mental health issues through our designated telehealth vendors.
  • For all of the affected areas, UnitedHealthcare remains committed to supporting its customers and their employees’ emotional well-being in times of tragedy.
  • Resources and support are available to help individuals directly and indirectly impacted by the storm. UHC has opened a public support line for the next two (2) calendar weeks considering this event at 866-447-3573.
  • Another resource is Optumwellbeing.com, a public website where employees can access resources to help them navigate difficult situations. The Critical Support Center section of the website includes a library of content for individuals to access during a critical event, grouped by topic (trauma, natural disasters, etc.).

We also have extensive prescription drug provisions with Express Scripts (High Option members) and OptumRx (Consumer Driven Option and the Medicare Advantage Plan members) to allow for refill too soon edits to be bypassed in order for members to obtain their prescription drugs if they have been damaged or lost.

Prescription Drug Coverage – Effective date of 9/26/2024 through 10/27/2024 for High Option Members:

  • Health Plan members who reside in the affected areas, with the designated zip codes will be able to obtain a 30-day supply of their prescription drugs at a network retail pharmacy – at retail copay/coinsurance during the designated timeframes. Additionally, the pharmacists have the ability to override the “refill too soon” edits for members who indicate that they have lost their prescriptions.
  • Paper claims submitted by members residing in the affected zip code areas for dates that fall within the designated timeframes will be identified in our data entry department prior to entry into ESD and sent hard copy to the Multiple Coverage Unit to be processed at the normal retail copay.
  • Express Scripts by Mail will hold shipments of narcotics and temperature-sensitive medications into impacted areas pending member contact.
  • Mail orders can be shipped to a temporary alternate address. Members should call Express Scripts customer service at 1-800-841-2734 (this number is also on the back of their ID card) and request their order be mailed to a temporary address. This applies to new orders, refills of existing prescriptions on file with Express Scripts and, in some instances, orders already placed.
  • If a member is unable to receive their order by mail, Express Scripts can transfer their prescription to a retail pharmacy for dispensing. Express Scripts Pharmacy Services (1-800-922-1557) can assist the local pharmacist in processing the prescription if necessary.
  • Doctor calls and drug utilization review (DUR) calls will continue and every effort will be made to complete these calls. Orders will not be cancelled and returned unfilled to the member. Express Scripts pharmacies are holding these orders in-house until the member/prescriber has been reached.

Prescription Drug Coverage -Effective date of 9/26/2024 through 10/27/2024 for Consumer Driven Option Members:

  • UHC will follow the same guidelines that the High Option has set out in this letter utilizing their network, telehealth vendors, pharmacy benefit manager and benefit structure. Their EOB message for payment of out-of-network claims at the in-network benefit level will be: “In-network coinsurance applied”, since there are no copays under the Consumer Driven Option.

Get the Support You Need with Maven

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APWU Health Plan members, we are thrilled to introduce you to Maven, your comprehensive digital women’s and family health platform designed to support you and your covered dependents throughout your maternity, postpartum, and newborn experience.

Here’s why Maven is your go-to resource:

  • Unlimited Coaching & On-Demand Video Appointments: Connect with top-rated providers across 30+ specialties, including OB-GYNs, pediatricians, and even career coaches. Schedule video appointments or utilize 24/7 messaging for ongoing support.
  • Your Own Care Advocate: Personalized one-on-one support to help answer questions about your benefits, connect you with the right Maven provider, and even provide referrals to in-person care when needed.
  • Expert Content Library & Virtual Classes: Access a wealth of trustworthy content vetted by healthcare providers, covering everything from prenatal health to postpartum depression and returning to work with confidence. Maven also offers enriching virtual classes led by experts to empower you on your parenthood journey.

Maven is completely free for APWU Health Plan members!

Here’s how to get started:

  • High Option Members: Call 866-569-2064
  • Consumer Driven Option Members: Visit www.mavenclinic.com

With Maven by your side, you will have the support you need to feel confident and empowered throughout every stage of parenthood.

Wendy Abraham Retires from APWU Health Plan

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Wendy Abraham, a valued member of our team for over three decades retires on Friday, September 06, 2024. Wendy’s departure marks the end of a remarkable career dedicated to providing exceptional healthcare services to our members.

Wendy began her tenure at the APWU Health Plan in August 1987, bringing with her a wealth of experience as a critical care nurse. Her nursing background, combined with her extensive tenure at the APWU Health Plan, has made her a valuable asset to our organization.

Throughout her time at the APWU Health Plan, Wendy demonstrated unwavering commitment to her work and a deep understanding of the healthcare industry. Her expertise in critical care, health insurance, and managed care was invaluable.

We are grateful for Wendy’s dedication, hard work, and contributions to the APWU Health Plan.  On behalf of the APWU Health Plan, I extend our sincere gratitude to Wendy for her many years of service. Her positive attitude and willingness to go beyond for our members will be greatly missed. We wish her all the best in her retirement and hope she enjoys this new chapter in her life.

August is National Immunization Awareness Month

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Protect Yourself and Your Loved Ones: The Importance of Immunization

August is National Immunization Awareness Month, a time to emphasize the critical role vaccines play in protecting individuals and communities from preventable diseases.

How Your Insurance Supports Immunization

At APWU Health Plan, we believe in the power of prevention. That’s why we cover recommended vaccines for all age groups as part of our comprehensive health plans.

If you have any questions about your insurance coverage for vaccines or need assistance finding a healthcare provider, please don’t hesitate to contact our Customer Service Department.

Why Immunization Matters

  • Protection for yourself and loved ones: Vaccines create a protective barrier against harmful diseases. By immunizing yourself, you reduce the risk of contracting and spreading illnesses.
  • Economic impact: Immunization saves lives and reduces healthcare costs by preventing costly hospitalizations and treatments.
  • Community immunity: When a high percentage of a population is vaccinated, it creates a “herd immunity” effect, protecting those who cannot be vaccinated due to medical reasons.

Understanding Vaccines

We understand that you may have questions or concerns about vaccines. It’s essential to rely on credible information from trusted sources. Here are some resources to help you learn more:

  • Centers for Disease Control and Prevention (CDC):
  • Immunization Action Coalition (IAC):

Your Role in a Healthier Community

By staying up-to-date on your vaccinations, you’re not only protecting yourself but also contributing to a healthier community. We encourage you to talk to your healthcare provider about your immunization status and any questions you may have.

Remember, vaccines are one of the most effective tools in preventing the spread of disease. Let’s work together to build a healthier future for everyone.

Thank you for choosing the APWU Health Plan as your health insurance provider