APWU
APWU Health Plan — High Option
PSHB Offered in 2027|APWU Health Plan|Traditional|PPO
Premium
biweekly · employee paysSelf Only
$142.97biweekly · employee pays
vs 2026+$35.82 +33.4%
Lowest$107.15 (2026)
Highest$142.97 (2027)
Since 2025+30.1%
Self Plus One
$279.13biweekly · employee pays
vs 2026+$62.95 +29.1%
Lowest$213.05 (2025)
Highest$279.13 (2027)
Since 2025+31.0%
Self & Family
$358.28biweekly · employee pays
vs 2026+$82.34 +29.8%
Lowest$275.94 (2026)
Highest$358.28 (2027)
Since 2025+29.2%
Premium history
SharePeriodRate type
Year by year
follows the chart's share, period and rate-type selection| Year | Self Only | Δ | Self Plus One | Δ | Self & Family | Δ | Listed as |
|---|
Changelog
- 2025First appears in OPM rate tablesNew plan option for 2025.
- 2026Largest decrease: -2.5%Self Only employee share went from $109.86 to $107.15.
- 2027Largest increase: +33.4%Self Only employee share went from $107.15 to $142.97.
Full rate schedule
Plan yearIn-network
2027 plan benefits file| Self Only | Self Plus One | Self & Family | |
|---|---|---|---|
| Annual deductible | $450 | $800 | $800 |
| Medical account contribution | Not applicable | Not applicable | Not applicable |
| Net deductible | $450 | $800 | $800 |
| Annual out-of-pocket maximum | $6,500 | $13,000 | $13,000 |
| Prescription out-of-pocket maximum | $6,500 | $13,000 | $13,000 |
- Type of accountNot Applicable
- Medicare Part D EGWP Prescription Drug Out-of-Pocket Maximum per enrollee$2,400
- Total Annual Part B Premium Reimbursement Amount Per Enrollee (MAPD)$1,200
- Tier 0$0 Copayment
- Tier 1$10 Copayment
- Tier 225% Coinsurance
- Tier 345% Coinsurance
- Tier 425% Coinsurance
- Tier 525% Coinsurance
- Tier 645% Coinsurance
- Mail Order PharmacyYes
- Deductible waiver (with Medicare Part A as Primary)Deductible waived
- Deductible waiver (with Medicare Part B as Primary)Deductible waived
- Deductible Waiver with Parts A & BDeductible waived
- Out-of-Pocket Maximum with Parts A & B$6,500
- Primary Care Physician Office Visit with Medicare A & B PrimaryMember Pays Nothing
- Specialty Physician Office Visit with Parts A & BMember Pays Nothing
- Inpatient Hospital Services with Parts A & BMember Pays Nothing
- Outpatient Hospital Services with Part AMember Pays Nothing
- Outpatient physician services (with Medicare Part B as Primary)Member Pays Nothing
- Part B Premium Reimbursement with Parts A & BNot applicable
- Requirement for Part B ReimbursementNot applicable
- Deductible Waiver with Part CDeductible waived
- Out-of-Pocket Maximum with Part C$6,500
- Primary Care Physician Office Visit with Medicare Advantage (Part C) PrimaryMember Pays Nothing
- Specialty Physician Office Visit with Part CMember Pays Nothing
- Inpatient Hospital Services with Part CMember Pays Nothing
- Outpatient Hospital Services with Part CMember Pays Nothing
- Outpatient physician services (with Medicare Advantage Part C as Primary)Member Pays Nothing
- Part B Premium Reimbursement with Part C$1,200
- Preventive CareMember Pays Nothing
- Primary Care Office Visit$25 Copayment
- Specialist Office Visit$25 Copayment
- Emergency Care15% Coinsurance
- Urgent Care$30 Copayment
- Doctor Costs for Inpatient Surgery15% Coinsurance
- Hospital Inpatient Cost Per Admission15% Coinsurance
- Hospital Room Costs15% Coinsurance
- Other Inpatient Hospital Costs15% Coinsurance
- Doctor Costs for Outpatient Surgery15% Coinsurance
- Other Outpatient Surgery Costs15% Coinsurance
- Diagnostic Tests or Procedures (e.g., Blood Tests, X-rays, Urinalysis, Ultrasounds)15% Coinsurance
- Diagnostic Tests or Procedures (e.g., CT scans, MRIs, PET Scans)15% Coinsurance
- Enhanced Lab Network15% Coinsurance
- Applied Behavioral Analysis (ABA)15% Coinsurance
- Chiropractic$25 Copayment
- Occupational Therapy15% Coinsurance
- Physical Therapy15% Coinsurance
- Speech Therapy15% Coinsurance
- Professional Services (Mental Health and Substance Use Disorder)$25 Copayment
- Inpatient Hospital (Mental Health and Substance Use Disorder Services)15% Coinsurance
- Outpatient Hospital (Mental Health and Substance Use Disorder Services)15% Coinsurance
- Diagnosis and Treatment (Infertility Services)15% Coinsurance
- Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services)15% Coinsurance
- Artificial Insemination Services (e.g. ICI, IVI, IUI)15% Coinsurance
- Assisted Reproductive Technology (ART) (e.g., IVF, GIFT, ZIFT) (Infertility Services)Member Pays All Charges
- Surgical Procedures15% Coinsurance
- Reconstructive Surgery15% Coinsurance
- Hearing Services15% Coinsurance
- Hearing Aids (external)Covered
- Prenatal Care, Screening for Gestational Diabetes, Delivery, and Postpartum Care (Maternity Care)Member Pays Nothing
- Hospital Stay--Vaginal Birth, Cesarean Birth (Maternity Care)Member Pays Nothing
- Hospice CareMember Pays Nothing
- Home Health Services (Skilled Nursing Care)15% Coinsurance
- Durable Medical Equipment15% Coinsurance
- Outpatient Rehabilitation (Skilled Nursing Care Facility)15% Coinsurance
- Diabetes Education15% Coinsurance
- Nutritional CounselingMember Pays Nothing
- Routine Dental Exams and Cleaning for AdultsCovered
- Routine Dental Exams and Cleaning for ChildrenCovered
- Routine Eye ExamsNot Covered
- Eye Exams for Medical Condition or Non-Surgical TreatmentCovered
- EyeglassesNot Covered
- Contact LensesNot Covered
- Acupuncture$25 Copayment
- Chronic Disease Management: Heart DiseaseCovered
- Chronic Disease Management: ObesityCovered
- Chronic Disease Management: HypertensionCovered
- Chronic Disease Management: AsthmaCovered
Out-of-network
2027 plan benefits file| Self Only | Self Plus One | Self & Family | |
|---|---|---|---|
| Annual deductible | $1,000 | $2,000 | $2,000 |
| Medical account contribution | Not applicable | Not applicable | Not applicable |
| Net deductible | $1,000 | $2,000 | $2,000 |
| Annual out-of-pocket maximum | $15,000 | $30,000 | $30,000 |
- Type of accountNot Applicable
- Tier 050% Coinsurance
- Tier 150% Coinsurance
- Tier 250% Coinsurance
- Tier 350% Coinsurance
- Tier 4100% Coinsurance
- Tier 5100% Coinsurance
- Tier 6100% Coinsurance
- Mail Order PharmacyYes
- Deductible waiver (with Medicare Part A as Primary)Not applicable
- Deductible waiver (with Medicare Part B as Primary)Not applicable
- Deductible Waiver with Parts A & BNot applicable
- Out-of-Pocket Maximum with Parts A & B$15,000
- Primary Care Physician Office Visit with Medicare A & B Primary40% Coinsurance
- Specialty Physician Office Visit with Parts A & B40% Coinsurance
- Inpatient Hospital Services with Parts A & B40% Coinsurance
- Outpatient Hospital Services with Part A40% Coinsurance
- Outpatient physician services (with Medicare Part B as Primary)40% Coinsurance
- Part B Premium Reimbursement with Parts A & BNot applicable
- Requirement for Part B ReimbursementNot applicable
- Deductible Waiver with Part CNot applicable
- Out-of-Pocket Maximum with Part C$15,000
- Primary Care Physician Office Visit with Medicare Advantage (Part C) PrimaryNot applicable
- Specialty Physician Office Visit with Part CNot applicable
- Inpatient Hospital Services with Part CNot applicable
- Outpatient Hospital Services with Part CNot applicable
- Outpatient physician services (with Medicare Advantage Part C as Primary)Not applicable
- Part B Premium Reimbursement with Part CNot applicable
- Preventive Care40% Coinsurance
- Primary Care Office Visit40% Coinsurance
- Specialist Office Visit40% Coinsurance
- Emergency Care15% Coinsurance
- Urgent Care40% Coinsurance
- Doctor Costs for Inpatient Surgery40% Coinsurance
- Hospital Inpatient Cost Per Admission40% Coinsurance
- Hospital Room Costs40% Coinsurance
- Other Inpatient Hospital Costs40% Coinsurance
- Doctor Costs for Outpatient Surgery40% Coinsurance
- Other Outpatient Surgery Costs40% Coinsurance
- Diagnostic Tests or Procedures (e.g., Blood Tests, X-rays, Urinalysis, Ultrasounds)40% Coinsurance
- Diagnostic Tests or Procedures (e.g., CT scans, MRIs, PET Scans)40% Coinsurance
- Enhanced Lab Network40% Coinsurance
- Applied Behavioral Analysis (ABA)Member Pays All Charges
- Chiropractic40% Coinsurance
- Occupational Therapy40% Coinsurance
- Physical Therapy40% Coinsurance
- Speech Therapy40% Coinsurance
- Professional Services (Mental Health and Substance Use Disorder)40% Coinsurance
- Inpatient Hospital (Mental Health and Substance Use Disorder Services)40% Coinsurance
- Outpatient Hospital (Mental Health and Substance Use Disorder Services)40% Coinsurance
- Diagnosis and Treatment (Infertility Services)40% Coinsurance
- Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services)40% Coinsurance
- Artificial Insemination Services (e.g. ICI, IVI, IUI)40% Coinsurance
- Assisted Reproductive Technology (ART) (e.g., IVF, GIFT, ZIFT) (Infertility Services)Member Pays All Charges
- Surgical Procedures40% Coinsurance
- Reconstructive Surgery40% Coinsurance
- Hearing Services40% Coinsurance
- Hearing Aids (external)Covered
- Prenatal Care, Screening for Gestational Diabetes, Delivery, and Postpartum Care (Maternity Care)40% Coinsurance
- Hospital Stay--Vaginal Birth, Cesarean Birth (Maternity Care)40% Coinsurance
- Hospice CareMember Pays Nothing
- Home Health Services (Skilled Nursing Care)40% Coinsurance
- Durable Medical Equipment40% Coinsurance
- Outpatient Rehabilitation (Skilled Nursing Care Facility)40% Coinsurance
- Diabetes Education40% Coinsurance
- Nutritional Counseling40% Coinsurance
- Routine Dental Exams and Cleaning for AdultsCovered
- Routine Dental Exams and Cleaning for ChildrenCovered
- Routine Eye ExamsNot Covered
- Eye Exams for Medical Condition or Non-Surgical TreatmentCovered
- EyeglassesNot Covered
- Contact LensesNot Covered
- Acupuncture40% Coinsurance
- Chronic Disease Management: Heart DiseaseNot Covered
- Chronic Disease Management: ObesityNot Covered
- Chronic Disease Management: HypertensionNot Covered
- Chronic Disease Management: AsthmaNot Covered
Offered nationwide.
Service area over time
| Year | States / areas listed |
|---|---|
| 2027 | Nationwide |
| 2026 | Nationwide |
| 2025 | Nationwide |