Plan Overview

Health Alliance Plan (HAP) offers comprehensive healthcare coverage tailored for USPS employees, retirees and families. This page provides an overview of costs, access to care, and service areas to help members understand their benefits and make informed healthcare decisions.

Costs at a Glance: Medical for Active Employees

Service	HAP PSHB High Medical Only for PDP	HAP PSHB Standard Medical Only for PDP
Deductible	$0	$350 single/$700 family
Coinsurance	0%	10%
Telehealth	Covered	Covered
Primary care office visit	$20 copay	$20 copay
Specialist office visit	$40 copay	$50 copay
Emergency care visit	$150 copay	$200 copay
Urgent care visit	$50 copay	$50 copay
Laboratory and pathology	Covered	10% coinsurance after deductible
Radiology	Covered	10% coinsurance after deductible
Inpatient hospital services	Covered	10% coinsurance after deductible
Outpatient surgery	$250 copay	10% coinsurance after deductible
Skilled nursing	Covered	10% coinsurance after deductible
Physical therapy	$40 copay	$25 copay
Chiropractic services	No Covered	$50 copay
Prescription Drugs	$4 Tier 1 - Generic $10 Tier 2 - Generic and select brand $40 Tier 3 - Preferred brand $60 Tier 4 - Non-preferred brand and non-preferred generic 20% up to a $200 max Tier 5 - Preferred specialty 20% up to a $200 max Tier 6 - Non-preferred specialty	$15 Tier 1 - Generic $25 Tier 2 - Generic and select brand $40 - Preferred brand $80 - Non-preferred brand and non-preferred generic 20% coinsurance ($200 max) Tier 5 - Preferred specialty 20% coinsurance ($200 max) Tier 6 - Non-preferred specialty

Costs at a Glance: Medicare Advantage Prescription Drug (MAPD)

Service	PSHB High Medical Option MAPD	PSHB Standard Option MAPD
Deductible	$0	$350 individual
Coinsurance	0%	10%
Telehealth	Covered	Covered
Primary care office visit	$20 copay	$20 copay
Specialist office visit	$40 copay	$50 copay
Emergency care visit	$125 copay	$125 copay
Urgent care visit	$50 copay	$50 copay
Laboratory and pathology	Covered	10% coinsurance after deductible
Radiology	Covered	10% coinsurance after deductible
Inpatient hospital services	$100 copay per day	10% coinsurance after deductible
Outpatient surgery	$250 copay	10% coinsurance after deductible
Skilled nursing	Covered	$0 copays - days 1-20, 10% coinsurance after deductible - days 21-730
Physical therapy	$40 copay	$25 copay
Chiropractic services	Covered	$20 copay
Prescription Drugs	$4 Tier 1 - Generic $10 Tier 2 – Generic and select brand names $40 Tier 3 – Preferred brand $60 Tier 4 – Non-preferred brand and non-preferred generic 20% coinsurance ($200 max) Tier 5 – Preferred specialty 20% coinsurance ($200 max) Tier 6 – Non-preferred specialty	$4 Tier 1 - Generic $10 Tier 2 - Generic and select brand names $40 Tier 3 - Preferred brand $60 Tier 4 - Non-preferred brand and non-preferred generic 20% coinsurance ($200 max) Tier 5 - Preferred specialty 20% coinsurance ($200 max) Tier 6 - Non-preferred specialty

Costs at a Glance: Prescription Drug Plan (PDP) Rx Only

Tiers		Copay
Tier 1 - Generic		$4 copay
Tier 2 - Generic and select brand names		$10 copay
Tier 3 - Preferred brand		$40 copay
Tier 4 - Non-preferred brand and non-preferred generic		$60 copay
Tier 5 - Preferred specialty		20% coinsurance ($200 maximum)
Tier 6 - Non-preferred specialty		20% coinsurance ($200 maximum)

*For more information on contraceptives, please click here.

High Option and Standard Option health benefits summary

High Option Benefits

In a high option benefit, there’s a $0 deductible with no coinsurance

High Option Summary of Benefits

Standard Option Benefits

In a standard option benefits, there’s a $350 self only/$700 family deductible with 10% coinsurance

Standard Option Summary of Benefits

High Option and Standard Option Rates


		Premium Rate
		Bi Weekly		Monthly
Enrollment Type	Enrollment Code	Gov’t Share	Your Share	Gov’t Share	Your Share
High Option
High Option Self Only	J5A	$286.09	$213.48	$619.86	$462.54
High Option Self Plus One	J5C	$618.40	$530.62	$1,339.87	$1,149.67
High Option Family	J5B	$672.95	$546.01	$1,458.06	$1,183.02
Standard Option
Standard Option Self Only	J5D	$225.61	$75.20	$488.82	$162.94
Standard Option Self Plus One	J5F	$518.90	$172.96	$1,124.27	$374.76
Standard Option Family	J5E	$550.48	$183.49	$1,192.70	$397.57

PSHB System (enrollment system) URL:

www.health-benefits.opm.gov/pshb

PSHB Landing Page URL:

www.opm.gov/pshb

Avoid surprise costs

You’re covered for an annual preventive visit. View your benefit summaries to find out costs for your specific plan. This can include a review of your medical and social history related to your health. You doctor and you should also discuss preventive services such as screenings recommended for you, shots and referrals for other care, if needed.
However, if your doctor or other health care provider performs additional tests or services during the same visit that aren’t covered under these preventive benefits, you may have to pay a copay and deductible, if applicable.

Knowing where to go for care can save you money

It’s important to know the difference between urgent and emergency conditions to make sure you get the right care at the right time. This can save you out-of-pocket expenses and ensure you’re treated quickly based on your condition. In most cases it will cost you less out-of-pocket to visit an affiliated urgent care center than an emergency room. Need help determining where to go for what? Check out our helpful tool.

Understanding deductibles

A deductible is a fixed amount of money you have to pay annually before HAP begins paying its portion of your medical costs.

Generally, prescription drugs and medical services covered by a copay do not count toward the deductible. All other covered services without copays count toward the deductible.

A health insurance deductible works similar to auto insurance. Let’s say you are involved in an accident. First, you have to pay your deductible amount, and then your insurance company pays for the rest for the repair work. Health insurance deductibles work the same way.

Return to the PSHB Homepage

Health Alliance Plan (HAP) has HMO, HMO-POS, PPO plans with Medicare contracts. HAP Medicare Complete Duals (HMO D-SNP) and HAP Medicare Complete Assist (PPO D-SNP) are Medicare health plans with Medicare contracts and a contract with the Michigan Medicaid Program. Enrollment depends on contract renewals.

Resources

Resources

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