| 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 |
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.
| Service | PSHB High Medical Option MAPD | PSHB Standard Medical Option MAPD |
|---|---|---|
| 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 | $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 $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 |
| 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
*For more information on 2026 plan specifics, please review the PSHB HAP plan brochure.
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 | $304.64 | $212.21 | $660.05 | $459.79 |
| High Option Self Plus One | J5C | $657.50 | $531.24 | $1,424.58 | $1,151.02 |
| High Option Family | J5B | $712.30 | $548.80 | $1,543.32 | $1,189.06 |
| Standard Option | |||||
| Standard Option Self Only | J5D | $234.71 | $78.23 | $508.53 | $169.51 |
| Standard Option Self Plus One | J5F | $539.81 | $179.94 | $1,169.60 | $389.86 |
| Standard Option Family | J5E | $572.68 | $190.89 | $1,240.80 | $413.60 |
PSHB System (enrollment system) URL:
www.health-benefits.opm.gov/pshb
PSHB Landing Page URL:
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.
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.